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AP
Longest shutdown over: Trump signs bill to reopen government

WASHINGTON — Submitting to mounting pressure amid growing disruption, President Donald Trump signed a bill Friday to reopen the government for three weeks, backing down from his demand that Congress give him money for his border wall before federal agencies get back to work.

Standing alone in the Rose Garden, Trump said he would sign legislation funding shuttered agencies until Feb. 15 and try again to persuade lawmakers to finance his long-sought wall. The deal he reached with congressional leaders contains no new money for the wall but ends the longest shutdown in U.S. history.

First the Senate, then the House swiftly and unanimously approved the deal. Late Friday, Trump signed it into law. The administration asked federal department heads to reopen offices in a "prompt and orderly manner" and said furloughed employees can return to work.

Trump's retreat came in the 35th day of the partial shutdown as intensifying delays at the nation's airports and another missed payday for hundreds of thousands of federal workers brought new urgency to efforts to resolve the standoff.

"This was in no way a concession," Trump said in a tweet late Friday, fending off critics who wanted him to keep fighting. "It was taking care of millions of people who were getting badly hurt by the Shutdown with the understanding that in 21 days, if no deal is done, it's off to the races!"

The shutdown ended as Democratic leaders had insisted it must — reopen the government first, then talk border security.

"The president thought he could crack Democrats, and he didn't, and I hope it's a lesson for him," said the Senate Democratic leader, Chuck Schumer. House Speaker Nancy Pelosi said of her members: "Our unity is our power. And that is what maybe the president underestimated."

Trump still made the case for a border wall and maintained he might again shut down the government over it. Yet, as negotiations restart, Trump enters them from a weakened position. A strong majority of Americans blamed him for the standoff and rejected his arguments for a border wall, recent polls show.

"If we don't get a fair deal from Congress, the government will either shut down on Feb. 15, again, or I will use the powers afforded to me under the laws and Constitution of the United States to address this emergency," Trump said.

The president has said he could declare a national emergency to fund the border wall unilaterally if Congress doesn't provide the money. Such a move would almost certainly face legal hurdles.

As part of the deal with congressional leaders, a bipartisan committee of House and Senate lawmakers was being formed to consider border spending as part of the legislative process in the weeks ahead.

"They are willing to put partisanship aside, I think, and put the security of the American people first," Trump said. He asserted that a "barrier or walls will be an important part of the solution."

The deal includes back pay for some 800,000 federal workers who have gone without paychecks. The Trump administration promises to pay them as soon as possible.

Also expected is a new date for the president to deliver his State of the Union address, postponed during the shutdown. But it will not be Jan. 29 as once planned, according to a person familiar with the planning but unauthorized to discuss it.

As border talks resume, Senate Majority Leader Mitch McConnell said he hopes there will be "good-faith negotiations over the next three weeks to try to resolve our differences."

Schumer said that while Democrats oppose the wall money, they agree on other ways to secure the border "and that bodes well for coming to an eventual agreement."

In striking the accord, Trump risks backlash from conservatives who pushed him to keep fighting for the wall. Some lashed out Friday for his having yielded, for now, on his signature campaign promise.

Conservative commentator Ann Coulter suggested on Twitter that she views Trump as "the biggest wimp" to serve as president.

Money for the wall is not at all guaranteed, as Democrats have held united against building a structure as Trump once envisioned, preferring other types of border technology. Asked about Trump's wall, Pelosi, who has said repeatedly she won't approve money for it, said: "Have I not been clear? No, I have been very clear."

The breakthrough came as LaGuardia Airport in New York and Newark Liberty International Airport in New Jersey both experienced at least 90-minute delays in takeoffs Friday because of the shutdown. And the world's busiest airport — Hartsfield-Jackson Atlanta International Airport — was experiencing long security wait times, a warning sign the week before it expects 150,000 out-of-town visitors for the Super Bowl.

The standoff became so severe that, as the Senate opened with prayer, Chaplain Barry Black called on high powers in the "hour of national turmoil" to help senators do "what is right."


Carbondale
alertfeatured
JACKSON COUNTY
New surgical robot allows Carbondale hospital to offer more complex surgeries

CARBONDALE — Robotic surgery is not new to SIH Memorial Hospital of Carbondale, but a new addition to its robotic surgery equipment is.

On Friday, Southern Illinois Healthcare announced use of a new Da Vinci Xi Robotic Surgery system during an open house and unveiling of the group’s new logo.

“All the procedures that can be done laparoscopically can be done with this equipment,” said Dr. Adrian Martin, a surgeon with SIH Medical Group.

Robotic surgery at the hospital was pioneered by Dr. Franics Tsung and other obstetrics and gynecology physicians in 1995. They continued to upgrade their robotic systems in 2011 with the addition of a Da Vinci robotic surgery system, and some of the newest Da Vinci technology with the XI.

