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Trying to access personal medical information has been an intermittent annoyance for most people in the United States until Covid-19 came along with a reminder of what a mess it can be.

We face flawed options for storing and accessing our Covid-19 vaccination information: a paper card that is too big for our wallet; a photo of the card stored in our phone for the matre d to squint at in low light; maybe a slick electronic vaccination card downloaded via QR code from our state health department that we can keep in our Apple Wallet. But wait! It only has our first two shots from last spring, and not the third one in November. Maybe our doctor has a portal app where we can pull up our immunizations except for that booster we got at Walgreens.

In an age where banking apps aggregate all our financial information on command and our favorite restaurant can remember our usual when we order online, its mystifying that a piece of cardboard holds many peoples only proof of vaccination.

Vaccination cards are only one small symptom of a larger problem. Health information on any particular person is usually scattered across multiple hospitals, clinics, and pharmacies. Large chunks of most peoples medical histories are lost to any useful purpose when they move or change doctors because getting their information transferred is too complicated. If youre lucky enough to get all your care within one health system and you stay put, you may have something close to a complete electronic health record (EHR). Otherwise, probably not.

Health care providers face these same hassles. Even when they use the same electronic health record software, health systems cannot always easily share information, and trying to corral a vaccination record from Walgreens or an emergency room report from out of state is, while sometimes feasible, always challenging. Health information exchanges (HIEs) operate in many states and allow providers to share basic demographic information and medical histories, but they vary in usefulness and availability.

However, federally mandated changes are afoot to make it significantly simpler to share any medical information electronically. Its difficult to overstate their potential not only to allow everyone full, complete, and easy access to their personal health information but also to unlock countless new ways to use that informationas long as the entities that generate the information are prepared to take advantage of this advance in technology.

Why is health information sharing so erratic, when virtually all health data is computerized? Cant computers talk to each other? Other industries have figured this out. Why not health care?

The reasons are many and complex, but they boil down to lack of motivation. On the front lines, clinicians would love to have easy access to the information they need, but in the executive suite, the return typically hasnt been large or obvious enough to justify the investment. For some providers, holding patients information hostage has been a competitive advantage: one way of keeping them from jumping to another provider. Some clinics and hospitals still grudgingly share information by handing the patient a disk or a folder of printouts.

Even basic computerization of medical information was going very slowly before billions of dollars in federal funding of electronic health records, appropriated as part of the Obama administrations stimulus package enacted in 2009, changed the investment equation. It took free money to induce a critical mass of providers to take the plunge.

Sending health information from one computer to another has its own spotty history. Many health care software vendors have made a lucrative business out of creating custom interfaces to connect the diverse systems in use at many hospitals, with billable tweaking every time the hospital acquires a new application or upgrades an existing one. Moreover, vendors often have blocked data portability as a client-retention strategy. If it is difficult or expensive to move their data to a different vendors system, they will just default to the next version of the one they already have. Some vendors have taken steps toward helping providers share. For example, EHR vendor Epic allows its customers to swap data easily if they mutually agree to do so. But it cant make them. If two Epic customers compete in a given market, they may decide its not in their best interest even if it might be in their patients best interest.

It is not that the health care industry lacks data standards; quite the opposite. But they are often created by groups with interests in specific types of data for example, standards developed for medical imaging by the American College of Radiologists. They have made data sharing somewhat less of a mess but cant solve the other issues we discussed.

Meanwhile, baffled patients cant access their information in any comprehensive way. Everything is probably on a computer somewhere, but there is no force powerful enough to compile it in one place and make it easy to find, let alone use it to improve our health.

Enter the federal government, the one party with enough clout, when it chooses, to drive genuine change in the U.S. health care industry. Through Medicare for everyone 65 and up, Medicaid for the poor, CHIP for children, the Veterans Affairs health care system, the Department of Defense health care system for military personnel, and health coverage for millions of federal employees and their families, the government pays for more care for more people than any other single entity.

In the waning days of the Obama Administration, the 21stCentury Cures Act finally leveraged this clout by including a requirement for easy exchange of health data by the end of 2022. Providers that dont comply with the requirements may not be able to participate in Medicare, and that amount of lost revenue would be devastating to most hospitals and physicians. They depend on their software vendors to accomplish what is required, putting them on the hot seat as well. The regulations also establish penalties for vendors, providers, and payers who continue to exhibit information blocking practices (which theoretically should abolish the practice of leveraging information access to keep your customers imprisoned).

