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Gov. Charlie Baker to make $294M in midyear budget cuts

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The Baker administration is offering buyouts to state employees and is not ruling out layoffs.

BOSTON -- Gov. Charlie Baker's administration plans to cut $294 million from executive branch spending through midyear budget cuts, Secretary of Administration and Finance Kristen Lepore said Friday.

That represents about 1 percent of the state budget.

"The administration will bring the budget into balance with savings initiatives and spending reductions that could reduce executive branch spending by about 1 percent of overall spending," Lepore said in a statement. "We will work with our executive branch agencies to identify solutions to close this gap."

Lepore did not identify where the cuts would come from. She said local government aid to cities and towns, local school aid and core services at the Department of Children and Families will not see any reductions.  

The administration will also offer buyouts to state workers. It will offer a $15,000 cash incentive to retirement-eligible employees and a $5,000 cash incentive to other employees. Administration officials did not rule out layoffs if not enough employees accept the buyouts. The administration also did rule out furloughs and the renewal of an early retirement program, in which the administration effectively increased the pensions of workers who retired early.

Under state law, Lepore must revise the state's revenue estimates by Saturday based on what tax collections looked like in the first three months of fiscal 2017.

Lepore wrote in a revenue certification letter that she estimates tax collections will be down $175 million from the revenue estimate used to craft the state budget, to a total of $26.056 billion. This is primarily due to lower than expected sales tax collections. Revenue from the sales tax was predicted to grow by 5.2 percent this year. It is now expected to grow by 2.3 percent, in what could be a worrying sign about consumer and business confidence.

The Baker administration is also projecting that it will need to spend additional money to cover accounts that were underfunded in the annual state budget. The Legislature often underfunds accounts for items the state is obligated to spend money on -- like public defenders, jails, snow and ice removal and emergency housing assistance -- then appropriates more money in midyear budget bills. To account for that underfunding, Baker vetoed $265 million in spending after the Legislature passed the budget, but lawmakers restored $231 million of that.

Noah Berger, president of the Massachusetts Budget and Policy Center, a liberal-leaning think tank, said the state's budget problem has less to do with the economy than with the "somewhat fragile state of our budget overall, which relies on over half a billion dollars of temporary solutions to achieve balance."

Berger said in addition to the underfunded accounts, Baker and the Legislature relied on things like excess capital gains tax revenue, which was supposed to go into the state's rainy day fund, and expected reversions, money left unspent at the end of the year, to balance the budget.

"A lot of things that might have otherwise been tools later in the year to address budget deficiencies were used to balance the budget at the beginning of the year," Berger said.


Photos: AIC men's hockey kicks off inaugural season at MassMutual Center in Springfield

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Dropping a gold colored puck, AIC President Vincent Maniaci and head hockey coach Eric Lang officially started the season of division 1 hockey in downtown Springfield

SPRINGFIELD -- With a bit of fanfare and a lot of gold hockey sticks, American International College's men's ice hockey team kicked off homecoming weekend and their inaugural season at Springfield's MassMutual Center with a ceremonial puck drop at center ice.

Two dozen local legislators, college officials and invited guests took part in a giant photo opportunity under the MassMutual scoreboard emblazoned with AIC's colors and logo.

Dropping a gold-colored puck, AIC President Vincent Maniaci and head coach Eric Lang officially started the season of NCAA Division I hockey in downtown Springfield.

A youth hockey clinic was scheduled to follow the puck drop, with AIC players teaching and interacting with young players who were all invited to stay for the game against Union College.

DA provides details of Orange home invasion that left 95-year-old man dead, his wife hospitalized

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Joshua Hart, 23, and Brittany Smith, 27, both of Athol, were arraigned in Orange District Court, where they pleaded not guilty to murder, attempted murder and a host of other charges in the home invasion that left 95-year-old Thomas Harty dead and his wheelchair-bound wife beaten and stabbed. Watch video

Updates a story posted Friday at 12:05 p.m.

ORANGE -- Law enforcement officials on Friday described a harrowing night that left a spry, energetic elderly man dead and his wheelchair-bound wife hospitalized after a home invasion at their East River Street home in Orange.

Prosecutors say on the night of Oct. 5, 95-year-old Thomas Harty was beaten and stabbed to death, and 77-year-old Joanna Fisher was beaten, nearly suffocated and survived a knife wound to the throat. Fisher remains in the hospital.

According to Northwestern District Attorney David Sullivan, Fisher told investigators that she and her husband were watching television when a pair of suspects invaded their home, launched a savage attack and fled with credit cards, cash and the couple's 2003 Toyota station wagon.

Joshua Hart, 23, and Brittany Smith, 27, both of Athol, were arraigned Friday in Orange District Court, where they pleaded not guilty to murder, attempted murder and a host of other charges. The pair were arrested Oct. 7 after fleeing to Virginia.

Sullivan, Assistant District Attorney Jeremy Bucci and Orange Police Chief Craig Lundgren spoke to reporters after the arraignment and revealed details of the attack.

According to a statement of alleged facts released by Sullivan's office:

* The home invasion lasted for approximately two hours. Hart immediately attacked Harty and stabbed him with a knife. Smith struck and pushed Fisher from her wheelchair to the floor. Smith stabbed Fisher and cut her throat. The two unsuccessfully tried to suffocate Fisher. They ransacked the home in search of money, took credit cards, a cellphone and cash, and fled the scene in the older couple's station wagon.

* Harty died after suffering stab wounds and being suffocated with a pillow.

* Fisher crawled in an effort to call for help. She learned that the suspects had disabled the phone and stolen Harty's cellphone. She took refuge within her home until health care workers made a scheduled visit around 9 a.m. on Oct. 6. The workers summoned help and Fisher was transported to the University of Massachusetts Medical Center in Worcester.

* Fisher described to police a white male, 5-foot-8 or 5-foot-9, with facial hair, and a female who was slender with dark hair and dark eyes.

* Within hours of the home invasion, a purchase was attempted at a Walmart in the Worcester area using a credit card stolen from Harty. A transaction for the same merchandise was then made using a debit card stolen from Fisher.

* Video surveillance at Walmart showed a vehicle matching the description of the Toyota, and a man and woman matching the description of the suspects. Investigators recognized the pair as Hart and Smith.

Gallery preview 

* On Friday night, Oct. 7, Massachusetts State Police attached to the Northwestern district attorney's office obtained arrest warrants for larceny of a motor vehicle and receiving stolen property, and activated them in a national warrant database.

* On Saturday morning, Oct. 8, members of the Rockridge County Sheriff's Department in Virginia arrested Hart and Smith without incident in a U-Haul parked in a Walmart parking lot.

* Hart admitted to Rockridge officials and Massachusetts State Police that he had murdered Harty and had tried to help Smith kill Fisher. Smith admitted that she and Hart had worked together and armed themselves with a knife prior to coming to the residence.

* Hart told investigators they looked at homes in the area for an older car to avoid tracking technology, and a target that would have money to help them escape.

* Hart told investigators he and Smith looked in the window and saw Harty. They tried to enter through a window and failed. Both told investigators they entered the garage, found keys to the car and entered the home through a door in the garage.

* Their stated motive was to avoid going to jail on a previous charge (Hart) and to avoid drug treatment (Smith) and to leave the area and start a new life.

Hart and Smith are charged with murder, attempted murder, home invasion, armed robbery, conspiracy and larceny over $250. In separate dockets, they are charged with larceny of a motor vehicle and receiving stolen property.

Conviction on the murder charge carries a mandatory life sentence without the possibility of parole.

The two are held without bail pending a court date in December. 

Human skull discovered in house in Vermont may be from 50-year-old murder

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Vermont State Police are investigating after a skull was discovered in a house in Sheldon, Vermont. Police say it could be from an unreported, 50-year-old murder.

SHELDON, Vt — A skull discovered in a house in Sheldon, Vermont may be linked to a murder that occurred over 50 years ago, Vermont State Police said in a statement Friday.

After receiving a tip about the possibility of human remains being located at a house at 899 Rice Hill Road in Sheldon, a team of investigators--including agents from the Vermont State Police Major Crime Unit--received a search warrant and descended upon the location early Friday.

Investigators say that during their investigation they found a human skull at the residence. The skull will be transferred to the Chief Medical Examiner for forensic analysis.

Sheldon is a small, largely rural town located near the Canadian border. It is unclear whether the house where the remains were found was inhabited at the time.

Investigators have said they believe the skull may be from a murder that occurred over 50 years ago.

Police say that the investigation is ongoing.

Vermont State Police have asked anyone with any information related to the case to get in touch with Det. Sgt. Angela Baker of the Major Crime Unit at 1-802-524-5993.

 

Woman injured after car drives into house in Chicopee

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A woman was injured after a car crashed into a house in Chicopee on Friday night.

CHICOPEE — A woman was injured after her car crashed into an apartment building in Chicopee on Friday evening.

Mike Wilk of the Chicopee Police Department said that an elderly woman was leaving the gas station at the corner of West Street and Hampden Street, when she accidentally accelerated, drove over the island, and crashed into the side of a nearby apartment structure, before crashing into another building.

In the crash, the car damaged large parts of the apartment building's porch.

The woman had to be taken to a nearby hospital with "some injuries," though police couldn't say how bad they were.

Police were waiting at the scene of the crash for a building commissioner to appear to inspect the integrity of the structure that had been damaged, Wilk said.

The Chicopee Fire Department was also at the site of the incident and firefighters and police could be seen inspecting the scene.


14 indicted in connection with distributing deadly 'Hollywood' and 'Donald Trump' heroin

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The indictment of 14 members of an alleged drug organization that brought deadly heroin to Western Massachusetts was hailed by law enforcement officials Friday as significant progress in the fight against opioid addiction.

