By HANNA ARHIROVA, SAMYA KULLAB and VASILISA STEPANENKO, Associated Press

KYIV, Ukraine (AP) — Russia unleashed a major missile and drone barrage on Kyiv early Friday, killing six people, leaving gaping holes in apartment buildings and starting fires as the sound of explosions boomed across the city and lit up the night sky. A pregnant woman was among at least 35 people wounded, Ukrainian authorities said.

Russia used at least 430 drones and 18 missiles in the nighttime attack, Ukrainian President Volodymyr Zelenskyy said.

Russia has waged a devastating aerial campaign against Ukraine since its all-out invasion of its neighbor nearly four years ago. U.S.-led diplomatic efforts this year to stop the fighting have so far come to nothing.

Friday’s aerial assault, which also targeted Odesa in the south and Kharkiv in the northeast, was mostly aimed at Kyiv, where drones and missiles smashed into high-rise apartment blocks, according to Zelenskyy.

It was “a specially calculated attack to cause as much harm as possible to people and civilians,” he said in a post on Telegram.

Moscow denies targeting civilian areas, with the Russian Defense Ministry saying Friday it carried out an overnight strike on Ukraine’s “military-industrial and energy facilities.” Ukrainian officials scoff at those claims, showing repeated damage to homes and public buildings.

The attack was the biggest on Kyiv in almost three weeks. Most recent Russian aerial attacks have aimed at electricity infrastructure around the country ahead of the bitter winter months.

Ukraine used its American-made Patriot air defense systems to repel the attack and shot down 14 missiles, Zelenskyy said. The Ukrainian leader has pleaded with foreign supporters to send more of the sophisticated systems.

Top European defense officials meeting in Berlin on Friday vowed to keep up their support for Ukraine. Ukrainian Defense Minister Denys Shmyhal joined the meeting remotely.

The Azerbaijan Embassy in Kyiv was damaged by debris from an Iskander missile — a development that Azerbaijan President Ilham Aliyev said was “unacceptable.” Azerbaijan is a key transport corridor for Russia’s trade with Iran and other partners in the Middle East.

In the Odesa region, Russian drones struck a busy street on market day in Chornomorsk, killing two people and wounding 11 others, including a 19-month-old girl, regional military administration chief Oleh Kiper said.

‘My hair was on fire’

Kyiv residents told of harrowing escapes and near misses in the dead of night.

Mariia Kalchenko said it was a miracle she survived after her building was hit.

“I didn’t hear anything, I just realized that my hair was on fire,” the 46-year-old volunteer rescue dog handler told The Associated Press.

She turned on her flashlight and saw that her dog had moved away in fright. “I turned around and saw that there was no wall, and there was a neighbor’s apartment, the neighbor was screaming, there was no door, and the flames were going from the front door into the apartment,” she said.

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Oleh Hudyma, 59, said he became aware of the attack and intended to go to a bomb shelter but she wasn’t quick enough.

“I got up, got dressed, went out, and there was an explosion. I couldn’t hear the (drone) engine running, just an explosion, flames, everything flew,” he said. “I was in the kitchen and just fell to the floor.”

Iryna Synyavska, 62, said three people were killed in two apartments next to hers.

“My neighbor and his father were killed by the ceiling that collapsed. In the next door (apartment), an elderly woman lived there, she was over 80,” Synyavska said. “Her daughter was visiting her. Her body was only just recovered because the walls fell down.”

Eight of the capital’s 10 districts reported damage. In the wider Kyiv region, Russian strikes damaged critical infrastructure, the head of the regional military administration, Mykola Kalashnyk, said.

Russia accuses Ukraine of hitting civilian sites

Ukraine has responded by launching its own domestically developed drones and missiles against targets on Russian soil, especially oil refineries and depots that provide Moscow with income and manufacturing plants that supply the armed forces.

The Russian Defense Ministry said Friday that its air defense forces shot down 216 Ukrainian drones overnight over a number of Russian regions, including the annexed Crimea. It did not mention missiles.

However, Zelenskyy said Ukraine used a modification of domestically produced Neptune missiles to strike targets deep inside Russia. The Russian Defense Ministry accused Ukraine of hitting civilian facilities and claimed the overnight strike on Kyiv came in response to that.

Over 60 Ukrainian drones were intercepted over the southern Krasnodar region that borders Crimea, according to the Defense Ministry. A total of 45 drones were destroyed over the Saratov region deeper inside Russia, while another 19 were shot down over Crimea.

Attack on Russia’s Novorossiysk port

In Novorossiysk, a port city in the Krasnodar region, an attack damaged an oil depot at the Sheskharis transshipment complex, as well as unidentified “coastal structures,” local authorities said.

A source in Ukraine’s Security Service confirmed the Novorossiysk attack to The Associated Press, speaking on condition of anonymity because he was not authorized to speak publicly.