Since the end of 2022 is not that far away, how is the health care industry going to accomplish this mission? By doing something it should have figured out how to do long ago without needing a federal mandate: adopting one standard method of having its computers talk amongst themselves.

That method is open, standardized application programming interfaces, or APIs. They are the reason your devices and software programs can swap data without your having to do anything. APIs support the ability of an application from one developer to read and write data from another developers application.

APIs are everywhere. If you have pulled information from all your banking and credit card accounts into one financial planning app, it was APIs that did the pulling. APIs let you use your Google or Facebook account information to sign into websites owned by neither Facebook nor Google. APIs are the reason you can move from a companys website to its phone app and back again and always pick up where you left off.

Imagine being able to do the same with all your health information, no matter where or when it was generated. (For starters, everyone could have an electronic vaccination card on their phone that would update automatically even if he or she used a different provider for every shot.) Using APIs to unlock electronic health record data could give people easy, efficient access to their own data to help them understand their health and make more informed choices. Providers would have a complete picture of each patients history. They could use that information not only to support their clinical decision-making but also as part of population health analytics to see patterns in their patient populations. Researchers could more easily identify patients who might benefit from a particular clinical trial just one way the data could be used to discover and evaluate new drugs and therapies.

Standardized APIs need a standards document outlining data formats and allowable values for each resource, or type of data to be exchanged. The standard could be as simple as specifying that all dates will be in the format mm/dd/yyyy, though more complex types of data will have correspondingly more complex standards. Health care generates many types of data, ranging from simple to extremely complex, and needs a thick, detailed instruction manual.

That manual is called Fast Healthcare Interoperability Resource (FHIR, pronounced fire), and its the one that the 21st Century Cures Act specifies be used to accomplish the easy interoperability we described above by the end of this year.

Why has FHIR gotten the federal endorsement? Several reasons:

Strong governance. FHIR is managed through Health Level Seven International (HL7), a health care standards development organization founded in 1987 and supported (with staff time, expertise, and money) by every significant player in health information technology. One of us (John Glaser) serves on its advisory council. HL7 has more than 500 corporate and organizational members, including:

HL7 has maintained strict control over the FHIR standards since development started in 2011. This control is important because it prevents a frequent problem with standards development: the progressive creation of exceptions to the standard. It doesnt take many exceptions before the standard is no longer standard.

HL7 has developed a strong set of services to support the implementation of FHIR. These services include testbeds, education programs, and implementation guides. The adoption and use of standards requires well-designed standards and strong support for the implementation of those standards.

International acceptance. FHIR has evolved to become a global, not just a U.S., standard. For app developers, this increases the value, of adopting the standards. Full FHIR documentation is currently available in Russian, Chinese, and Japanese, in addition to English.

Current successful use. The industry is already embracing FHIR and its use is delivering value.

HL7 has formed several accelerators focused on target segments of health care information exchange. The first was the Argonaut Project, established in 2014 to develop the basic building blocks of the FHIR standards. Within each accelerator, developers and users work together to define use casesthe contexts in which the proposed information exchange will occur and the data standards needed to support those use cases. HL7 accelerators also develop guides to support the implementation of the standards they develop for vendors to use in creating software products or incorporating new features into existing products. Participants fund the accelerators efforts and, within HL7 guidelines, establish how the accelerator will operate (including choosing the name of the accelerator).

A few examples:

Broad adoption of FHIR is in its early stages. However, we think it holds enormous promise given the strength of FHIRs tailwinds:

To be clear, people will not be enjoying immediate, seamless access to all their health information by the end of this year. Universal FHIR compatibility is a baseline, not the finish line. Standards are still in development. Legacy systems need to be retrofitted with FHIR APIs. All entities that handle health data must become comfortable sharing it.

But at least we can start the race. Standard APIs can work their magic relatively quickly: The Apple App Store launched in 2008 with 500 apps and today has 2 million. The Google Play Store (launched the same year) has almost 3 million. While the health care software industry doesnt have a single corporate entity with the dominance of a Google or an Apple, the universal support enjoyed by HL7 serves the same purpose and in many ways facilitates better collaboration in the user community.