When new operating rooms were opened in June 2016, Dr. Suven Shankar, surgical oncologist and chairman of surgery at Memorial, said the new rooms would allow physicians to treat more patients and more complex cases. That is exactly what has happened.

The new robotic equipment is one more step toward offering more complex procedures in the heart of Southern Illinois.

The equipment is impressive. It contains four arms as opposed to three in older-generation robotic surgery equipment. Arnold explained that one arm holds the endoscope or camera, two arms hold surgical equipment. The fourth arm moves diagonally. It is used to hold tissue in a better location for the procedure, something a person’s hand might do during an open surgery.

“It allows you to assist yourself,” Arnold said.

It is important to note that the equipment does not operate by itself. A surgeon still has to operate the robotic equipment. 

The equipment has a console where the surgeon sits and another larger console with a larger screen that contains the robotic arms and other equipment.

The new Da Vinci also is easier to place in the exact position for surgery. It has a cross-hatch computerized system that assists in positioning. The surgeon’s console also adjusts for better surgical ergonomics, allowing the surgeon to operate without hurting himself.

On Jan. 18, Dr. Don Arnold II, an advanced endourologic robotic surgeon, performed a radical nephrectomy.

Arnold explained that the equipment allows a surgeon to perform procedure that would have been done in open surgery before. It also allows them to treat some patients who would not be good candidates for surgery due to other medical conditions such as diabetes or lung or heart disease.

“It helps speed up surgery,” Arnold said.

For patients, robotics surgery offers several benefits. The patient has several small incisions rather than a large incision. They are at less risk for infection and other complications. They spend less time in the hospital.

“The patient goes home in 24 to 48 hours. Open surgery requires 10 to 14 days in the hospital,” Arnold said. “The incision is the size of a keyhole.”

Dr. Shankar is performing esophagectomy (removal of all or part of the esophagus) using the surgical robot. This robotically-assisted procedure not offered anywhere in Southern Illinois, the metropolitan St. Louis area, Paducah or Cape Girardeau, according to the company that manufactures the equipment.

Dr. Arnold is able to discharge patients with pain medication that is less addictive, such as tramadol. 

How do physicians train to use the robotic equipment?

Arnold, Shankar and Martin said robotic surgery takes a little while to learn. SIH currently has 14 surgeons performing robotic procedures. Some, like Arnold, were fellowship trained.

“A dear friend of mine who was a doctor suggested I do a urology rotation, and I fell in love with it,” Arnold said.

He was introduced to robotic surgery during that rotation at University of Illinois College of Medicine in Chicago. He continued his education with a fellowship at Loma Linda University College of Medicine.

He started by becoming proficient in open surgery.

Dr. Martin demonstrated the robotic surgery simulator during a press tour and demonstration Jan. 18.

He said the first thing you must demonstrate on the simulator is that you know anatomy. The simulator screen, very similar to video games, asks the operator to touch a certain anatomy, such as the bladder or ureter. The operator uses the robotic controller to “touch” the bladder. It turns green for correct responses.

The simulator also has games to improve the accuracy in controlling movement of the robotic arms. Journalists on the press tour used the simulator to place rings on spikes. It has a bit of a learning curve both in moving and holding objects with the robotic arms.

It also offers guided surgeries, telling the operator what to do, and free simulations where the operator chooses what to do.

Martin explained by the time a surgeon is practicing on the simulator, he or she is proficient in both open and laparoscopic surgery.

There is a downside for the surgeon. In robotic surgery, you do not feel the resistance from the tissues in the body.

“It makes some of what we do, like sutures, very, very difficult,” Martin said.


Carbondale
alerttop story
Southern Illinois Healthcare unveils new logo during open house in Carbondale

CARBONDALE — Southern Illinois Healthcare administrators unveiled the organizaton's new logo and talked about its newest robotic surgical system during an open house Friday at SIH Memorial Hospital of Carbondale.

Rex Budde, president and CEO of SIH, said the new logo replaces the cross logo the healthcare organization began using in 1995.

“We don’t care for people for any other reason than they need care. The new logo is consistent with our mission,” Budde said.

Budde thanked the medical staff for their commitment to patient care and expanding the quality of care, as well as current and former employees, senior leadership team and the community.

He introduced Bart Millstadt, SIH senior vice president and chief operating officer, to talk about some exciting additions to the surgical department at SIH Memorial Hospital of Carbondale.

He told the crowd that 10 days ago in operating room 10, the hospital began using a “new, top of the line Da Vinci XI” Robotic Surgery System. To date, 1,900 robotic procedures have been performed at Memorial.

The Da Vinci program began in 2011. Millstadt called the OB-GYN (obstetrics and gynecology) doctors super users of the technology.

Dr. Francis Tsung, SI Ob-Gyn and Associates in Herrin and Carbondale, is one of those “super-users.” He spoke about the history of robotic surgery at the hospital.