SPRINGFIELD -- The indictment of 14 members of an alleged drug organization that brought deadly heroin to Western Massachusetts was hailed by law enforcement officials Friday as significant progress in the fight against opioid addiction.

The suspects, all but one of whom were arrested Sept. 22, were indicted Thursday in U.S. District Court in Springfield on charges of conspiracy to distribute and possess with intent to distribute heroin. The "Hollywood" and "Donald Trump" heroin they are accused of peddling has been linked to at least five overdose deaths in Chicopee and Holyoke.

"Our city has unfortunately seen too many overdoses, and deaths, from heroin," Chicopee Police Chief William Jebb said in a press release issued by U.S. Attorney Carmen M. Ortiz's office. "Because of the efforts of all involved, this dangerous drug was kept off of our streets, and resulted in many lives saved."

Ortiz's office said the drugs were supplied by sources in New York and the Dominican Republic.

One of the indicted, Alberto Marte, 31, of Springfield, is described in court documents as the leader of the organization and operator of a "stash/mill house" at 152 Lebanon St. in Springfield.

Co-defendant Julian Declet, 32, allegedly sold heroin out of AJ Buy & Sell, a glorified pawn shop at 895 Carew St.

Ortiz's office said the organization transported 8 to 20 kilograms of heroin to the Springfield area per month. During the course of the investigation, more than 5 kilograms of heroin was seized by federal agents, Ortiz's office said.

Nine of the other suspects are also from Springfield: Marcos Pena, 29, Jiovanni Rodriguez, 29, Jose Miguel Ramos, 36, Anyuly Tavarez, 30, William Brantley, 45, Mirelvy Vasquez, 26, Diolfi Antonio Marte Vasquez, 25, Anthony Patino, 31, and Juan Perez, 29.

Also arrested were Pablo Rosario, 32, of the Bronx, New York, and Eduardo Ferndandez, 38, of Hazelton, Pennsylvania.

The 14th defendant, Carlos Sierra, aka Rivera, remains at large. In court documents, Sierra is described as a heroin quality tester who reported to Marte.

The eight-month investigation involved local and state law enforcement as well as the federal Drug Enforcement Administration and Homeland Security Investigations.

"DEA and its law enforcement partners have effectively dismantled the command and control elements as well as the distribution network in New England and the Dominican Republic that are responsible for putting this poison on the streets of Springfield and Chicopee, as well as throughout New England," said Special Agent in Charge Michael J. Ferguson.

"Here in western Massachusetts, local, state, and federal law enforcement agencies are successfully working together to combat the opioid crisis," said Hampden County District Attorney Anthony D. Gulluni. "This investigation shows that we will hold accountable those who seek to profit from addiction by selling and trafficking drugs on our streets and in our neighborhoods."

Veteran FBI agent to lecture at Westfield State University

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Cowley has spent more than 10 years investigating public corruption, civil rights and white collar crime.

WESTFIELD - Westfield State University will host veteran FBI agent Julia Cowley for a lecture Tuesday from 4 to 6 p.m. in the Garden Level Conference Room in the Horace Mann Building.

Cowley's lecture is hosted by WSU departments of psychology and criminal justice and will focus on her experience in the FBI's Behavioral Analysis Unit. The lecture is open to the public free of charge.

Cowley is a supervisory senior resident agent with 17 years experience currently assigned to the Boston Division as part of the Springfield Resident Agency to oversee all federal criminal investigations in Western Massachusetts. That includes public corruption, civil rights, white collar crime, organized crime, violent crime and crimes against children.

In 2010, Cowley was promoted to FBI headquarters where she served in the b ureau's behavioral Analysis Unite followed by assignment to the Laboratory Division's Evidence Response Team Unit.

Before joining the FBI, Cowley was a special agent/forensic scientist with the Tennessee Bureau of Investigation. In tat position whe analyzed biological evidence for the presence of alcohol, drugs and toxins. She holds a Bachelor of Science degree in chemistry from the University of Oregon and a Master of Science degree in forensic science from George Washington University.

2 arrested in North Adams during investigation into cocaine distribution

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Two men were arrested in North Adams on Thursday as part of a wider crackdown on drug distribution in the area.

NORTH ADAMS — Two men were arrested at two separate locations in North Adams on Thursday as part of a wider crackdown by local and county authorities on drug distribution in the area.

George Jackson, of New Jersey, and Brett Logan, of North Adams were taken into custody after search warrants were executed at two separate residences in North Adams, where police say crack cocaine, drug distribution paraphernalia, ammunition and cash were also found and confiscated.

The search warrants and arrests were part of a larger, ongoing investigation concerned with the trafficking of crack cocaine from New Jersey into the North Adams area for distribution purposes, North Adams police said.

Agents from the Berkshire County Drug Task Force, as well as North Adams police assisted with the investigation.


State Police K-9 catches suspect who fled from Brookfield courthouse

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A State Police K-9 helped authorities to catch a fleeing suspect on Wednesday, according to police.

BROOKFIELD — Massachusetts State Police say that K-9 "Nanuk" assisted authorities apprehend a suspect who fled from a courthouse in Brookfield on Wednesday.

The suspect, wanted on felony warrants, escaped from Brookfield District Court and ran into a section of woods nearby to the courthouse, according to police.

Police say Immigration and Customs Enforcement officers (ICE) were in the process of chasing the suspect on foot, but were not able to apprehend him.

After State Police Troopers were called in to help with the chase, a K9 Unit was deployed and "Nanuk" was used to track from the point where the suspect was last seen.

Acquiring a scent, police say Nanuk tracked into the wooded area where the suspect was spotted, and was able to find several pieces of clothing that belonged to the suspect.

After plunging through thickly wooded areas, underneath a bridge, and through deep water, police say Nanuck began to "air scent"--which was an alert to authorities that the suspect was within a close distance.

According to police, the suspect was apprehended a short time later, roughly 100-150 feet away from where Nanuck began to "air scent."

Brittany Smith, woman charged in Orange home invasion is under investigation in Alaska for theft

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Brittany E. Smith, the woman facing charges for an Orange home invasion that left a 95-year-old man dead and his 77-year-old wife injured, was wanted for theft in Alaska.

ORANGE -- Brittany E. Smith, the woman facing charges for an Orange home invasion that left a 95-year-old man dead and his 77-year-old wife injured, was wanted for theft in Alaska.

Brittany Smith and Joshua Hart plead not guilty to charges in deadly Orange home invasion

According to the Alaska Dispatch News, Smith recently lived in Bethel and worked as a customer service agent for Ryan Air.

Bethel police in November 2015 received a report that Smith had stolen money orders made out to the company, Alaska Dispatch News reported. Smith allegedly cashed the 18 money orders totaling $6,268.91 at the Alaska Commercial Co. store in Bethel.

Seth Madole, AC store branch manager, released video surveillance he told police showed Smith cashing money orders that matched the time-stamp on them, according to Alaska Dispatch News.

Smith and Joshua Hart are expected to be arraigned in Orange District Court Friday.

The two are suspected of forcing their way into the home of Thomas Harty and his wife Joanna Fisher sometime during the evening of Wednesday, Oct. 5 or the early morning hours of Oct. 6.

Shooting in Amherst leaves one man dead, another injured

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Amherst police responded to a shooting reported in the area of Southpoint Townhouses and Apartments off East Hadley Road early Saturday morning.

AMHERST -- A double shooting at the at the Southpoint Apartments in Amherst just after midnight Saturday left one man dead and another man hospitalized at the UMass Medical Center in Worcester.

Police believe this was not a random act, and that members of the public are not at risk, said Mary Carey, communications director for the Northwestern District Attorney's Office.

Amherst Police, Massachusetts State Police attached to the Northwestern District Attorney's Office and MSP Crime Scene Services are investigating, she said.

Anyone with information is asked to contact the Amherst Police Department at (413) 259-3015, or to text a tip to the anonymous tip line at 274637.

Amherst Police Sgt. Brian Johnson said the report came in just after midnight at the housing development off East Hadley Road.

The townhouse and apartment complex is located on Southpoint Drive off East Hadley Road, not far from the Crocker Farm Elementary School and the Hickory Ridge Golf Club.


This is a developing story which will be updated as additional information becomes available.

Chicopee, South Hadley Police arrest man for break-ins to 3 stores on Memorial Drive

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Richard Ittner, 59, is to be arraigned in Chicopee District Court on Monday. Watch video

CHICOPEE - A 59-year-old man who is a suspect in two break-ins here and one is South Hadley has been arrested.

magris.jpgRichard Ittner 

Richard Ittner, of 2089 Memorial Drive, is scheduled to be arraigned in Chicopee District Court on Monday on two counts of breaking and entering in the nighttime to commit a felony and two counts of larceny, Michael Wilk, public information officer for Chicopee Police, said.

Ittner is being accused of breaking into Magri's Fruit Company and KNT Computers over a two-week period. In both cases he allegedly broke the door, ran into the stores and grabbed items and left before police arrived, Wilk said.

During the investigation, Chicopee Police Det. Chris Sawa learned that South Hadley Police were also investigating a similar breaking and entering into the Route 33 Pizza shop, 2080 Memorial Drive. The restaurant is near Magri's Fruit Company, 2009 Memorial Drive, and KNT Computers, 1880 Memorial Drive, he said.

Chicopee Police publicized a video and photos of the man caught on surveillance cameras and a number of people shared information about identifying the man.

Chicopee Police and South Hadley Police together found Ittner at a home on Memorial Drive and he was arrested, Wilk said.

Newtown families lawsuit dismissed against Westfield's Camfour, too

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Camfour of Westfield was sued by families of Sandy Hook victims as well as gun manufacturer Remington Arms and now-closed gun shop Riverview Gun Sales.

WESTFIELD -- A Connecticut judge's decision Friday to strike down a lawsuit brought by Sandy Hook families also ends litigation against Camfour, a Westfield gun distributor.