To capitalize on the opportunities provided by FHIR APIs, providers, health plans, and software vendors should take several steps.

Learn as much as possible about the FHIR standards and the federal regulations. Organizations should review federal agency overviews of FHIR and related regulations and take advantage of the resources that always accompany a change of this magnitude: meetings, webinars, and industry articles. The 2022 HIMSS meeting, the largest health IT gathering in the world, features almost 40 sessions on various aspects of FHIR implementation, from prior authorization to cancer research to health care cost transparency.

Become active in the HL7 FHIR accelerator program. These development activities need broad input to ensure that the standards are responsive to everyones needs.

Develop implementation plans to migrate current legacy interfaces to FHIR APIs. Failure to comply with the regulations risks penalties and problems in the market. Moreover, given the next point, the APIs provide a foundation for the next generation of health care apps.

Be prepared to identify and evaluate novel applications that FHIR facilitates. A wave of innovations will accompany the implementation of FHIR to address any problem that can be solved with better information flow. But remember, FHIR APIs are the baseline, and any new solution requires the same old due diligence.

The new federal mandate will both enable and force the removal of stubborn technological and business barriers to the flow of health information, and, in the process, we believe will accelerate a wave of innovation rarely seen in this historically stodgy corner of the IT world. FHIR will speed the implementation of any application that depends on complex information-sharing such as matching organ donors to recipients or identifying situations where the risk of maternal mortality is elevated.

And we hope (and expect) that there will come a day when we can all stop worrying about accidentally putting our Covid-19 vaccination record through the wash.

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Standardized APIs Could Finally Make It Easy to Exchange Health Records - HBR.org Daily

Vanced, a popular YouTube app that enabled Android users to watch ad-free videos without a subscription, has been discontinued. In a statement shared on its official Twitter page, Vanced says it will take down download links from its website in the coming days.

While the statement doesnt include any details behind the discontinuation, developers of the app revealed in a Telegram message that they had to do it due to legal reasons.

According to The Verge, the developers recently received a cease and desist letter from Google, asking them to remove all references to YouTube. The owners were also asked to change their app logo and remove all links related to YouTube products.

The existing versions of the app will continue to work, at least for now. Since Vanced will no longer push any updates, the app will become outdated in two years or so.

In addition to access to add-free videos, Vanced also supported auto-repeat, background playback, and picture-in-picture features on the best Android phones. While Vanced is no longer available to download, there are still a few other free apps like NewPipe and SkyTube that deliver a lightweight YouTube experience.

Unsurprisingly, Vanced now suggests that users consider getting a YouTube Premium subscription to continue watching ad-free videos and unlock other features such as background play, access to YouTube Music, and the ability to download videos.

This isnt the first time that YouTube has taken action against third-party apps. Back in August, Google forced the Groovy Discord music bot offline. The music bot allowed Discord users to listen to music from YouTube videos. Just weeks later, Google forced the Rythm music bot to go offline. Before it was shut down, the Rythm bot was installed on over 20 million Discord servers.

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Google's legal threat forces YouTube Vanced app to shut down - Android Central

It's all about creating a place for people to monetize, grow and curate the ecosystem, no matter where they're building their audience, Zaccaria said. That is the key thing.

The platform, which was founded in 2016 by Zaccaria, his brother Alex and Nick Humphreys, hit 24 million users last year, with major names like Selena Gomez, Shawn Mendes, Bella Poarch and Dwayne The Rock Johnson joining in. Now its attracted a third round of funding, raising $110 million from a host of venture capital firms and bringing its valuation to $1.3 billion, the company announced Wednesday. Its also bringing on Mike Olson, former SVP of Growth Initiatives at Twitch, as its president, focusing on U.S. market expansion.

Protocol spoke to Zaccaria about the state of the creator economy, how Linktree works for creators, its recent integrations and the future of the platform.

This interview has been edited and condensed for clarity.

Can you generally speak to the state of the creator economy as it stands, and where Linktree fits into the space?

Obviously creators as a whole have been a thing for a long time. Thinking back to YouTubers and vloggers, and people monetizing content and monetizing their personalities, that has been around for 10 or 15 years. Particularly through the pandemic, people [are] realizing they can do a whole lot more. Tech enabling that has increased.