Novorossiysk is the second biggest port in Russia for oil exports, the source said, adding that the attack damaged oil-loading stands at the piers, pipeline infrastructure and the units, sparking a large fire.

Ukraine also struck the positions of a S-300/S-400 air defense system in Novorossiysk, the source said.

Falling drone debris also damaged a civilian vessel in the port, and three crew members were hospitalized with injuries, Russian officials said. Several residential buildings were also damaged, and a man from one of those buildings was hospitalized with injuries, officials said.

In the Saratov region, Gov. Roman Busargin said that the attack damage unspecified “civilian infrastructure.” Unconfirmed media reports said that an oil refinery was hit.

Illia Novikov in Kyiv, Ukraine and Geir Moulson in Berlin contributed to this report.

Follow AP’s coverage of the war in Ukraine at https://apnews.com/hub/russia-ukraine

After Hurricane Melissa’s exceptionally strong winds subsided, the roots of breadfruit trees clung deep into the fertile Jamaican soil — offering hope and a step toward food security in the future.

For the past 16 years, Mary and Mike McLaughlin, Jamaican natives who now live in Winnetka, have helped plant almost half a million fruit trees — mostly non-native breadfruit — across the Caribbean and Africa, about 250,000 of those in Jamaica alone. Despite its resilience, breadfruit has long been an underutilized source of food, Mary McLaughlin said.

The couple’s Trees That Feed Foundation aims to expand its use as a crop in locations vulnerable to extreme weather events that are intensifying because of human-made climate change. Several rapid scientific analyses found Hurricane Melissa was made more likely and intense because of global warming from fossil fuels.

“It’s one of the worst hurricanes — well, it’s the worst hurricane ever” in the Caribbean country, Mary McLaughlin told the Tribune, “and it hit Jamaica in its breadbasket,” the southwestern parish of St. Elizabeth, dubbed after its fertile soil, favorable to many crops that feed the country.

Having planted trees in that area, the foundation expects to have some losses.

“However, we have worked in countries that have had hurricanes and seen recovery, and if the trees have roots in the ground, those trees will recover. And we know we may miss a bearing season, but the following year, they will produce,” Mary McLaughlin said.

At the same time, she said, the trees “lock carbon away while feeding people,” essentially addressing the root of increasingly destructive weather events.

Jamaicans are now coping with the aftermath of a hurricane so severe it is tied with one from 1935 for the third strongest ever recorded in the Atlantic Ocean and most intense to make landfall.

Rita Hilton, who has lived in Jamaica for 60 years, works with the McLaughlins and helps farmers export their crops. She called the hurricane “the most intense, horrific storm” she has experienced. Hilton was airlifted to Kingston, the country’s capital, this week after seven days in her isolated, torn-down home.

“If you look at all the forest trees, there’s not a green leaf; there are tree stumps sticking out of the ground or lying across the road,” she told the Tribune. “Whatever crops were in the ground have been destroyed in that area.”

But not all is lost — especially where those stumps belong to breadfruit trees.

“In times of disaster such as this, when a lot of agricultural produce is damaged, we need things that can actually survive … and if not survive as they were, actually regenerate,” said Ainsley Henry, conservator of forests and CEO at Jamaica’s Forestry Department, with which the foundation has collaborated for years. “And the beauty of breadfruit is, it’s a very hardy species. … If it does get broken or all the leaves get blown off, it doesn’t matter.”

Because these trees reproduce vegetatively — that is, new plants grow from parts of a parent plant such as roots, stems or leaves — they are resilient to and can even propagate after this kind of storm damage, Henry said.

While breadfruit trees were introduced to the Caribbean by colonizers in 1793, the specific variety they brought in is noninvasive as it is seedless, and its propagation can be easily controlled. British explorers learned about them in the Pacific Islands, where the trees evolved to withstand tropical cyclones.

A convoy carrying aid to Black River, which was hit by Hurricane Melissa, makes its way through Holland Bamboo, Jamaica, Oct. 29, 2025, where downed trees and debris partially block the road. (Matias Delacroix/AP)

“They’ve had to adapt to challenging environments. And they do tend to be able to bend, like you see palm trees adapted to wind, they are able to resist some of those strong winds,” said Nyree Zerega, director of a collaborative program of plant biology and conservation between Northwestern University and the Chicago Botanic Garden. “And also when they do break, they grow back. Those are the characteristics that help them do really well in island-type settings.”

Zerega, who is a board member at the foundation, studies underutilized tree crops, especially in the genus Artocarpus, to which breadfruit belongs. She said research at Northwestern has shown there are some areas in the world, such as sub-Saharan Africa, where breadfruit could be grown in the future, depending on potential changes to the climate, boosting food security.