The judge's decision in the Newtown, Connecticut, case is available online here.

The families of nine children and adults killed by disturbed gunman Adam Lanza in December 2012 at Sandy Hook elementary school and one adult who survived  sued in 2014 saying Remington Arms, the company that made the Bushmaster rifle Lanza used,  distributor Camfour and now-closed Riverview Gun Sales of East Windsor where Lanza's mother bought the rifle were all responsible for putting a military-style firearm out on the streets.

This was believed to be the first wrongful death lawsuit of its kind against a gun manufacturer.

Camfour is owned by a group of local investors headed by Peter A. Picknelly, chairman and CEO of Peter Pan Bus Lines and part-owner of a number of local manufacturing enterprises. The group also owns sister company Hill Country Wholesale in Pflugerville, Texas.

The judge dismissed the suit under the 2005 federal Protection of Lawful Commerce in Arms Act which protects gun companies from liability lawsuits. 

Camfour was the wholesaler and Riverview was the gun store where the Lanza's mother purchased the Bushmaster rifle in 2010. But that suit was first filed in Connecticut Superior Court sitting in Bridgeport.

Riverview's owner, David LaGuercia, was reported as living in Agawam at the time, according to The Associated Press.

The lawsuit alleged that the Bushmaster should not have been sold to the public because it is a military weapon, unsuited for hunting or for home defense.

Picknelly and partners bought Camfour in 1998 from Albert F. and Amelia "Millie" A. Ferst.

The Fersts were longtime philanthropists in and around Westfield. Their legacy includes the $6 million Amelia Park complex off South Broad Street that supports Amelia Ice Rink, Children's Museum, Amelia Park Garden, the Albert and Amelia Ferst Boys and Girls Club and an outdoor skateboard park. They also backed the Interfaith Center on the campus of Westfield State University and Samaritan Inn homeless shelter on Free Street. 

Albert Ferst died in 2011 at age 92. Amelia Ferst died in 1997.

Baystate Health Breast Network's Dr. Grace Makari-Judson offers perspective on disease

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Veteran oncologist discusses mammogram screenings, treatment, diagnoses.

SPRINGFIELD - Dr. Grace Makari-Judson is a veteran oncologist and chair of the Baystate Health Breast Network. She was asked about guidelines Baystate Health provides on mammogram screenings, and how it approaches treatment options available today based on individual diagnoses.

Q. What factors do you discuss with a patient of average risk for breast cancer in terms of when to have a mammogram?

A. Baystate Health developed practice guidelines intended to provide background on the pros and cons of screening mammography to support primary care providers as they have one-on-one discussions with women.

The consensus recommendation is to initiate the mammogram discussion at age 40, and consider starting between ages 40 to 49 but no later than age 50. Screening should not stop at any arbitrary age, but should continue based on a woman's overall health. Mammograms should be done every one to two years as a minimum, but not longer than every 24 months. Women who are at high risk based on family or personal history are excluded from these recommendations and are considered separately.

Q. There has been much medical discussion in recent years of how to treat DCIS, the most common form of non-invasive breast cancer.

Because DCIS represents a spectrum of changes, it is not fair to generalize treatment as if it were one disease. Low grade (indolent DCIS) is often difficult to differentiate from certain types of benign breast conditions, and has an excellent prognosis.

Small areas of low-grade DCIS may be appropriately treated with surgery to remove the area as the sole treatment. High grade DCIS has a higher recurrence rate and half of recurrences may be invasive (in other words, have the potential to spread outside the breast). This type of DCIS should be considered for additional treatments after surgical removal including radiation and possible hormone medication.

Q. What about treatment of invasive breast cancer?

For invasive breast cancer, after removing the lump, radiation is generally recommended to treat the remaining breast tissue. There are new radiation options with doses adjusted to allow for a shorter course in certain situations. Radiation may be omitted completely in patients over 70 with hormone receptor positive cancers who will be taking hormonal treatment.

Q. What are you seeing in terms of women with DCIS or invasive breast cancer elected to have a mastectomy rather than breast conservation surgery?

A. Mastectomy rates are sometimes higher for DCIS than invasive cancer because DCIS spreads as though it were running along branches of a tree rather than forming a lump making it harder to conserve the breast.

For most women with breast cancer, be it the non-invasive DCIS or invasive cancer, breast conserving treatment is recommended. Sadly, although we have over 40 years of experience showing that survival rates are the same after mastectomy compared to breast conservation, mastectomy rates have gone up in recent years.

Mastectomy is often recommended for certain advanced breast cancers, and bilateral mastectomy is considered for those with genetic risk, but many women are selecting this not out of necessity, but out of preference.

The complication rate is higher with double mastectomy. This means that for women with invasive breast cancer who need chemotherapy after surgery, this may delay the start of chemotherapy, which may negatively impact survival. Some women also still need radiation after a mastectomy depending on the features of the cancer.

Q. What do genomic tests on a tumor allow you to determine and are you using them to help women with early stage breast cancer decide on their course of treatment?

A. We routinely perform genomic testing on hormone receptor positive invasive breast cancers to determine the need for chemotherapy in addition to hormone medication. Genomic profile identifies those tumors that are most likely to derive added benefit from chemotherapy above and beyond hormone treatment alone. We started performing these tests close to 10 years ago and Baystate patients participated in the landmark TailorX clinical trial. Thanks to this testing, we are recommending approximately 30 percent less chemotherapy than in years past.

Q. Are their better options today in terms of chemotherapy drugs and in terms of their toxicity?

A. Supportive care, i.e. the art of managing side effects from chemotherapy, has continued to improve each year. Before, the focus was preventing vomiting, and now we are honing down on nausea and have new drugs to attempt to eliminate even that.

Q. What type of breast cancer may be treated today with targeted therapies and what percentage of Baystate's breast cancer patients are? Are any biological therapies used for breast cancer treatment?

Targeted treatments are recommended for nearly all breast cancer patients that have tumors that overexpress "her 2 neu" a protein associated with cell growth found in 20 to 30 percent of breast cancers. These cancers had previously been considered some of the most aggressive cancers, but they have been "tamed" by the monoclonal antibody trastuzumab (Herceptin). Trastuzumab has been used along with chemotherapy in early stage breast cancer. For advanced breast cancer, additional biologics and targeted agents are also available.

Of course, the first "target" ever identified in cancer treatment was the estrogen receptor and the drugs used include tamoxifen and aromatase inhibitors. Additional targeted treatments include new drugs to overcome resistance to these hormone treatments in patients with ER positive cancer. Many of these small molecules are available as pills. These drugs are used to treat advanced breast cancer but we also have clinical trials investigating use in earlier stage disease.

Q. Are you seeing any improvement in treatment outcomes for diagnoses of triple negative breast cancer, and are researchers close to targeted therapies for TNBC?

Triple negative cancer is breast cancer that is ER, PR and Her2 negative and represents 20 percent of all breast cancers. These cancers are a challenge because in general, there is not a "target" like the estrogen receptor or Her2 neu. Chemotherapy is the standard treatment for triple negative cancers.

At Baystate Medical Center, we have clinical trials for subsets of triple negative patients. For example, in hereditary breast cancer patients with BRCA 1 or 2 mutations, drugs called PARP inhibitors are being tested. In other triple negative patients, representing a very small percent, the tumor may express androgen receptor and there is a clinical trial for this subset.

Q. What do you advise patients in terms of hormonal therapy?

Hormonal treatment is important to consider in every patient with a cancer that is estrogen receptor positive. For premenopausal women, tamoxifen is recommended. For postmenopausal women either tamoxifen or one of the three aromatase inhibitors is prescribed. The best hormone medication is the one that the patient can stick with for at least 5 years. Recent clinical trials support the notion that longer is better. We now have information that 10 years is better than five for both tamoxifen and the aromatase inhibitors.

When I have this important discussion with my patients we consider these questions: What is the risk of breast cancer coming back?; How is their overall health?; and How are they tolerating the medicine? The hard part is that breast cancer can come back even 20 to 30 years later. My patients at high risk of recurrence are pleased that we have the data to support longer duration treatment. For most patients, this requires a thorough discussion of risks versus benefits.

Q. When do you use hormonal therapy to lower the risk of someone getting breast cancer?

A. We have three different agents that have been shown in large clinical trials to lower the risk of developing breast cancer in individuals that do not have a diagnosis but are at higher risk. High risk includes those with a significant family history, or certain types of benign breast disease including atypical hyperplasia and a condition called LCIS. All three drugs lower risk of hormone positive breast cancer but do not lower risk of the less common hormone negative cancer.

Tamoxifen is the only medication for pre-menopausal women. For post-menopausal women, tamoxifen, raloxifene (Evista) or one of the aromatase inhibitors are all options. My preference in post menopausal women is raloxifene since it is generally well tolerated and also helps prevent bone loss.

Q. Studies have shown a link between obesity and mortality in terms of breast cancer. What do you think of studies looking at weight loss and breast cancer re-occurrence, as well as studies looking at how effective eating a Mediterranean style diet is in breast cancer prevention?

There is no proven breast cancer prevention diet. The Mediterranean diet is a healthy diet similar to what the American Cancer Society and American Heart Association recommend. For women that have had a diagnosis of breast cancer, the Women's Intervention Nutrition Study (WINS), that Baystate participated in, suggested that a very low fat diet was beneficial in reducing risk of recurrence in women with a diagnosis of breast cancer, but the women who benefited also lost weight. Currently, we are involved in studying exercise after a diagnosis. Women who exercise regularly appear to lower the risk of recurrence.

For women without a diagnosis of breast cancer, I recommend eating a healthy diet, similar to the Mediterranean diet, exercise 2 to 3 hours per week, limit alcohol and don't smoke. It's never too late to start exercising, so join us for the Rays of Hope Walk/Run, Oct. 30th!

