Mayo Clinic: Less-invasive option as effective as esophagus removal in early esophageal cancer

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7-Nov-2013

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Contact: Kevin Punsky
punsky.kevin@mayo.edu
904-953-2299
Mayo Clinic

JACKSONVILLE, Fla. Use of a minimally invasive endoscopic procedure to remove superficial, early stage esophageal cancer is as effective as surgery that takes out and rebuilds the esophagus, according to a study by researchers at Mayo Clinic in Florida. The research, published in Clinical Gastroenterology and Hepatology, examined national outcomes from endoscopic treatment compared to esophagectomy, surgical removal of the esophagus.

It found that endoscopic therapy offered long-term survival rates similar to those for esophagectomy, says lead author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic in Florida.

"Endoscopic resection in the esophagus is similar to how we remove polyps in the colon, although it is much more technically complex. Esophagectomy is a major surgical procedure that cuts out the entire esophagus, and pulls the stomach into the neck to create a new food tube," Dr. Wallace says.

"Our study on national outcomes, as well as our own experience with the procedure at Mayo Clinic in Florida, suggests that both offer the similar changes for cure and long-term survival," he says. "Patients now have the option to preserve their esophagus when only early stage cancer is present."

The research looked at national outcomes from the two procedures in patients with esophageal adenocarcinoma, the most common type of esophageal cancer in the United States. The research team examined data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database.

They identified 1,619 patients with superficial, early stage esophageal adenocarcinoma who had endoscopic therapy (19 percent) or surgery (81 percent) from 1998 through 2009. Many of these patients were treated for cancers that arose from Barrett's esophagus, a condition in which the cells in the lower part of the esophagus morph into a precancerous state.

The researchers collected survival data through the end of 2009, and found that endoscopy therapy increased progressively from 3 percent in 1998 to 29 percent in 2009 and was more often used in older patients. After adjusting for patient and tumor factors, the researchers concluded that patients treated by endoscopy had similar overall survival times compared to surgery.

"Endoscopy therapy for early stage esophageal cancer is becoming an acceptable method for all patients with very early esophageal cancer," Dr. Wallace says. He adds that because of its complexity the procedure is generally offered at centers of endoscopic excellence, such as Mayo Clinic in Florida, that have extensive experience in a multidisciplinary approach to endoscopic therapy.

###

Co-authors included Mayo Clinic gastroenterologists Saowanee Ngamruengphong, M.D., and Herbert Wolfsen, M.D.

The study was funded by the Mayo Foundation for Medical Education and Research.

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit http://www.mayoclinic.com and http://www.mayoclinic.org/news.

Journalists can become a member of the Mayo Clinic News Network for the latest health, science and research news and access to video, audio, text and graphic elements that can be downloaded or embedded.

VIDEO ALERT: Video resources including an interview
with Dr. Wallace describing the study can be found on the Mayo Clinic News Network.

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PUBLIC RELEASE DATE:

7-Nov-2013

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Contact: Kevin Punsky
punsky.kevin@mayo.edu
904-953-2299
Mayo Clinic

JACKSONVILLE, Fla. Use of a minimally invasive endoscopic procedure to remove superficial, early stage esophageal cancer is as effective as surgery that takes out and rebuilds the esophagus, according to a study by researchers at Mayo Clinic in Florida. The research, published in Clinical Gastroenterology and Hepatology, examined national outcomes from endoscopic treatment compared to esophagectomy, surgical removal of the esophagus.

It found that endoscopic therapy offered long-term survival rates similar to those for esophagectomy, says lead author, Michael B. Wallace, M.D., a gastroenterologist at Mayo Clinic in Florida.

"Endoscopic resection in the esophagus is similar to how we remove polyps in the colon, although it is much more technically complex. Esophagectomy is a major surgical procedure that cuts out the entire esophagus, and pulls the stomach into the neck to create a new food tube," Dr. Wallace says.

"Our study on national outcomes, as well as our own experience with the procedure at Mayo Clinic in Florida, suggests that both offer the similar changes for cure and long-term survival," he says. "Patients now have the option to preserve their esophagus when only early stage cancer is present."

The research looked at national outcomes from the two procedures in patients with esophageal adenocarcinoma, the most common type of esophageal cancer in the United States. The research team examined data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database.