A precursor to robotic surgery was introduced at the hospital in 1995, when the first minimally invasive procedure was performed. At that time, 80 to 90 percent of hysterectomies required traditional open surgeries with large incisions. That type of surgery comes with a higher incidence of infection, greater blood loss and requires six weeks off work.

By 2006, 98 percent of hysterectomies done at the hospital were done laparoscopically. Patients had fewer infections, less blood loss and shorter recuperation.

Addition of the first Da Vinci system in 2011 allowed for more complex procedures like those to treat pelvic organ prolapse, as well as better outcomes for patients with more complex medical issues or multiple diseases.

“The Da Vinci has enabled our patients to go home in one or two days or two and return to work in one to two weeks without many complications,” Tsung said.

His colleague, Dr. Amanda Mulch, SI Ob-Gyn and Associates and chair of the robotics committee at Memorial, is excited to have the opportunity to offer robotic surgery to patients in Carbondale.

“Robotics is a highly advanced surgical procedure that takes a highly advanced team, and is only as good as the team,” Mulch said.

She is proud of the number of procedures their team has performed and the amount of training they undergo to prepare for those procedures.

Dr. Suven Shankar, SIH surgical oncologist and chief of surgery at SIH Memorial Hospital of Carbondale, is performing one of the more complex surgeries offered at the hospital, an esophagectomy. He spoke about advanced procedures using the new Da Vinci XI.

The equipment allows another physician to assist with surgery and enables the physician to assist himself with the robotic fourth arm. It also makes multi-quadrant abdominal surgeries possible and has advanced optics.

“It allows more complex procedures to be performed in Southern Illinois. Patients don’t have to leave home,” Shankar said.

He also invited guests to the second floor for refreshments and to try the robotic surgery simulator.

Budde said the new logo rollout began in Carbondale and will continue throughout the system at other locations. Patients will see changes coming.

“I am extremely happy and excited because we have a logo that really speaks to our mission,” Budde said.


Crime-and-courts
breaking
PERRY COUNTY
Lots of leads, little evidence: Investigators at a standstill in Stroud missing person case

PINCKNEYVILLE — In the week since Billy Stroud Jr. was reported missing, there have been more questions than answers and law enforcement says the one person who could clear things up won’t talk.

Stroud was reported missing Jan. 17 to the Du Quoin Police Department, though he hadn’t been seen since Jan. 13.

A release from the Missing Person’s Awareness Network said Stroud was last seen leaving his girlfriend’s house with a person familiar to him and that his car had later been found off of a rural road in Perry County. The friend who had reportedly been driving the car is not missing.

A news release from Perry County Sheriff Steve Bareis’ office said that investigators determined that Stroud "may have been" a passenger in a car that led deputies on a chase on Sunday, Jan. 13, into the Campbell Pond area off of Campbell Road.

Bareis later said that his deputies tried to pull over a vehicle that had a “junked” title, which meant the vehicle was not road-safe. He said the driver of the car took officers through a series of back roads that ultimately reached a dead end. Then, he said, the two men got out and fled on foot.

It was believed that Stanley Rector was the driver of the vehicle — but even this is in question now, Bareis said Friday.

“He still won’t even admit that he was the driver,” Bareis said.

According to Judici, Rector was arrested and charged with auto theft in Jackson County. Bareis said Jackson County investigators have done their best to get Rector to talk about what he might know of Stroud’s whereabouts, but he won’t budge. In fact, Bareis said Rector reported the vehicle Perry County deputies tried to stop as stolen, putting even more distance between him and the last known whereabouts of Stroud.

In the absence of hard facts, conjecture has filled the void. Facebook is alive with rumors of all types. Some have accused Rector not only of being the last person to have seen Stroud, but also of perhaps having actually killed him.

Still others finger Stroud’s girlfriend as having a hand in the disappearance. Her public Facebook page has been filled with posts asking for information and begging Stroud to come home.

“We’re just dealing with a lot of hearsay,” Bareis said Friday, adding that all of it's interesting, but without concrete evidence, none of it is terribly useful.

Bareis said he took time this week to go back over the dashcam footage of the attempted stop where officers believed to have seen Stroud flee a vehicle on foot. But by the time the camera catches up the vehicle, the doors are open and the men are gone. Bareis explained that the responding officer said based on a description of Stroud, he believes he was one of the men he saw, though he can’t be certain.

“The only person that knows 100 percent is Rector,” Bareis said, and he’s not talking.

“It unnerves me … that a person could be so depraved,” Baries said. He doesn’t know how someone could likely know something that could help a lost friend and say nothing.

Bareis said until someone comes forward or hard evidence is found, his investigators remain at a stand still. Even a further ground search wouldn’t be useful. He said the area where it’s believed Stroud was last seen is sitting under several feet of flood water. The drone search didn’t turn anything up and dogs had to be called off for safety reasons — the water too deep and the temperatures too cold.

So they wait.

“It just kind of eats at you,” Bareis said. “It’s sad that we can’t get closure for the family.”