Editor's note: The annual Rays of Hope Walk/Run Toward The Cure for Breast Cancer will be held Oct. 30. The 8K run steps off at 8:30 a.m., with registration at 7:30 a.m. at Temple Beth El, 979 Dickinson St., or in advance online. The walk begins at 10:30 a.m. from Beth El. The event has raised $13 million to date. In partnership with the Baystate Health Breast Network and Baystate Health Foundation, funding benefits research at the Rays of Hope Center for Breast Cancer Research, and helps fund state-of-the-art equipment, breast health programs and outreach and education throughout Baystate Health, as well as grants to community support programs.

What's in the hacked emails from Clinton's campaign chair posted by WikiLeaks?

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Hacked emails released in daily dispatches this past week by the WikiLeaks group exposed the inner workings of Hillary Clinton's campaign leading up to her 2015 announcement that she would seek the presidency, and through this year's primary.

WASHINGTON -- Hacked emails released in daily dispatches this past week by the WikiLeaks group exposed the inner workings of Hillary Clinton's campaign leading up to her 2015 announcement that she would seek the presidency, and through this year's primary.

The thousands of emails were hacked from the accounts of Clinton campaign chairman John Podesta.

U.S. intelligence officials have blamed the Russian government for a series of breaches intended to influence the presidential election. The Russians deny involvement.

Among the revelations from Podesta's hacked emails:

WALL STREET SPEECHES

The campaign asked former President Bill Clinton to cancel a planned speech to a Wall Street investment firm last year because of concerns the Clintons might appear to be too cozy with Wall Street just as the former secretary of state was about to announce her White House bid.

Clinton aides wrote that Hillary Clinton did not want her husband to cancel the speech, but was eventually convinced that canceling was the right step.

Campaign manager Robby Mook said he realized canceling the speech would disappoint both Clintons, but said, "it's a very consequential unforced error and could plague us in stories for months."

Clintons' paid speeches have been an issue throughout the campaign, particularly Hillary Clinton's private speeches to Wall Street firms.

Bill Clinton was scheduled to speak to Morgan Stanley executives in April 2015, a few days after his wife was set to launch her bid for president.

"That's begging for a bad rollout," Mook wrote in an email from March 11, 2015.

SHUFFLING PRIMARY DAYS

The Clinton campaign tried to move the Illinois presidential primary to a later date. The campaign said a contest held after the Super Tuesday primaries might stop momentum for a moderate Republican candidate, and it emphasized that Clinton and her husband "won't forget" a political favor.

The email, from Mook to Podesta, said Obama administration officials should use their connections in the president's home state to try to push back the March 15 Illinois primary by at least a month.

"The overall goal is to move the IL primary out of mid-March, where they are currently a lifeline to a moderate Republican candidate after the mostly southern Super Tuesday," Mook wrote. "IL was a key early win for (GOP presidential candidate Mitt) Romney" in 2012.

"The Clintons won't forget what their friends have done for them," he added.

Mook suggested that Bill Daley, a former White House chief of staff and longtime Illinois power broker, should reach out to Illinois House Speaker Michael Madigan to make the request.

The effort was ultimately unsuccessful.

PRIVATE EMAIL SYSTEM

As news broke last year about her use of a private email server, one of Clinton's top aides suggested simply releasing all the messages from her time as secretary of state.

The email was sent on March 4, 2015, the day The Associated Press first reported that Clinton had been running a private server inside her home in New York.

Within hours of AP's reporting, Republicans from the House Select Committee on Benghazi issued a subpoena demanding Clinton's emails regarding the deadly 2012 attacks on the U.S. diplomatic compound in Libya.

Adviser Phillipe Reines proposed that Clinton should respond by tweet: "No need for this, happy for you to have what I gave State. If they can't, I will. Bring a dolly!" -- referring to a moving cart.

Clinton lawyer and chief of staff Cheryl Mills responded: "Seriously?"

Reines, who had worked for Clinton at the State Department, reiterated that he was serious, though he suggested maybe a campaign spokesman could respond less "flippantly."

Mills appeared to like the idea, at least initially. "Can we implement this in the next hour?"

It never happened.

Instead, Clinton's team waited more than a year as the State Department pored through more than 55,000 pages of Clinton's work-related emails from her time as the nation's top diplomat. And the issue kept bubbling up, no matter how hard Clinton's team worked to put it behind her.

HOW TO REPLY

Clinton's campaign was slow to grasp the seriousness of the email controversy and believed it might blow over after one weekend.

Two days after the AP report, her advisers were shaping their strategy to respond to the revelation.

Campaign spokesman Nick Merrill optimistically suggested that the issue might quickly blow over.

"Goal would be to cauterize this just enough so it plays out over the weekend and dies in the short term," Merrill wrote on March 6, 2015.

It did not, and instead became the leading example of Clinton's penchant for secrecy, which has persisted as a theme among her campaign critics and rivals throughout her election season. Clinton did not publicly confirm or discuss her use of the email server until March 10 in a speech at the United Nations, nearly one week after AP revealed the server's existence.

BILL CLINTON'S BUSINESS

There was consternation among those closest to Hillary Clinton about how Bill Clinton's business dealings might damage his reputation and potentially affect her presidential hopes.

The emails also gave insight into tension and turmoil within the Clinton Foundation while Clinton was secretary of state. The chief operating officer of the family charity was reported to be threatening to commit suicide over the stress.

The messages that circulated among Podesta, Chelsea Clinton and former Bill Clinton aide Doug Band detail internal tensions that simmered inside the Clinton Foundation and appear to have played a role in Band's departure from the family charity.

After Chelsea expressed concerns about Band and the private corporate advisory firm he co-founded, Teneo Holdings, Band wrote that she was "acting like a spoiled brat kid who has nothing else to do but create issues to justify what she's doing because she, as she has said, hasn't found her way and has a lack of focus in her life."

Also in December 2011, Clinton Foundation chief operating officer Laura Graham contacted Band to complain that stress she blamed on the former president and Chelsea Clinton was causing her to consider suicide.

Band wrote that when Graham called him, she was in her car parked near the water with her foot on the gas pedal. He said he dissuaded her from hurting herself.

TRADE POLICY

Hillary Clinton told bankers behind closed doors that she favored "open trade and open borders" and said Wall Street executives were best-positioned to help reform the U.S. financial sector, according to transcripts of her private, paid speeches that appeared in hacked emails released Oct. 7.

Excerpts of the speeches given in the years before her 2016 campaign included some blunt and unguarded remarks to her private audiences, which collectively had paid her at least $26.1 million in speaking fees. Clinton had refused to release transcripts of the speeches, despite repeated calls to do so by her Democratic primary opponent, Sen. Bernie Sanders.

Among the emails was a compilation of excerpts from Clinton's paid speeches in 2013 and 2014. It appeared campaign staff had read all Clinton's speeches and identified passages that could be potentially problematic for the candidate if they were to become public.

One excerpt put Clinton squarely in the free-trade camp, a position she has retreated on significantly during the 2016 election. In a talk to a Brazilian bank in 2013, she said her "dream" is "a hemispheric common market, with open trade and open borders" and asked her audience to think of what doubling American trade with Latin America "would mean for everybody in this room."

Donald Trump, the Republican presidential nominee, has made opposition to trade deals a cornerstone of his campaign.


New Hampshire Democrats protest Donald Trump's comments on women, his supporters take aim at Hillary Clinton

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With Donald Trump facing criticism over remarks he made about women in a leaked 2005 recording, New Hampshire Democrats took to the streets outside the GOP presidential nominee's Saturday rally in protest.

PORTSMOUTH, N.H. -- With Donald Trump facing criticism over remarks he made about women in a leaked 2005 recording, New Hampshire Democrats took to the streets outside the GOP presidential nominee's Saturday rally in protest.

Members of the New Hampshire Young Democrats and others held signs outside the businessman's Portsmouth campaign event blasting his controversial comments about kissing and groping women -- remarks which they argued are unacceptable.

Supporters of the Republican nominee hopeful, however, questioned the timing of attacks on Trump's character and why the same scrutiny isn't given to his opponent.

Rally-goers further contended that the White House race should instead focus on issues.

New Hampshire Young Democrats President Lucas Meyer, a 26-year-old Concord resident, said protesters decided to focus on Trump's comments and not promoting Democratic nominee Hillary Clinton due to the "gravity of what's at stake."

"A nominee for a major political party -- who's the nominee for president -- that says things like this is unacceptable," he said. "We don't have to spin anything, we don't have to make up any creative catch lines, these are just his words."

Echoing many of the arguments First Lady Michelle Obama made about Trump during a stop in Manchester earlier this week, Meyer stressed that the GOP nominee's comments are "not normal" or "politics as usual."

Michelle Obama rips Donald Trump's comments on women at New Hampshire rally, says 'enough is enough'

Sheila Vargas, 26, of Pittsfield, New Hampshire, said although she hasn't been too active as a member of the New Hampshire Young Democrats, she felt personally compelled to protest Trump's comments on women as a survivor of sexual assault.

"I felt like me coming out here and saying that sexual assault is not a joke was really important not just for me personally as a healing process, but also giving other people the strength to do it themselves," she said. "I would absolutely love to live in a world where someone running for president doesn't say things about women, calling them 'Miss Piggy,' 'Miss Housekeeping,' or his most recent comments, which I can't even repeat, but that's the world that we live in today."

Vargas added that she finds it unfortunate that Trump has cast his comments as "locker room banter," contending that the conversation around sexual assault needs to change at the societal level.

"I think that the excuse that they're making that it's locker room talk is completely unacceptable," she said. "I know his supporters are really drilling that into peoples' heads, but I think there's no excuse for it."