They identified 1,619 patients with superficial, early stage esophageal adenocarcinoma who had endoscopic therapy (19 percent) or surgery (81 percent) from 1998 through 2009. Many of these patients were treated for cancers that arose from Barrett's esophagus, a condition in which the cells in the lower part of the esophagus morph into a precancerous state.

The researchers collected survival data through the end of 2009, and found that endoscopy therapy increased progressively from 3 percent in 1998 to 29 percent in 2009 and was more often used in older patients. After adjusting for patient and tumor factors, the researchers concluded that patients treated by endoscopy had similar overall survival times compared to surgery.

"Endoscopy therapy for early stage esophageal cancer is becoming an acceptable method for all patients with very early esophageal cancer," Dr. Wallace says. He adds that because of its complexity the procedure is generally offered at centers of endoscopic excellence, such as Mayo Clinic in Florida, that have extensive experience in a multidisciplinary approach to endoscopic therapy.

###

Co-authors included Mayo Clinic gastroenterologists Saowanee Ngamruengphong, M.D., and Herbert Wolfsen, M.D.

The study was funded by the Mayo Foundation for Medical Education and Research.

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit http://www.mayoclinic.com and http://www.mayoclinic.org/news.

Journalists can become a member of the Mayo Clinic News Network for the latest health, science and research news and access to video, audio, text and graphic elements that can be downloaded or embedded.

VIDEO ALERT: Video resources including an interview
with Dr. Wallace describing the study can be found on the Mayo Clinic News Network.

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-11/mc-mcl110713.php
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Senate OKs gay rights bill banning discrimination

Sen. Tom Harkin, D-Iowa, chairman of the Health, Education, Labor, and Pensions Committee, talks to reporters after the Senate cleared a major hurdle and agreed to proceed to debate a bill that would prohibit workplace discrimination against gay, bisexual and transgender Americans, at the Capitol in Washington, Monday, Nov. 4, 2013. The bipartisan vote increases the chances that the Senate will pass the bill by week's end, but its prospects in the Republican-led House are dimmer. (AP Photo/J. Scott Applewhite)

Sen. Tom Harkin, D-Iowa, chairman of the Health, Education, Labor, and Pensions Committee, talks to reporters after the Senate cleared a major hurdle and agreed to proceed to debate a bill that would prohibit workplace discrimination against gay, bisexual and transgender Americans, at the Capitol in Washington, Monday, Nov. 4, 2013. The bipartisan vote increases the chances that the Senate will pass the bill by week's end, but its prospects in the Republican-led House are dimmer. (AP Photo/J. Scott Applewhite)

WASHINGTON (AP) — The Senate approved legislation outlawing workplace discrimination against gay, bisexual and transgender Americans, demonstrating the nation's quickly evolving attitude toward gay rights nearly two decades after Congress rejected same-sex marriage.

Fifty-four members of the Democratic majority and 10 Republicans voted Thursday for the first major gay rights bill since Congress repealed the ban on gays in the military three years ago. The vote in favor of the Employment Non-Discrimination Act was 64-32.

Two opponents of a similar measure 17 years ago, Arizona Republican Sen. John McCain, the presidential nominee in 2008, and Republican Sen. Orrin Hatch of Utah, backed the measure this time.

"We are about to make history in this chamber," Sen. Susan Collins, R-Maine and a chief sponsor of the bill, said shortly before the vote.

The enthusiasm of the bill's supporters was tempered by the reality that the Republican-led House, where conservatives have a firm grip on the agenda, is unlikely to even vote on the legislation. Speaker John Boehner, R-Ohio, maintains his longstanding opposition to the measure, arguing that it is unnecessary and certain to create costly, frivolous lawsuits for businesses.

Outside conservative groups have cast the bill as anti-family.

President Barack Obama welcomed the vote and urged the House to act.

"One party in one house of Congress should not stand in the way of millions of Americans who want to go to work each day and simply be judged by the job they do," Obama said in a statement. "Now is the time to end this kind of discrimination in the workplace, not enable it."

Gay rights advocates hailed Senate passage as a major victory in a momentous year for the issue. The Supreme Court in June granted federal benefits to legally married same-sex couples, though it avoided a sweeping ruling that would have paved the way for same-sex unions nationwide. Illinois is on the verge of becoming the 15th state to legalize gay marriage along with the District of Columbia.

Supporters called the bill the final step in a long congressional tradition of trying to stop discrimination, coming nearly 50 years after enactment of the Civil Rights Act and 23 years after the Americans with Disabilities Act.