We're seeing people really find ways to monetize their passions, their hobbies, their side hustles, whether it's creating and building something physical or purely just through content. And I think we're seeing a new economy rise up and a new source of revenue for people, whether people make this a full-time living, whether it's through platforms like Twitch or YouTube or TikTok being a secondary source of income.

We see ourselves playing a big part of that, as a platform-agnostic place for everyone to curate their ecosystem, whether they're digital talent that lives in the world of YouTube or TikTok, or they live in the physical and digital world where they have they have physical goods and they're making products a bit selling through Etsy or Amazon, but they're also using content to promote and build their audiences.

What kinds of creators use Linktree the most?

We have over 23 million users worldwide. For verticals or user groups, there are just over 250 [groups] on the platform that self-identify when they sign up. We're pretty evenly split across those verticals. There isn't really one that makes up the majority. We say that we're platform-agnostic and we have a use case and value prop across the spectrum.

Do people that are bigger on different platforms use Linktree differently? What is Linktree doing to help facilitate all of their needs?

We don't see different use cases by platform, whether you're TikTok, Twitter, Instagram. What we see as different is the type of user on that platform. So if you're a musician that is bigger on Instagram, how you use it might be different to someone who's producing educational content on TikTok or a realtor who might be showing their listings on TikTok or a gamer on Twitch. Regardless of the platform you're coming from, Linktree is still this place that unifies your whole ecosystem, everything you care about, what's important, relevant and recent for you.

For example, as a musician, we see our music users using our music-link functionality, which integrates Songlink/Odesli, which we acquired last year. That allows artists to embed their Spotify link or any other platform and it will show all the streaming services that the song or album is available on in the country that the user is in. They integrate our Bandsintown link, which we just recently partnered with, to show tour dates, or they might use our Shopify integration to show their merch.

Does Linktree plan to expand from individual and creator uses to enterprise uses?

Absolutely, and we have. Over the last year, we've seen the small business vertical itself grow about 327%, and brands like Red Bulls or Qantas, those kinds of big names using the product [have grown] over 500%. So we're sort of seeing brands really use it and drive their audience to the links in profiles to either go to Shopify or sign up to see new content. So we're seeing that as a big growth area. We already have quite a few users on enterprise plans, which is discounted pricing for bulk accounts. But were continuing to build functionality for brands, or even just users that want to manage and control multiple user profiles in one spot whether it's integration with payments or marketing tech or whatnot.

Does Linktree plan to get into the crypto/blockchain space? If so, what will that look like?

Web3 as a whole aligns with our vision of empowering creators. We're not necessarily pivoting to be a Web3 company and changing everything about what we do, but continuing to build on our vision of empowering creators to curate the digital universe. There is some specific functionality and integrations and tools that are coming down the line that we'll be rolling out over the next couple of months as well that are in a similar space to what we're doing already. I can't talk about the specifics on the partnerships and integrations, but they will be coming soon.

Were building functionality that will help service the NFT community, service Web3, service crypto, while still being true to what Linktree does without necessarily all of a sudden pivoting. We're already used by a lot of the Web3 community: Bored Ape Yacht Club, for example, use[s] Linktree. So we still have a product that can straddle Web 2.0 and Web3 quite easily.

What does Linktree plan to do with the funding?

It's obviously super exciting. We've got such a big product vision, and the capital is really to execute on that vision. The team really is the first part to help execute on that. Were at about 240 employees now and will likely be somewhere between 450 and 500 by the end of this year, with a bigger focus on the U.S. as well as some other global markets that are emerging for us. A lot of it is really going into the team, and also reinvesting back into the team to continue to ensure our employee experience is top of class.

Can you expand a little bit more upon how you're planning on building your product vision? In the near future, what is that going to look like for users?

We've done some recent ecommerce functionality, so well continue to build upon that [with] deeper functionality and partnerships with some other like-minded businesses. We [recently] did a partnership that has been in the works for a while, but we've pushed ahead with it because of the situation in Ukraine, with GoFundMe and allowing folks to create a GoFundMe link within their Linktree profiles so they can drive donations for Ukraine. So well continue to build upon that sort of area.

Is an IPO or public debut in Linktrees future?