Mike Kimball, a 48-year-old Trump supporter from Seabrook, New Hampshire, agreed with that sexual assault needs to be addressed at a cultural level, but questioned whether it should be the focus of a presidential campaign.

"It's always on the politics side and in this, people bring out the worst in other people. It's not really what it should be about," he said. "I agree to a point that you obviously don't want vote for people who treat people badly, but unfortunately, who's the lesser of two evils here and that's what it comes down to."

Kimball added that Clinton's campaign should face similar criticism over her history of treatment toward women.

"How can the Clinton campaign degrade Donald Trump over the things people are saying he's done when she's been covering for her husband for years for things that he's actually done," he said, alluding to rape and sexual harassment accusations former President Bill Clinton has faced.

Kimball further took issue with what he called the level of "bullying" in the presidential campaign.

"Maybe this is a good opportunity for either one of these politicians to talk about the bullying crisis in America. We're seeing it right now in the election process -- we're seeing outright bullying between each other, so I think that's a major problem in the world," he said. "But we're looking right past it and concentrating on the bullying that they've done."

Laura Young, a 56-year-old Haverhill, Massachusetts resident, meanwhile, said she decided to attend the rally at a Portsmouth Toyota dealership to show Trump that women do support his campaign.

"It's not all about what he said and definitely Clinton has done worse," she said.

Young further questioned the timing of the leaked recording and recent reports of women accusing Trump of sexual assault.

"Why did it come out now? It's been years -- 30 years (since) this one lady she he groped her on a plane. Come on, 30 years you waited? And at that point in time?" she said.

Sunday's final SIDS Race for Life event in Springfield will include live music, food trucks

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Congressman Richie Neal has been involved in the charity event, which raises money for sudden infant death syndrome, for 26 years.

SPRINGFIELD -- The annual SIDS Race for Life, a Springfield tradition sponsored by Congressman Richard Neal for over a quarter century, returns for a final lap this Sunday, Oct. 16, at the John Boyle O'Reilly Club, where participants will set out on either a 5-mile run or 3.5-mile walk at 11 a.m.

"We've made extraordinary progress on SIDS," Neal told The Republican on Friday, referring to sudden infant death syndrome -- the sudden unexplained death of a child less than 1 years old.

This year marks the 26th and final year of the SIDS event, which the Springfield congressman has been involved with from the beginning. "This has been my charity effort," Neal said. "It's been genuinely a heartfelt achievement."

The race and fun walk begin and end at the Boyle, as the Irish fraternal club is commonly called. Event registration is at 9:30 a.m., followed by the race at 11 a.m. The race will be followed by a food truck festival and live entertainment at the Boyle, 33 Progress Ave., Springfield.

Proceeds will benefit the Massachusetts Center for Sudden Infant Death Syndrome, which provides services to bereaved families of children who have died unexpectedly.

Since 1990, friends of Barry and Anne Metayer have been holding the SIDS Race for Life in memory of Barry Jr., who succumbed to the syndrome. Over the past 26 years, the race has raised about $25,000 to $30,000 annually, according to Neal. That's roughly $650,000 to $780,000 over the lifespan of the event.

Meanwhile, the food truck component of the event continues to draw a crowd, too, according to organizers, who have lined up a diverse selection of offerings for this year's after-race party.

Participants include MJ's, White Hut, Log Rolling, and the Cupcake Brake. Also, Chanterelle's will be serving "farm-to-table" soups and salads, while the Holyoke Hummus Company's Great Garbanzo truck will be offering up falafel, hummus and grape leaves.

In addition to Neal, the SIDS Race for Life event is sponsored by Williams Distributing, Darby O'Brien Advertising, Baystate Health, and many other local organizations. More information is available online at www.sidsrace4life.org.


 

Law enforcement continues fatal Amherst shooting investigation; neighbor describes hearing gunshots, screaming, police response

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One man is dead and another hospitalized at UMass Medical Center in Worcester after a shooting at the Southpoint Apartments in Amherst early Saturday.

Updates a story posted Saturday at 10:13 a.m.

Further update 2:23: Mary Carey, a spokeswoman for the Northwestern District Attorney's Office said police got the call at 12:15 a.m. and the deceased victim was already dead when they arrived.

AMHERST -- Police wrapped up their on-scene investigation Saturday into an overnight shooting at the Southpoint Apartments that left one man dead and another injured and hospitalized at UMass Medical Center in Worcester.

Detectives at the scene early Saturday afternoon said they were going back to the station to meet and go over what they'd learned so far. Any further word would come from the office of the Northwestern District Attorney, they said.

Meanwhile, a resident of the complex said he heard gunshots, screaming and the police response.

Earlier Saturday, Northwestern District Attorney's Office spokeswoman Mary Carey issued a short bulletin saying police believe this was not a random act and that members of the public are not at risk.

The shooting occurred shortly after midnight Saturday.

Amherst Police, Massachusetts State Police attached to the Northwestern District Attorney's Office and state Crime Scene Services are investigating, Carey said.

Anyone with information is asked to contact the Amherst Police Department at 413-259-3015 or to text a tip to the anonymous tip line at 27463.

Neighbors gathered at the well-kept complex Saturday, coming and going from errands and youth football practices amid reporters and police tape.

UMass graduate student Md Nazmul Islam lives in the same building where the shooting occurred. He said he heard gunshots, then screaming followed by the hurried arrival of police with search dogs. He watched as police searched the woods behind the complex.

Meikkel Murray, a neighbor and senior at Amherst High School, said he's shocked.

"Look at it out here, it's beautiful. You're out with the fields and trees in the country," he said. "Nothing ever happens here."

Amherst police investigated incidents involving robbery and assault in December and a break-in at the complex in March.

What are the issues at stake in the presidential election?

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A selection of issues at stake in the presidential election and their impact on Americans, in brief.

WASHINGTON -- A selection of issues at stake in the presidential election and their impact on Americans, in brief:

MONEY IN POLITICS

Voters are disgusted with the way political races are paid for -- disproportionately by big-money donors, including those who stand to gain or lose from government decisions. The rules even allow donors to hide their identities by giving to politically active nonprofit groups that don't file detailed public paperwork about their finances.

The system leaves everyday Americans fearing that their voices are being drowned out by these moneyed interests.

So far, donors have pumped more than $1.7 billion into the presidential race, according to an Associated Press tally.

Both presidential candidates talk a good game when it comes to money in politics, but both fail to back their words with action.

Democrat Hillary Clinton and Republican Donald Trump denounce big money in politics, but they are both largely funded with big money. Trump also has no proposals addressing campaign finance, while Clinton's are vague and difficult to execute.

HOMEGROWN EXTREMISM

Radical Islamic militancy has inspired a series of deadly attacks on U.S. soil, shaking the American psyche and leaving the presidential contenders at odds over how to respond.

The culprits typically have no ties to foreign terrorist organizations, no explicit directions from overseas and no formal training.

Instead, they've blended into American society and skated beneath the radar of federal investigators grappling with a frenetic threat landscape and hundreds of investigations across the country.

The bombing in Manhattan in September that injured more than two dozen people crystallized concerns: A journal found with the Afghan-born U.S. citizen accused in the explosion praised terrorists like Osama bin Laden, prosecutors say.

Donald Trump has proposed various means of choking off a terrorist influx, though that would do little to stop self-radicalized Americans.

Hillary Clinton says Muslim-Americans help the struggle against homegrown extremism because they can prevent young people from joining jihadis and notify authorities when they suspect radicalization. She'd prohibit people on terrorist watch lists from being able to purchase weapons.

ENERGY

Energy independence has been a goal of every president since Richard Nixon. Hillary Clinton and Donald Trump have very different ways to get there. How energy is produced and where it comes from affect jobs, the economy and the environment.

Domestic production of all types of energy except coal has boomed in recent years, spurred by improved drilling techniques such as fracking and discoveries of vast oil supplies in North Dakota and natural gas in states such as Pennsylvania, Ohio, New York and West Virginia.

Hillary Clinton vows to continue the boom while ensuring the U.S. generates enough renewable energy to power every home in America within 10 years.

Donald Trump vows to "unleash American energy," allowing unfettered production of oil, coal, natural gas and other sources to push the U.S. toward energy independence and create jobs.

Both Clinton and Trump support natural gas, a cleaner alternative to coal. Trump calls for rescinding the Clean Power Plan, a key element of President Barack Obama's strategy to fight climate change. Clinton is committed to Obama's climate-change goal of reducing greenhouse gas emissions by up to 30 percent by 2025.

LGBT

Same-sex marriage is now the law of the land, but there are other battlegrounds related to civil rights and nondiscrimination protections for lesbians, gays, bisexuals and transgender people. Two polarizing questions: What sort of access should transgender people have to public bathrooms? And are the advances for LGBT rights infringing on the religious freedom of some Americans?

Whoever wins the presidency will be somewhat limited in his or her ability to influence national LGBT-rights policies. A pending LGBT-inclusive nondiscrimination bill is unlikely to advance through a Republican-controlled House. And the nationwide legality of same-sex marriage is unlikely to be threatened.

However, the election outcome could determine how aggressively federal agencies work to expand LGBT rights. Hillary Clinton would probably press efforts to bolster transgender rights.

Thus far, federal judges have generally been unsympathetic to arguments that certain types of anti-LGBT discrimination are permissible if in accordance with a person's religious beliefs. Donald Trump has told conservatives he'd place a high priority on religious liberty.

RACE AND POLICING

Campaign 2016 Why It Matters Race and PolicingFILE - In this Sept. 22, 2016. file photo, protesters block I-277 during a third night of unrest following the police fatal shooting of Keith Lamont Scott in Charlotte, N.C. Policing in the United States' minority communities has been a flashpoint since the deaths of Trayvon Martin in Florida, Michael Brown in Missouri, Tamir Rice in Ohio, Sandra Bland in Texas and others. The increasing number of graphic photos and film depicting the deaths of black men, women and children at the hands of police officers has sparked unrest around the nation.  
The continued deaths of unarmed African-American men women and children at the hands of police are turning into one of the most consequential civil rights issues of the new millennium. Since the death of Michael Brown in Ferguson, Missouri, the sharing of video-recorded deaths of African-Americans at the hands of law enforcement has sparked unrest in many cities around the country, and prompted calls for additional training and more monitoring of police forces.