"Now we've finished the trilogy," Sen. Tom Harkin, D-Iowa, a chief sponsor of the disabilities law, said at a Capitol Hill news conference.

The first openly gay senator, Democrat Tammy Baldwin of Wisconsin, called the vote a "tremendous milestone" that she will always remember throughout her time in the Senate.

Democrats echoed Obama in pushing for the House to act, with Sen. Dick Durbin of Illinois reminding the GOP leader of the history of his party.

"The Republican Party in the United States of America came into being in the 1980s over the issue of slavery, and the man who embodied the ideals of that Republican Party was none other than Abraham Lincoln, who gave his life for his country to end discrimination," Durbin said. "Keep that proud Republican tradition alive."

In the Senate, opponents of the legislation remained mute through three days of debate, with no lawmaker speaking out. That changed on Thursday, as Republican Sen. Dan Coats of Indiana said the legislation would force employers to violate their religious beliefs, a direct counter to rights embodied in the Constitution.

"There's two types of discrimination here we're dealing with, and one of those goes to the very fundamental right granted to every American through our Constitution, a cherished value of freedom of expression and religion," Coats said.

The Senate rejected an amendment sponsored by Republican Sen. Pat Toomey of Pennsylvania that would have expanded the number of groups that are covered under the religious exemption. Opponents argued that it would undermine the core bill.

If the House fails to act on the bill, gay rights advocates are likely to press Obama to act unilaterally and issue an executive order barring anti-gay workplace discrimination by federal contractors.

Backers of the bill repeatedly described it as an issue of fairness.

"It is well past time that we, as elected representatives, ensure that our laws protect against discrimination in the workplace for all individuals, that we ensure ... some protections for those within the LGBT community," said Sen. Lisa Murkowski, R-Alaska, who described the diversity in her state.

Murkowski's support underscored the generational shift. Seventeen years ago, when a bill dealing with discrimination based on sexual orientation failed by one vote in the Senate, the senator's father, Frank, voted against it. That was the same year that Congress passed and President Bill Clinton signed the Defense of Marriage Act.

Current federal law prohibits discrimination on the basis of sex, race and national origin. But it doesn't stop an employer from firing or refusing to hire workers because they are gay, lesbian, bisexual or transgender.

The bill would bar employers with 15 or more workers from using a person's sexual orientation or gender identity as the basis for making employment decisions, including hiring, firing, compensation or promotion. It would exempt religious institutions and the military.

By voice vote Wednesday, the Senate approved an amendment from Republican Sens. Rob Portman of Ohio and Kelly Ayotte of New Hampshire that would prevent federal, state and local governments from retaliating against religious groups that are exempt from the law.

Likely Senate approval of the overall bill reflects the nation's growing tolerance of gays and the GOP's political calculation as it looks for support beyond its core base of older voters. A Pew Research survey in June found that more Americans said homosexuality should be accepted rather than discouraged by society by a margin of 60 percent to 31 percent. Opinions were more evenly divided 10 years ago.

Twenty-two states and the District of Columbia have approved laws banning workplace discrimination on the basis of sexual orientation, and 17 of those also prohibit employers from discriminating based on gender identity.

About 88 percent of Fortune 500 companies have adopted nondiscrimination policies that include sexual orientation, according to the Human Rights Campaign. About 57 percent of those companies include gender identity.

Sens. Bob Casey, D-Pa., Tom Coburn, R-Okla., and Jeff Sessions, R-Ala., did not vote.

Associated PressSource: http://hosted2.ap.org/APDEFAULT/386c25518f464186bf7a2ac026580ce7/Article_2013-11-07-Gay%20Rights-Senate/id-a127626cfdca475c9f0281003988fe43
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Facebook's latest test run puts star ratings on businesses' pages

Facebook's known for testing new features with a limited group before a broader rollout, and it's latest one could have some real implications for both businesses and individual users of the social network alike. As TechCrunch reports, Facebook is now testing a new five star rating system that's ...

Source: http://feeds.engadget.com/~r/weblogsinc/engadget/~3/acImEeqcLSU/
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Study using stem cells to improve organ transplantation to receive $12 million

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Contact: Bret Coons
bcoons@nmh.org
312-926-2955
Northwestern Memorial Hospital

Northwestern Medicine promised $12 million to continue organ transplant research with stem cells to improve outcomes

CHICAGO An innovative Northwestern Medicine research program investigating if stem cells may be the key to allowing organ transplant patients to stop taking immunosuppressive drugs has received $12 million in research funding. The grant will allow researchers to finish Phase II of the clinical trials and begin Phase III. Northwestern began the study's clinical trial in early 2009 as part of a partnership with the University of Louisville, which engineers the specialized stem cells used in each transplant procedure.