To be honest, I think we're still pretty early. We were bootstrapped up until we took funding at the start of 2020 and profitable to that point. We did that all ourselves, we took on venture to help us grow and scale. We have a big vision and that has been great so far. So whilst the business has been around for five or six years, we still feel we are quite early on in the journey, particularly in the venture journey. So acquisition conversations and IPO conversations aren't really things we're talking about.

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Snap plans to turn every public space into an AR experience - Protocol

Former President Donald Trump rallied supporters on March 12, 2022 in Florence, S.C. Sean Rayford/Getty Images hide caption

Former President Donald Trump rallied supporters on March 12, 2022 in Florence, S.C.

Donald Trump hasn't said for sure if he will run in 2024. But he's having a hell of a lot of fun teasing it.

"We are going to take back that beautiful, beautiful White House. I wonder who will do that. I wonder, I wonder," he said to roaring applause at a Saturday rally in Florence, S.C.

More than a year after he left the White House, Trump is still the center of the Republican universe. And that's truest of all for his most committed fans. Thousands of rallygoers waited for hours on Saturday in frigid, gusty weather for Trump to speak.

"It shows the love people have to be out in this," said Rhonda Moore, from Columbia, in the rain as the temperature plummeted. It would still be more than 5 hours until Trump took the stage. She turned around to show off the flag she had wrapped herself in.

"It's President Trump dressed like a gladiator. So I thought I'd let him keep me warm," she said with a laugh.

A Trump rally is the easiest place to see just how much of a cult of personality has built up around Trump in the party. But as he works to sway Republican primaries and oust incumbents in the process it also is an opportunity to see not only how much he has changed the party, but how much he is shaping the future of the party.

RINOs draw lots of attention

Moore, holding her flag tightly around her head, said she doesn't consider herself a Republican, despite her support of Trump.

Donna Eiden sold merchandise dedicated to former President Donald Trump before his rally on Saturday. Sean Rayford/Getty Images hide caption

Donna Eiden sold merchandise dedicated to former President Donald Trump before his rally on Saturday.

"I classify as an American conservative. Republicans have been disappointing in some things that they've done. They're part of the swamp. Some of them, I think, they're RINOs," she said.

RINO meaning "Republican In Name Only" is a decades-old Republican epithet that has gained new currency in the Trump era. He uses it not so much to indicate a lack of ideological purity as to slam Republicans who've been critical of him. And it was used liberally at this rally.

"Unfortunately for the patriots of South Carolina, you currently have two atrocious RINOs they're bad people in the House, who went to Washington, sold you out and partnered with the Democrats to stab the Republican Party and frankly, to stab our country in the back," Trump said in his speech.

He was referring to Republican Representatives Nancy Mace and Tom Rice. Mace criticized Trump sharply after the January 6 attack on the Capitol, and Rice subsequently voted to impeach trump.

In response, Trump is supporting their Republican primary challengers, and the rally was an opportunity to give them high-profile guest-speaking gigs. State Rep. Russell Fry is challenging rice. Former State Rep. Katie Arrington is challenging Mace.

"Let's not forget those RINOS. Let's not forget those turncoats," she yelled in her speech. "And you know who I'm talking about the Liz Cheney of the South, none other than Nancy Mace. Nancy Mace is who I'm here to take out. She turned her back on President Trump, she turned her back on me, and she turned her back on you."

When loyalty matters more than a voting record

Some voters in the district have taken this to heart, according to Jerry Rovner, the chair of the 7th-district Republican Party Congressman Rice's district.

"I'll never forget I was in a Lutheran church, and this little lady took her mask down," he said. "And I said, 'Yes?' And she goes, 'What are you gonna do about that Tom Rice - he voted against Donald Trump, you know.'"

Talking to Rovner, you understand just how much loyalty to Trump can outweigh ideology in the GOP these days.

"When I talked to Tom, he said, 'But I had 50,000 votes, I only did one thing,' and I said, 'Well, look: I'm 70 years old, I've never killed anybody, but if I did, I'd be a murderer,'" Rovner recounted.

Trump's meddling in primary elections has added a dose of chaos to how the party runs, according to Brendan Buck, a Republican strategist who worked as an aide to House Speakers Paul Ryan and John Boehner.

"Oh, this is entirely unprecedented," he said.