Hillary Clinton has offered specific proposals, including legislation that would help end racial profiling, providing federal matching funds for more police body cameras and overhauling mandatory minimum sentencing.

Donald Trump has described himself as the "law and order" candidate, and has not specifically addressed plans on race and policing. He endorsed a former New York City police policy called "stop and frisk" after unrest in Charlotte, North Carolina, over the police shooting of Keith Lamont Scott.

ISLAMIC STATE

As Islamic State militants suffer setbacks in Iraq and Syria, they are becoming more intent on inspiring lone-wolf attacks, already seen in the U.S. and Europe.

The group seized swaths of land in Iraq and expanded its territory in Syria in a dramatic blitz in 2014. The militant group slaughtered civilians in its march to try and establish a radical caliphate, and has spawned a string of deadly attacks across Europe, the Middle East and the United States.

Besides holding major cities in Iraq and Syria, the group has either claimed responsibility or been linked as a possible inspiration for the November attacks in Paris; the mass shootings in San Bernardino, California; the subway and airport bombings in Brussels; the Orlando nightclub shootings; and the Bastille Day truck attack in Nice, France.

Hillary Clinton's plan to deal with the IS threat abroad and at home mostly embraces what President Barack Obama is doing. Donald Trump has vowed relentless bombing and expressed support for enhanced interrogation techniques. Other details are lacking.

ISRAEL

Support for Israel has been a mainstay of American foreign policy since the Jewish state's creation in 1948. Despite occasionally strong and even pointed differences, successive U.S. administrations of both parties have steadily increased financial, military and diplomatic assistance to Israel over the past six decades.

The U.S. now provides Israel with roughly $3 billion every year, making it the largest single recipient of American foreign aid, and the Obama administration boosted that amount to $3.8 billion with a new memorandum of understanding on defense.

Debate over Washington's pro-Israel position has intensified in recent years -- notably over the Iran nuclear deal that Israel opposes, failed efforts to forge an Israeli-Palestinian peace deal and Israel's continued construction in territory claimed by the Palestinians. But the Democratic and Republican parties and their presidential candidates have never wavered from that stance and strong congressional backing for Israel makes any significant change in policy unlikely.

TAXES

Presidents like to try reshaping the tax code to make substantive changes in fiscal policy and to show voters their priorities.

Both Donald Trump and Hillary Clinton have made clear that that's just what they want to do. There's an enormous difference between their approaches and goals.

Trump, the Republican, is intent on cutting taxes. He'd collapse the current seven income tax brackets, which peak at 39.6 percent, into just three tiers with a top rate of 33 percent, slice the corporate income tax and eliminate the estate tax. Analysts say the wealthy would benefit disproportionately.

Clinton, the Democrat, is proposing tax increases on the rich, including a minimum 30 percent tax on incomes over $1 million and higher taxes on big inheritances. Most taxpayers would see little or no impact on their tax bill, but the government might look different. She'd use the added revenue to expand domestic programs.

GUNS

The right to bear arms is carved into the Constitution and seemingly embedded in the national DNA. But after a seemingly endless stretch of violence, Americans are confronting how far those rights extend.

Do Americans have the right to have AR-style firearms, the long guns with a military look used in the past year in several mass shootings? Should they be able to buy magazines that hold 10 or more bullets? Should every gun buyer have to pass a background check?

Donald Trump casts himself as an ardent protector of gun rights and proclaims that if more "good guys" were armed there would be fewer gun tragedies.

Hillary Clinton wants to renew an expired ban on assault-type weapons instituted when her husband was president. She's also called for measures to ensure background checks are completed before a gun sale goes forward, mandating such checks for gun-show sales and repealing a law that shields gun manufacturers from liability.

RUSSIA

Russia is reasserting itself, posing vexing questions for the U.S. and a presidential field seemingly split on Vladimir Putin.

After briefly looking inward during much of President Barack Obama's first term, Russia has returned to the international stage with force under Putin.

Russia is militarily involved in Syria, supports separatists in eastern Ukraine and areas of Georgia and has even been accused of trying to meddle in the U.S. presidential race. At the same time, the U.S. has been forced to accept that working with Russia is probably the only way to achieve results on many complicated international issues. Thus, Russia was central in the Iran nuclear negotiations and is a player as well as negotiator in the Syria truce effort.

Donald Trump advocates improved relations with Russia and has been strikingly complimentary of Putin's strong leadership style.

Hillary Clinton has had direct negotiating experience with Putin and his aides and that has left her wary of cooperating with Moscow. She promises to stand up to Putin and deter Russian aggression in Europe.

JOBS

Tepid income growth and a smaller share of the population at work have kept many Americans anxious about jobs and the economy, seven years after the Great Recession ended.

And most jobs that pay decent wages require more education than in the past, leaving many workers feeling left behind.

Donald Trump says he would cut regulations and taxes to spur more hiring, and renegotiate or withdraw from trade agreements to bring jobs back to the U.S.

Hillary Clinton says she would spend more on roads, tunnels, and other infrastructure and make state colleges and universities tuition free to most students.

Even though hiring has been healthy for the past six years, incomes have lagged. A typical household didn't see its income recover to pre-recession levels until just this past July. And the proportion of Americans working or looking for work remains below pre-recession levels, as some of the unemployed have given up searching for jobs.

SOCIAL SECURITY

Big changes are coming to Social Security, sooner or later.

If left to later, those changes promise to be wrenching.

The trustees who oversee the program say it has enough money to pay full benefits until 2034. But at that point, Social Security will collect only enough taxes to pay 79 percent of benefits. Unless Congress acts, millions of people on fixed incomes would get an automatic 21 percent cut in benefits.

Social Security's financial problems might seem far off. But the longer Congress waits to act, the harder it will be to save Social Security without dramatic tax increases, big benefit cuts or some combination.

Hillary Clinton has proposed expanding Social Security benefits for widows and family caregivers. She says she would preserve Social Security by requiring "the wealthiest" to pay Social Security taxes on more of their income. Republican Donald Trump has promised not to cut Social Security. He's suggested he'd revisit the program after his tax-cut plan boosts economic growth.

EXECUTIVE AUTHORITY

"Your Majesty" isn't in the American political lexicon. But when a president sets a major policy by edict, skirting Congress, it sets off a debate that traces back to the time of kings and queens -- and the Founding Fathers who rejected the authority of the crown. Lawmakers cry foul when a president, especially of the other party, usurps their authority through executive action. Defenders say it can be the only way to get something done when Congress is gridlocked.

President Barack Obama has used executive authority expansively, most notably on immigration.

Donald Trump says he'd make sure Obama's "unconstitutional actions" never come back. But some Republicans worry Trump, too, might pursue an "imperial presidency." Hillary Clinton supported Obama's unilateral move to curb deportation of millions of immigrants in the U.S. country illegally. The Supreme Court deadlocked in June over the major portion of the immigration executive actions, effectively killing the plan for the rest of Obama's presidency.

MINIMUM WAGE

Modest income gains, strikes by fast-food workers, the rapid growth of low-paying jobs while middle-income work shrinks. These factors have combined to make the minimum wage a top economic issue for the 2016 campaign.

Millions would benefit from higher pay, of course. But an increase in the minimum wage would also boost costs for employers and may slow hiring.

Hillary Clinton supports raising the minimum wage at least to $12 an hour, even higher at state and local levels. Donald Trump has said he supports an increase to $10, but thinks states should "really call the shots." It's $7.25 now.

Why the momentum for higher minimums? The typical household's income has fallen 2.4 percent since 1999. Low-paying industries, such as retail, fast food and home health care aides, are among the largest and fastest-growing. And many low-wage workers are older, have families and are probably more willing to demand higher pay.

WALL STREET REGULATION

The debate over rules governing banks and the markets comes down to this: how to prevent another economic catastrophe like the Great Recession ignited by the financial crisis in 2008. The worst upheaval since the 1930s Depression wiped out $11 trillion in U.S. household wealth and about 8 million jobs. More than 5 million families lost their homes to foreclosure.

The economic recovery over eight years has been halting and slow.

The goal behind the most radical overhaul of financial rules since the 1930s was to rein in high-risk practices on Wall Street and prevent another multibillion-dollar taxpayer bailout of banks. In the package of rules Congress enacted in 2010, regulators gained new tools to shut banks without resorting to bailouts. Risky lending was restricted and a new federal agency was charged with protecting consumers from deceptive marketing of financial products.

Republicans and many in the business community say the restrictions have raised costs for banks, especially smaller ones. They want the overhaul law repealed. Donald Trump calls it a "disaster," saying he would dismantle most of it.

Hillary Clinton says the financial rules should be preserved and strengthened.

INFRASTRUCTURE

The nation's infrastructure is in need of repair and improvement. On that, politicians generally agree. Harder to answer: How to pay for it and which projects should take priority?

A reliable infrastructure system is important for the nation's economy, safety and quality of life.

Public health can be put at risk by poor infrastructure, such as the lead-tainted pipes that contaminated the water supply of Flint, Michigan.

Poorly maintained highways and congested traffic also can raise the cost of shipping goods and the price consumers pay.

A recent report by the American Society of Civil Engineers projects the U.S. will face a $1.4 trillion funding gap for its infrastructure by 2025.