"During our clinical trials, we have been able to take the novel stem cell technology that the University of Louisville pioneered from the bench to the bedside," said Joseph Leventhal, MD PhD, director of kidney and pancreas transplantation at Northwestern Memorial Hospital, and professor of Surgery at Northwestern University Feinberg School of Medicine. "The results of our clinical trial were a catalyst for Novartis' long-term investment in this new cellular based therapy for solid organ transplantation."

The clinical trial uses specially engineered stem cells from kidney donors to make the organ recipient's immune system recognize the new kidney as its own. In mainstream transplant procedures, a recipient faces the danger of their immune system treating a newly transplanted organ as a foreign body that should be removed, causing it to attack and try to kill the new organ. To prevent a recipient's immune system from attacking their new organ, doctors must currently prescribe toxic anti-rejection medicines to weaken the immune system and keep it at bay.

In March of 2012, Leventhal and his colleagues published the study's initial clinical results from eight participants in Science Translational Medicine. The article outlined that of the study's eight participants, five were able to successfully stop taking all anti-rejection medicines in just one year after they received a new kidney, and two required only low-doses of anti-rejection medicine to be maintained instead of a normal regimen. The final patient suffered an unrelated illness that required another kidney transplant to be performed.

"Northwestern's Comprehensive Transplant Center has demonstrated for the first time in the history of organ transplantation that we can safely achieve durable transplantation tolerance in mismatched and unrelated donor/recipient combinations," said Leventhal. "I am very excited to be able to continue this groundbreaking translational research."

The first subjects to participate in the research study underwent surgery on February 26, 2009. To date, more than 20 patients have been enrolled and have received new kidneys as part of the clinical trial, the majority of which have been successfully taken off of all anti-rejection medicines. In order to qualify, the donor and recipient pairs must be blood-type compatible and have a negative cross-match, which means that testing has been done to confirm the recipient does not have antibodies in the blood that would cause rejection of the kidney.

The grant is a result of a license and research collaboration agreement between Regenerex LLC and Novartis to provide access to the novel technology developed by the University of Louisville's Institute for Cellular Therapeutics. Leventhal does not receive financial incentives or payment from Novartis or Regenerex LLC.

###

Northwestern Memorial is home of the largest living donor kidney transplant program in the nation. For more information, visit transplant.nmh.org.

About Northwestern Memorial HealthCare

Northwestern Memorial HealthCare is the parent corporation of Chicago's Northwestern Memorial Hospital, an 894-bed academic medical center hospital and Northwestern Lake Forest Hospital, a 201-bed community hospital located in Lake Forest, Illinois.

About Northwestern Memorial Hospital

Northwestern Memorial is one of the country's premier academic medical center hospitals and is the primary teaching hospital of the Northwestern University Feinberg School of Medicine. Along with its Prentice Women's Hospital and Stone Institute of Psychiatry, the hospital has 1,705 affiliated physicians and 6,769 employees. Northwestern Memorial is recognized for providing exemplary patient care and state-of-the art advancements in the areas of cardiovascular care; women's health; oncology; neurology and neurosurgery; solid organ and soft tissue transplants and orthopaedics.

Northwestern Memorial has nursing Magnet Status, the nation's highest recognition for patient care and nursing excellence. Northwestern Memorial ranks 6th in the nation in the U.S. News & World Report 2013-14 Honor Roll of America's Best Hospitals. The hospital is recognized in 14 of 16 clinical specialties rated by U.S. News and is No. 1 in Illinois and Chicago in U.S. News' 2013-14 state and metro rankings, respectively. For 14 years running, Northwestern Memorial has been rated among the "100 Best Companies for Working Mothers" guide by Working Mother magazine. The hospital is a recipient of the prestigious National Quality Health Care Award and has been chosen by Chicagoans as the Consumer Choice according to the National Research Corporation's annual survey for 15 consecutive years.