"It makes a lot of people really uncomfortable, that incumbents are seen as expendable," he added. "And of course, Donald Trump only thinks in terms of what's good for him or who's slighted him."

Indeed, Trump's endorsees were not the real focus of the rally; Trump was, with an hourlong speech that hit on all the usual points the lie that he won in 2020, for example, and insulting his perceived enemies.

And while he's not on a ballot, he had the potential to win still more support at this rally for a potential 2024 run. Robin Herbert, a dental assistant from Florence, came with a coworker and said she considers herself "liberal" ... but she added that her feelings about trump have been shifting recently.

"They were negative to start with," she said. "I thought he was just kind of harsh, but then the more I've heard him talk, I'm trying to feel a little different about it."

She elaborated why she's "trying" to come around to Trump in particular.

"I have not been happy with Biden at all," she said. "I just don't think he has been together at all. I think he's just I don't think he knows what he's doing."

Biden's approval rating has been underwater since fall. The upshot for the Republican party is that people like Herbert, who are disappointed with Biden, will either have to come around to Trump or get hooked by someone else.

For many rallygoers, the No. 1 alternative is clear: Florida Gov. Ron DeSantis. And it quickly became clear why: they see him and Trump as similar. Anthony Barber, a petroleum inspector from Somerville, talked about what he likes about the two men.

"They like to punch back. They don't sit there and take it, take it, take it show weakness," he said. "You know, to run a country, you've got to show strength."

Others echoed the comparison.

"He's just like Trump, he says it like it is," said Shannon Reynolds, an Air Force veteran from Sumter. "He puts people in their place when they're wrong. He calls them out, but he's there for the people."

Trump and DeSantis have traded swipes at each other in recent months. But DeSantis' popularity in this crowd, and the fact that it's because many Republicans see him as distinctly Trumpy, is also proof of Trump's power.

While Trump keeps wondering aloud whether he will be on the 2024 ballot, it's clear that he has created conditions for people like him to hold sway in the GOP for years to come.

In other words, the conditions are ripe for Trumpism to outlast Trump himself.

Barbara Sprunt contributed to this report.

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Braving rain and cold, Trump's supporters soak up hints of another run - NPR

Just a week after telling a couple hundred Republican donors, We have to do it, former President Donald Trump hinted again at a White House challenge in 2024 during in a campaign-style rally in South Carolina on Saturday.

We may have to run, Trump told told the cheering crowd. As he did last week in New Orleans and in previous appearances, the former president said Republicans in 2024 are going to take back that beautiful, beautiful White House. I wonder who will do that. I wonder. I wonder.

Trumps comments came a day after The Wall Street Journal released a poll, of 1,500 registered voters, which showed him deadlocked with President Joe Biden in a hypothetical rematch of 2020s contest.

Even though Bidens approval overall rating may have seen a bounce since his State of the Union address earlier this month withpollsters citing broad support for his tough sanctions on Russia over President Vladimir Putins unprovoked attack on Ukraine the Democrat remains tied with Trump, 45% to 45%, when voters were asked who theyd vote for in the next presidential election.

About 57% of respondents said they were unhappy with Bidens overall performance, compared to 42% approving figures similar to the Journals last poll in November.

The Journal noted, however, that Trump remains unpopular: a majority, 55% of respondents, held unfavorable views of him. About 15% of voters view both men unfavorably, but those voters back Biden 36% to 24% in a potential 2024 race, the Journal reported.

In addition to signaling hed throw his hat in the ring in 2024, Trump suggested Saturday that Republicans would triumph in midterm elections, projecting a slate of wins for so-called America-first GOP governors and lawmakers.

The Journal poll showed 42% of respondents said they were likely to vote for Republican candidates this November, compared to 29% for Democrats.

Biden has faceddeclining approval ratingssince notching several strong polls shortly after taking office in 2021.

His handling of the COVID-19 pandemic initially seen as a strong point as vaccinations ramped up Afghanistan withdrawal and rising inflation are often cited by pollsters as leading concerns among voters.

The White House counters by pointing to millions of jobs gained over the last year and Bidens signature of a bipartisan infrastructure package, a bill that should see at least$9 billion go toward Massachusetts projects.

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Donald Trump again hints at White House run in 2024, after poll shows him tied with President Joe Biden in re - MassLive.com