Democrat Hillary Clinton wants to spend $250 billion over the next five years on public infrastructure and direct an additional $25 billion to a new infrastructure bank to help finance local projects. Republican Donald Trump has said he wants to spend at least double that amount on infrastructure, financed with bonds. Whoever becomes president, it's a staggering amount of money for the federal treasury to put out -- if Congress goes along.

IRAN

Last year's nuclear deal with Tehran has significantly reduced for now the threat of a U.S.-Iranian military confrontation. But the deal rests on shaky ground.

The accord curtailed Iran's nuclear program, pulling it back from atomic weapons capability in exchange for the end of many economic sanctions.

But the next president could have his or her hands full, dealing with Iran in general and the agreement in particular. Various restrictions on Iran start ending in about seven years.

For Hillary Clinton and Donald Trump, it's basically a question of continuity versus change.

As secretary of state, Clinton helped lay the groundwork for the pact. She supports it, while taking a generally tougher tone on Iran than President Barack Obama.

Trump hates the deal. But he contends that he can renegotiate its terms.

Both are prepared to use force to prevent Tehran from acquiring the bomb. If the deal collapses or expires without sufficient safeguards, that possibility is back in play.

REFUGEES

With millions of Syrians displaced by a years-long war and hundreds of thousands of people fleeing to Europe, countries around the world are being pressed to help resettle people seeking refuge.

The United States pledged to accept 10,000 such refugees by the end of the budget year in September and did so, a month early.

Republicans have balked at the idea of allowing people from Syria into the United States and Donald Trump has called for a halt on refugee resettlement for them. He says vetting of these refugees is inadequate.

Hillary Clinton has pledged to expand the Syrian refugee program and allow as many as 65,000 such refugees into the United States.

The fate of the program almost certainly hinges on the outcome of the November election.

CHILD CARE/PAY EQUITY

In much of the U.S., families spend more on child care for two kids than on housing. And if you're a woman, it's likely you earn less than your male colleagues. That's according to the latest research, which suggests that while the U.S. economy has improved, women and their families are still struggling to make the numbers work.

Women comprise about 57 percent of the labor force and many of them have young children. If they aren't getting paid enough to make ends meet, more families will seek out government aid programs or low-quality, unlicensed daycares for their children.

Clinton wants a 12-week government-paid family and medical leave program, guaranteeing workers two-thirds of their wages up to a certain amount. Trump proposes six weeks of leave for new mothers, with the government paying wages equivalent to unemployment benefits.

Both candidates propose tax relief for child care costs. Trump's plan provides for a new income tax deduction for child care expenses, other tax benefits and a new rebate or tax credit for low-income families. Clinton says no family should spend more than 10 percent of its income on child care. She would double the child tax credit for families with children 4 and younger, to $2,000 per child.

EDUCATION

Education is a core issue not just for students and families, but for communities, the economy, and the nation as a global competitor.

The country has some 50 million K-12 students. Teaching them, preparing them for college and careers, costs taxpayers more than $580 billion a year, or about $11,670 per pupil per year. A better education usually translates into higher earnings.

And while high school graduations are up sharply and dropout rates down, the nation has a ways to go to match the educational outcomes elsewhere. American schoolchildren trail their counterparts in Japan, Korea, Germany, France and more.

For students seeking higher education, they face rising college costs and many are saddled with debt.

Hillary Clinton has proposed free tuition at in-state public colleges and universities for working families with incomes up to $125,000 -- free for families, that is, not for taxpayers. Donald Trump has focused on school choice, recently proposing to spend $20 billion in his first year in office to expand programs that let low-income families send their children to the local public, private, charter or magnet school that they think is best.

STUDENT DEBT

More Americans are getting buried by student debt -- causing delays in home ownership, limiting how much people can save and leaving taxpayers at risk as many loans go unpaid.

Student debt now totals around $1.26 trillion. This amounts to a stunning 350 percent increase since 2005, according to the New York Federal Reserve.

More than 60 percent of the class of 2014 graduated with debt that averaged nearly $27,000, according to the College Board. Not all that taxpayer-backed debt is getting repaid. Out of the 43 million Americans with student debt, roughly 16 percent are in long-term default -- a potential hit in excess of $100 billion that taxpayers would absorb.

Democrat Hillary Clinton proposes no tuition for students from families making less than $85,000 who go to an in-state, public college. Republican Donald Trump promises to cap payments at 12.5 percent of a borrower's income, with loan forgiveness if they make payments for 15 years.

Campaign 2016 Why It Matters RussiaFILE - In this Dec. 10, 2009, file photo, people walk in Red Square, with St. Basil Cathedral, left, the Kremlin's Spassky Tower, right back, and Lenin Mausoleum, right, in Moscow, Russia. Russia cannot be ignored. Since the end of the Cold War, Russia has never posed such a vexing problem to U.S. policymakers as it does now. From Eastern Europe to the Middle East and increasingly Asia and the Americas, Russia is making its voice heard and its presence felt.  
IMMIGRATION

The future of millions of people living in the U.S. illegally could well be shaped by the presidential election. The stakes are high, too, for those who employ them, help them fit into neighborhoods, or want them gone.

Republican Donald Trump at first pledged to deport the estimated 11 million immigrants in the country illegally. Not only that, he'd build a wall all along the Mexican border. But his position has evolved. He's sticking to his vow to build the wall and make Mexico pay. But he's no longer proposing to deport people who have not committed crimes beyond their immigration offences. Still, he's not proposing a way for people living in the country illegally to gain legal status.

Democrat Hillary Clinton, in contrast, would overhaul immigration laws to include a path to citizenship, not just legal status.

Illegal immigration has been at nearly 40-year lows for several years. It even appears that Mexican migration trends have reversed, with more Mexicans leaving the U.S. than arriving. Billions of dollars have been spent in recent years to build fencing, improve border technology and expand the Border Patrol.

Nonetheless the Mexican border remains a focal point for those who argue that the country is not secure.

CLIMATE CHANGE

It's as if Donald Trump and Hillary Clinton live on two entirely different Earths: one warming, one not. Clinton says climate change threatens us all, while Trump repeatedly tweets that global warming is a hoax.

Measurements and scientists say Clinton's Earth is much closer to the warming reality. And it is worsening.

The world is on pace for the hottest year on record, breaking marks set in 2015, 2014, and 2010. It is about 1.8 degrees warmer than a century ago.

But it's more than temperatures. Scientists have connected man-made climate change to deadly heat waves, droughts and flood-inducing downpours.

Studies say climate change is raising sea levels, melting ice and killing coral. It's making people sicker with asthma and allergies and may eventually shrink our bank accounts.

The American Association for the Advancement of Sciences says warming can be highly damaging to people and the planet and potentially irreversible.

ROLE OF GOVERNMENT

It's the Goldilocks conundrum of American politics: Is the government too big, too small or just right? Every four years, the presidential election offers a referendum on whether Washington should do more or less.

Donald Trump favors cutting regulation and has promised massive tax cuts, but his plans are expected to add trillions to the national debt. Unlike most conservatives, he supports eminent domain and has spoken positively about government-run health care. And don't forget that massive border wall. Hillary Clinton has vowed new spending on education and infrastructure that could grow government, too. She strongly supports "Obamacare," which most small government proponents see as overreach.

At its heart, the debate about government's reach pits the desire to know your basic needs will be cared for against the desire to be left alone. For the last few decades, polls have found Americans generally feel frustrated by the federal government and think it's wasteful. A smaller government sounds good to a lot of people until they're asked what specific services or benefits they are willing to do without.

DEBT

The federal government is borrowing about one out of seven dollars it spends and steadily piling up debt. Over the long term, that threatens the economy and people's pocketbooks.

Most economists say rising debt risks crowding out investment and forcing interest rates up, among other problems. At the same time, rapidly growing spending on federal health care programs like Medicare and the drain on Social Security balances caused by the rising tide of baby boomers could squeeze out other spending, on roads, education, the armed forces and more.

It takes spending cuts, tax increases or both to dent the deficit. Lawmakers instead prefer higher spending and tax cuts.

Neither Hillary Clinton nor Donald Trump has focused on the debt.

Trump has promised massive tax cuts that would drive up the debt and he's shown little interest in curbing expensive benefit programs like Medicare.

Clinton, by contrast, is proposing tax increases on the wealthy. But she wouldn't use the money to bring down the debt. Instead, she'd turn around and spend it on college tuition subsidies, infrastructure and health care.

TRADE

In this angry election year, many American voters are skeptical about free trade -- or hostile to it.

The backlash threatens a pillar of U.S. policy: The United States has long sought global trade.

Economists say imports cut prices for consumers and make the U.S. more efficient.

But unease has simmered, especially as American workers faced competition from low-wage Chinese labor. Last year, the U.S. ran a $334 billion trade deficit with China -- $500 billion with the entire world.

The Democratic and Republican presidential candidates are both playing to public suspicions about trade deals. Hillary Clinton broke with President Barrack Obama by opposing an Asia-Pacific trade agreement that she had supported as secretary of state.

Donald Trump vows to tear up existing trade deals and to slap huge tariffs on Chinese imports.

But trade deals have far less impact on jobs than forces such as automation and wage differences between countries. Trump's plans to impose tariffs could start a trade war and raise prices.

SUPREME COURT

The ideological direction of the Supreme Court is going to tip one way or the other after the election. The outcome could sway decisions on issues that profoundly affect everyday Americans: immigration, gun control, climate change and more.

The court has been operating with eight justices since Antonin Scalia died in February. His successor appears unlikely to be confirmed until after the election, at the earliest. The court is split between four Democratic-appointed, liberal justices and four conservatives who were appointed by Republicans -- although Justice Anthony Kennedy has sided with the liberals on abortion, same-sex marriage and affirmative action in the past two years.

The ninth justice will push the court left or right, depending on whether Democrat Hillary Clinton or Republican Donald Trump becomes president. President Barack Obama has nominated Merrick Garland to take Scalia's seat, but the Republican Senate has refused to consider Garland's nomination, in an effort to prevent a liberal court majority.