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PUBLIC RELEASE DATE:

7-Nov-2013

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Contact: Bret Coons
bcoons@nmh.org
312-926-2955
Northwestern Memorial Hospital

Northwestern Medicine promised $12 million to continue organ transplant research with stem cells to improve outcomes

CHICAGO An innovative Northwestern Medicine research program investigating if stem cells may be the key to allowing organ transplant patients to stop taking immunosuppressive drugs has received $12 million in research funding. The grant will allow researchers to finish Phase II of the clinical trials and begin Phase III. Northwestern began the study's clinical trial in early 2009 as part of a partnership with the University of Louisville, which engineers the specialized stem cells used in each transplant procedure.

"During our clinical trials, we have been able to take the novel stem cell technology that the University of Louisville pioneered from the bench to the bedside," said Joseph Leventhal, MD PhD, director of kidney and pancreas transplantation at Northwestern Memorial Hospital, and professor of Surgery at Northwestern University Feinberg School of Medicine. "The results of our clinical trial were a catalyst for Novartis' long-term investment in this new cellular based therapy for solid organ transplantation."

The clinical trial uses specially engineered stem cells from kidney donors to make the organ recipient's immune system recognize the new kidney as its own. In mainstream transplant procedures, a recipient faces the danger of their immune system treating a newly transplanted organ as a foreign body that should be removed, causing it to attack and try to kill the new organ. To prevent a recipient's immune system from attacking their new organ, doctors must currently prescribe toxic anti-rejection medicines to weaken the immune system and keep it at bay.

In March of 2012, Leventhal and his colleagues published the study's initial clinical results from eight participants in Science Translational Medicine. The article outlined that of the study's eight participants, five were able to successfully stop taking all anti-rejection medicines in just one year after they received a new kidney, and two required only low-doses of anti-rejection medicine to be maintained instead of a normal regimen. The final patient suffered an unrelated illness that required another kidney transplant to be performed.

"Northwestern's Comprehensive Transplant Center has demonstrated for the first time in the history of organ transplantation that we can safely achieve durable transplantation tolerance in mismatched and unrelated donor/recipient combinations," said Leventhal. "I am very excited to be able to continue this groundbreaking translational research."

The first subjects to participate in the research study underwent surgery on February 26, 2009. To date, more than 20 patients have been enrolled and have received new kidneys as part of the clinical trial, the majority of which have been successfully taken off of all anti-rejection medicines. In order to qualify, the donor and recipient pairs must be blood-type compatible and have a negative cross-match, which means that testing has been done to confirm the recipient does not have antibodies in the blood that would cause rejection of the kidney.

The grant is a result of a license and research collaboration agreement between Regenerex LLC and Novartis to provide access to the novel technology developed by the University of Louisville's Institute for Cellular Therapeutics. Leventhal does not receive financial incentives or payment from Novartis or Regenerex LLC.

###

Northwestern Memorial is home of the largest living donor kidney transplant program in the nation. For more information, visit transplant.nmh.org.

About Northwestern Memorial HealthCare

Northwestern Memorial HealthCare is the parent corporation of Chicago's Northwestern Memorial Hospital, an 894-bed academic medical center hospital and Northwestern Lake Forest Hospital, a 201-bed community hospital located in Lake Forest, Illinois.

About Northwestern Memorial Hospital

Northwestern Memorial is one of the country's premier academic medical center hospitals and is the primary teaching hospital of the Northwestern University Feinberg School of Medicine. Along with its Prentice Women's Hospital and Stone Institute of Psychiatry, the hospital has 1,705 affiliated physicians and 6,769 employees. Northwestern Memorial is recognized for providing exemplary patient care and state-of-the art advancements in the areas of cardiovascular care; women's health; oncology; neurology and neurosurgery; solid organ and soft tissue transplants and orthopaedics.

Northwestern Memorial has nursing Magnet Status, the nation's highest recognition for patient care and nursing excellence. Northwestern Memorial ranks 6th in the nation in the U.S. News & World Report 2013-14 Honor Roll of America's Best Hospitals. The hospital is recognized in 14 of 16 clinical specialties rated by U.S. News and is No. 1 in Illinois and Chicago in U.S. News' 2013-14 state and metro rankings, respectively. For 14 years running, Northwestern Memorial has been rated among the "100 Best Companies for Working Mothers" guide by Working Mother magazine. The hospital is a recipient of the prestigious National Quality Health Care Award and has been chosen by Chicagoans as the Consumer Choice according to the National Research Corporation's annual survey for 15 consecutive years.

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Source: http://www.eurekalert.org/pub_releases/2013-11/nmh-sus110713.php
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The Galaxy Note 3 Experience app shows you what using a Note is all about

Get a deeper look into the many features of Samsung's latest Note

Ever been curious about using a Note device, but never given one a try? Well Samsung is hoping that an app in the Play Store called the Galaxy Note 3 Experience will help you discover all of its great features. You get a chance to watch some promo videos, and live interactive full-screen tutorials showing how features work on the Note 3 on whatever device you currently use.

Things like Air Command, Multi Window, Scrapbook and more are all on display, and they actually look pretty good considering that everything is just running in an app. You can also see how interactions work between the Galaxy Note 3 and the Galaxy Gear, although that implementation is a little clunky to our eyes.

The app also does you some good even if you already have made the choice to go with a Note 3. If you install it on your device, you'll get tutorials on all of the great features at your disposal that you may not have discovered on your own. If you're at all curious about the Note 3, you may want to take a look.

Source: http://feedproxy.google.com/~r/androidcentral/~3/kO_PA_0hhoY/story01.htm
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Why Chris Christie's Popularity May Tear His Party Apart

Gov. Chris Christie visits with students at Jose Marti Freshman Academy in Union City, N.J., on Wednesday.

Rich Schultz/AP

Gov. Chris Christie visits with students at Jose Marti Freshman Academy in Union City, N.J., on Wednesday.

Rich Schultz/AP

Chris Christie has become a national phenomenon.

His "crushing margin" for re-election as governor of New Jersey on Tuesday has landed him on the cover of Time. He's now considered a "leading contender" for the Republican presidential nomination in 2016.

Christie clearly has the attention of the national media, as well as his mostly likely rivals. But a bigger question is how well his message and persona will play in the critical states that vote early in the process.

That picture is decidedly mixed.

"I think he's DOA in South Carolina," says Daniel Encarnacion, state secretary of the Republican Liberty Caucus, a libertarian group. "The perception is, he is just too moderate for the average, everyday South Carolina voter."

The split in early opinion about Christie — that he has the best potential to open up an electoral map that has favored Democrats in recent elections, as opposed to the conviction that he is simply not conservative enough to lead today's GOP — is an important phenomenon that may come to dominate the 2016 race.

Republicans, who historically have tended to coalesce around an early front-runner, face the kind of intraparty schism that has been more common for the Democratic Party in the past.

Christie is likely to be far and away the favorite of the "establishment" — or money — wing of the party, but he still has a long way to go to win over the hearts and minds of rank-and-file conservatives who have yet to settle on a champion.

"I have a feeling that through the process, you'll have a hard-line conservative candidate emerge as a front-runner and a mainstream conservative, and it's likely to come down to one of each of those," says Steve Grubbs, a former Iowa GOP state chairman.

Why Christie Rankles

Christie holds conservative positions on many issues, including abortion. He withdrew his state from a regional climate change initiative, as well as from a multibillion-dollar federal infrastructure project. He has also prided himself on taking on public-sector unions.

Yet conservatives aren't convinced that, at heart, he's one of them. The very things that helped him win big in New Jersey — working with the Democratic legislative majority and his handling of Superstorm Sandy, during which he praised President Obama for the federal response — have made him suspect to some on the right.

Unlike many of his Republican peers, Christie accepted the expansion of Medicaid in his state under the Affordable Care Act, which is anathema to conservatives.

Christie vetoed a bill giving in-state tuition rates to young people in the country without documentation, but angered conservatives by suggesting in a recent speech that he'd changed course on the issue.

Similarly, they're dismayed that, while he vetoed a same-sex marriage law, he dropped a court challenge on the issue. At a news conference Wednesday, Christie said of gay couples getting married in his state, "I'm happy for them, if they're happy."

"When you're kind of all over the place, seemingly blowing with the wind, that's where rank-and-file conservatives ask, 'Who is this guy, really?' " says Matt Reisetter, a GOP consultant in Iowa.

Just Win, Baby

In 2011, a group of Iowa businessmen flew to New Jersey in hopes of convincing Christie to run for president. They were convinced, like many others, that he was the party's best hope for beating Obama.

Many feel similarly, looking ahead to 2016. With the GOP having lost the popular vote in five of the last six presidential elections, many party elders feel that it's time, as Christie himself says, to try to win elections rather than trying to win arguments by staying pure.

"A lot of Republicans up here would like to see someone nominated who has a chance to win," says Tom Rath, a former New Hampshire attorney general and longtime political operative in the state. "One of the great attractions of Gov. Christie would be his ability to expand the electoral map and make us competitive in places where we're not competitive."