CHINA

Tensions have been rising over China's assertive behavior in the seas of Asia. The U.S. also accuses China of unfair trading practices and cyber theft of business secrets.

Donald Trump says that the sheer volume of trade gives the U.S. leverage over China. He accuses China of undervaluing its currency to make its exports artificially cheap and proposes tariffs as high as 45 percent on Chinese imports if Beijing doesn't change its behavior. Such action could risk a trade war that would make many products in the U.S. more expensive.

Clinton says the U.S. needs to press the rising Asian power to play by international rules, whether on trade or territorial disputes.

While many of China's neighbors are unnerved by its military build-up, the wider world needs the U.S. and China to get along, to tackle global problems. The U.S. and China are also economically inter-dependent, and punishment by one party could end up hurting the other.

INCOME INEQUALITY

Income inequality has surged near levels last seen before the Great Depression. The average income for the top 1 percent of households climbed 7.7 percent last year to $1.36 million, according to tax data. That privileged sliver of the population saw pay climb at almost twice the rate of income growth for the other 99 percent, whose pay averaged a humble $48,768.

Dogged on the issue during the primaries by Bernie Sanders, Hillary Clinton has highlighted inequality in multiple speeches. She hopes to redirect more money to the middle class and impoverished. Clinton would raise taxes on the wealthy, increase the federal minimum wage, boost infrastructure spending, provide universal pre-K and offer the prospect of tuition-free college.

Donald Trump offers a blunter message about a system "rigged" against average Americans. To bring back jobs, Trump has promised new trade deals with better terms, greater infrastructure spending than Clinton foresees and tax cuts that he says would propel stronger growth (though independent analysts say his budget plans would raise deficits).

OPIOID EPIDEMIC

More than 28,000 Americans died from overdosing on opioids in 2014, a record high for the nation.

That's 78 people per day, a number that doesn't include the millions of family members, first responders and even taxpayers who feel the ripple of drug addiction in their daily lives.

A rise in prescription painkillers is partially to blame: The sale of these drugs has quadrupled since 1999, and so has the number of Americans dying from an addiction to them. When prescriptions run out, people find themselves turning to the cheaper alternative heroin and, increasingly, the even more deadly drug fentanyl.

Recovering addicts and their family members are increasingly speaking out, putting a face on drug addiction and lessening the stigma surrounding it. But dollars for prevention, treatment and recovery services are still hard to come by, leaving many people waiting weeks or months to find the treatment they're seeking. Meantime, family members empty bank accounts in search of help, while law enforcement officers and emergency rooms serve as a first line of defense.

Donald Trump says the wall he wants to build along the southern border is essential to stopping the flow of illegal drugs into the country. Hillary Clinton, meanwhile, pledges to spend $10 billion to increase access to prevention, treatment and recovery services, among other things.

NORTH KOREA

Pariah state North Korea could soon be capable of targeting America with nuclear weapons. What can the U.S. do to stop it?

Diplomacy and economic sanctions have not worked so far. North Korea's isolation is deepening, but it has continued to conduct nuclear test explosions and make advances in its missile technology.

Republican presidential candidate Donald Trump says the U.S. can put more pressure on China to rein in its North Korean ally. He says he is willing to meet the North Korean leader, Kim Jong Un.

Democrat Hillary Clinton wants the world to intensify sanctions as the Obama administration did with Iran, a course that eventually opened the way for a deal to contain its nuclear program.

But it will be tough to force North Korea back to negotiations that aim at its disarmament in exchange for aid. Kim views atomic weapons as a security guarantee for his oppressive regime

HEALTH CARE

About 9 in 10 Americans now have health insurance, more than at any time in history. But progress is incomplete, and the future far from certain. Rising costs could bedevil the next occupant of the White House.

Millions of people previously shut out have been covered by President Barack Obama's health care law. No one can be denied coverage anymore because of a pre-existing condition. But "Obamacare" remains divisive, and premiums for next year are rising sharply in many communities.

Whether Americans would be better off trading for a GOP plan is another question. A recent study found that Donald Trump's proposal would make 18 million people uninsured. GOP congressional leaders have a more comprehensive approach, but key details are still missing.

Overall health care spending is trending higher again, and prices for prescription drugs -- new and old -- are a major worry.

Medicare's insolvency date has moved up by two years -- to 2028.

Hillary Clinton would stay the course, adjusting as needed. Republicans are united on repealing Obama's law, but it's unclear how they would replace it.

AMERICA AND THE WORLD

How the U.S. uses its influence as the world's sole superpower is a central feature of presidential power.

It can mean taking the country to war -- to protect the homeland or to defend an ally. Or it can mean using diplomacy to prevent war. It can affect U.S. jobs, too, as choices arise either to expand trade deals or to erect barriers to protect U.S. markets.

In the contest between Hillary Clinton and Donald Trump, America's role in the world is a point of sharp differences. Each says the U.S. must be the predominant power, but they would exercise leadership differently. Trump calls his approach "America first," meaning alliances and coalitions would not pass muster unless they produced a net benefit to the U.S. Clinton sees international partnerships as essential tools for using U.S. influence and lessening the chances of war.

These divergent views could mean very different approaches to the military fight and ideological struggle against the Islamic State, the future of Afghanistan and Iraq, the contest with China for influence in Asia and the Pacific, and growing nervousness in Europe over Russian aggression.

VOTING RIGHTS

Voting rights in America are in flux. Republican-controlled legislatures are tightening voter laws, placing limits on early voting and same-day registration, and imposing new requirements for IDs at polling places. In 2013, the Supreme Court invalidated a key provision of the 1965 Voting Rights Act. That provision had required states with a history of racial discrimination to get federal preclearance to change election laws.

The issue has become highly partisan with the rapid growth of minority populations, which in recent presidential elections have tilted heavily Democratic.

The Obama Justice Department has challenged voter ID and other laws, saying they could restrict access for minorities and young people. Federal court rulings softened some of the toughest restrictions, but litigation remains knotted up with Supreme Court appeals underway. Bills in Congress to restore the Voting Rights Act are stalled.

Donald Trump opposes same-day voter registration, backing laws to ensure only citizens vote. Hillary Clinton wants Congress to restore the Voting Rights Act and seeks a national standard of at least 20 days of early in-person voting.

Donald Trump unleashes on Hillary Clinton, calls for pre-debate drug test at New Hampshire rally

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Calling Hillary Clinton "the most corrupt person to ever seek the office of the presidency," Republican presidential nominee Donald Trump took aim at his Democratic rival's record and stamina during a New Hampshire rally on Saturday.

PORTSMOUTH, N.H. -- Calling Hillary Clinton "the most corrupt person to ever seek the office of the presidency," Republican nominee Donald Trump took aim at his Democratic rival's record and stamina during a New Hampshire rally on Saturday.

Trump, speaking to supporters who gathered at a Portsmouth Toyota dealership, blasted the former secretary of state's use of a private email server and accused her of colluding with federal agencies to avoid charges.

The GOP nominee further questioned his rival's decision to take time off the campaign trail for "debate prep," calling for Clinton to take a drug test before Wednesday's final head-to-head forum.

Taking aim at the email controversy that has plagued his Democratic rival's campaign, Trump argued that allegedly hacked Clinton campaign emails published by WikiLeaks suggest she colluded with the U.S. State and Justice Departments to avoid federal charges in an investigation into her private server.

Contending that Clinton "should be in jail," Trump further argued that his opponent sought to "cover up her crimes" by deleting 33,000 emails from her server after receiving a congressional subpoena.

"She acid washed them, lied to Congress under oath, made 13 iPhones disappear -- some with a hammer -- and now, last week we learned that two boxes of emails and evidence are mysteriously missing," he said, drawing chants of "lock her up" from supporters. "Hillary Clinton should've been prosecuted and should right now be in jail."

Trump also called for Clinton to submit to a drug test ahead of the next presidential debate, telling supporters that he believes she is "getting pumped up."

The top 10 moments from Donald Trump and Hillary Clinton's matchup at Washington University

"I think she's getting pumped up, you understand...we're like athletes. More and more we make them take a drug test, I think we should take a drug test prior to the debate," he said. "Why don't we do that?...Because I don't know what's going on with her. But, in the beginning of the last debate she was all pumped up...and at the end it was, 'take me down.' She could barely reach her car."

The businessman added that he's "willing to" take a drug test.

The Republican nominee, referencing recent allegations he has faced for sexual assault, further accused "the corrupt media" of rigging the 2016 presidential election against him.

"The election is being rigged by corrupt media, pushing completely false allegations and outright lies in an effort to elect her president and you know what I mean," he said. "In fact, the cousin of one of these people -- the cousin said it was a lie...We can't let them get away with this folks. It's total lies that you've been seeing, but we're going to stop it."

Trump further took direct aim at allegations he sexually assaulted a woman on a plane decades ago.

"How about this crazy person on the airplane, can anyone believe this?...It's a crazy world we're living it," he told supporters. "It's a rigged election, we're talking unsubstantiated claims, no witnesses, put on the front pages of newspapers."

Trump's visit came just days after First Lady Michelle Obama took aim at the businessman's comments on women during a Clinton campaign event at Southern New Hampshire University in Manchester.

Borrowing a line from Obama's speech, the businessman stressed that "enough is enough."

New Hampshire Democrats protest Donald Trump's comments on women, his supporters take aim at Hillary Clinton

The GOP nominee, in addition to taking swipes at his opponent, touted his plans to address the opioid epidemic, help veterans and defend the country's southern border with Mexico.

Polls give Clinton a nearly 4-point edge over Trump in the important battleground state, according to RealClearPolitics' averages -- down from the 6-point lead she enjoyed earlier this week.

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