Of the early states, New Hampshire offers Christie the most favorable territory. Its primary electorate tends to be broader and less religious than those found in Iowa or South Carolina, says Andrew Smith, director of the University of New Hampshire Survey Center.

"Right now, he gets the most votes among Republicans in our polls," Smith says. "But he's also tied as one of the Republicans the most people wouldn't vote for under any circumstances."

The Romney Hangover

People who wanted Christie to run last time around believed he would be a stronger candidate than Mitt Romney. As he prepares to run in 2016, one of the problems Christie has to deal with is the party's lingering disappointment with Romney.

"The same people who didn't like the establishment candidate Romney are going to have similar problems with Christie," says Scott Huffmon, a pollster and political scientist at Winthrop University in Rock Hill, S.C. "They really want to see strong conservative bona fides down here."

Conservative voters will be skeptical about claims about Christie's electability, Huffmon says.

"There will be the people who say going with what experts predicted would be the safe route has lost us the White House two times in a row, and we're not going to go down that path again," he says.

Arguing The Party's Path

This debate has happened before. In 1964 and 1980, conservatives were unhappy about having been saddled with losing nominees they perceived as too moderate in earlier cycles and insisted on nominating one of their own.

That worked out well for the party in 1980, when Ronald Reagan was elected president, but not so well in 1964, when Barry Goldwater suffered one of the biggest defeats in modern history.

Now, the same type of argument within the party about whether Christie is too moderate or represents the party's best chance of winning is only just beginning.

"There are a lot of people I know who will be very excited about [Texas Sen.] Ted Cruz," says Grubbs, the former Iowa GOP chair. "But there are an equal number of people who will be very excited about a Christie type."

Source: http://www.npr.org/blogs/itsallpolitics/2013/11/07/243745054/why-chris-christies-popularity-may-tear-his-party-apart?ft=1&f=1001
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All In The Family: Jimmy Carter's Grandson Runs For Governor

Former President Jimmy Carter and his grandson, Georgia state Sen. Jason Carter, watch a baseball game between the Atlanta Braves and Philadelphia Phillies in Atlanta on Aug. 14.

John Bazemore/AP

Former President Jimmy Carter and his grandson, Georgia state Sen. Jason Carter, watch a baseball game between the Atlanta Braves and Philadelphia Phillies in Atlanta on Aug. 14.

John Bazemore/AP

Jimmy Carter's grandson is running for Carter's old job — governor of Georgia.

Democratic state Sen. Jason Carter formally announced Thursday he will challenge Republican Gov. Nathan Deal, joining a long list of relatives of famous politicians on ballots in 2014.

In fact, Georgia voters will determine the fate of a second statewide legacy candidate next year: Michelle Nunn. She's running as a Democrat to become the state's next senator, a position her father, Sam Nunn, held for 24 years.

The practice of dynasty politics is a familiar phenomenon. But, notably, 2014 is shaping up as an election year that will feature legacy candidates from some of the nation's most accomplished and best-known political clans — the families of past presidents and vice presidents.

Republican George P. Bush, the grandson of George H.W. Bush and nephew of George W. Bush, is the favorite to become the next land commissioner of Texas as he embarks on his own political career. Dick Cheney's daughter Liz is challenging Wyoming Sen. Mike Enzi in a GOP primary.

Then there's Democratic Rep. Joe Kennedy III, the great-nephew of John F. Kennedy and sixth member of the Kennedy family to serve in Congress, who is likely to win a second term in Massachusetts' 4th District.

As for the current administration, Delaware Attorney General Beau Biden, the son of Vice President Biden, is running for re-election in 2014 — a recent poll ranked him as the most popular elected official in the state. Farther down along family trees, Milton Wolf, a distant cousin of President Obama's and a Tea Party enthusiast, is challenging Kansas Sen. Pat Roberts in the Republican primary.

Looking ahead to 2016, presidential families figure to be well-represented again: Secretary of State Hillary Clinton, the wife of Bill Clinton, and former Florida Gov. Jeb Bush, the son of George H.W. Bush, are both top White House prospects.

Click here to hear NPR Special Correspondent Susan Stamberg's 2002 interview with Jimmy and Jason Carter.

Source: http://www.npr.org/blogs/itsallpolitics/2013/11/07/243748706/all-in-the-family-jimmy-carters-grandson-runs-for-governor?ft=1&f=1001
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