“You don’t have to replant a tree like you replant rice or you replant corn or wheat,” Mike McLaughlin said. “And these fruit trees live 100 years or more, and they’re giving you hundreds of fruit. The return on your initial investment — the financial return on the fruit tree — is huge.”

Once mature, he said, a single breadfruit tree can produce 100 to 200 fruits each year.

“The hundreds of thousands of trees, times hundreds of fruit per year — and each fruit can be multiple meals,” Mike McLaughlin said. Since the breadfruit program started, he said, “we’ve supported, we’ve fed people to the extent of, we estimate, 450 million meals over the course of time. That’s not every year, but over the course of time. So that’s a big impact.”

Mary McLaughlin compared the starchy, tropical fruit, which is round and yellow when ripe, to a potato growing from a tree, but with a shorter shelf life than a banana.

“Some (varieties) tend to have higher this or that than others, but on the whole, they all have a lot of valuable nutrients and minerals and vitamins,” said Zerega.

The fruit has a subtle, pleasant flavor that complements a wide variety of dishes, she said. And it can be prepared in many different ways.

“You can use breadfruit for anything that you can use a potato for,” Mary McLaughlin said. “You can boil it, you can roast it, you can fry it, and you can use the sun to dry it, and then it can be ground into flour.”

Still, there is an immediate need for food, as the second harvest season was just getting underway in Jamaica.

“All the crops are wiped out,” Hilton said. “And there’s going to be a serious issue with food security in the next six months.”

Fallen breadfruit, however, has emerged for locals as a crucial form of subsistence in recent weeks; two Jamaican newspapers wrote about people eating them in a pinch, as the food supply has suffered with roads impassable from the storm damage.

“The breadfruit trees that did come down,” Hilton said, “have been a godsend for some of the communities.”

As the country recovers, replanting more trees will be crucial to ensuring food security.

In the next few months, a new grant from the foundation will fund the planting of at least 15,000 trees in Jamaica, according to the McLaughlins.

The yearslong collaboration between the foundation and Jamaica’s Forestry Department began when the latter started replanting native forests, mostly timber trees such as blue mahoe and mahogany, that are more evolved to withstand strong winds.

“The plan is to use more and more natives in our reforestation programs and to transition some of the existing areas that have a high percentage of nonnative species,” Henry said. “This will increase the resilience of these spaces, particularly in light of the threat — the obvious and current problem of hurricanes in Jamaica.”

The couple approached the local government with the idea of also distributing fruit trees, which have the added benefit of offering a bountiful harvest every year without the need to replant a crop.

After moving to the United States for Mike McLaughlin’s job as an actuary in 1978, the McLaughlins settled down in the Chicago area a decade later. But their connection to their homeland remained strong, especially in the early 2000s when they began feeling an itch to take action because of the climate crisis and its consequences for island nations such as Jamaica. And so Trees That Feed was founded.

The way the partnership works in Jamaica, the foundation gives the Forestry Department grants to buy cuttings from the country’s plant nurseries, which the government then distributes among small farmers at no cost.

“We do get our hands dirty, but us two little people can’t plant half a million trees,” Mike McLaughlin said. “We work with farmers. They really know what they’re doing.”

“So we don’t go in and impose,” his wife added.

The farmers want a sense of ownership over the trees, she said, which carries on to the small businesses that can grow from selling the fruit.

The program facilitates food security and income generation, said Henry, the head of Jamaica’s Forestry Department.

“You heard of win-win? Well, this is win-win-win-win,” Mike McLaughlin said. “The win is nutrition. The win is the environment. And the win is the economy. … And our donors are generous people, and I would say they are winning too. They want to help, and we give them a way to help that is very efficient.”

adperez@chicagotribune.com

Elisabeth Rosenthal, KFF Health News 

A cancer patient might live in a town with four oncology groups, but only one accepts his insurance — the one owned by his insurer. A young couple could see huge bills after their child is born, because their insurer agreed to the health system’s rates in exchange for a contract with obstetricians across the country. A woman might have to pay a big sum she can’t afford for basic lab tests at a hospital — inflated rates her insurer accepted so its customers have access to the system’s children’s hospital elsewhere in the state.

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And even well-insured patients receive unaffordable bills in this era of high-deductible health plans, narrow insurance networks, and 20% cost sharing.

Health systems, doctor groups, and insurers are merging and coalescing into ever-bigger giants. While these mergers are good for business, studies show the escalating consolidation in health care is driving up prices, harming patient outcomes, and decreasing choice for people who need care. A recent study found that six years after hospitals acquired other hospitals, they had raised prices by 12.9%, with hospitals that engaged in multiple acquisitions raising their prices by 16.3%.

These new deals are “mutually enforced monopolization,” said Barak Richman, the Alexander Hamilton professor of business law at George Washington University. “It’s not competition. It’s more like collusion. They don’t care about price.”

Those market factors contributed to a landscape where a dose of the antiviral Paxlovid given in a hospital costs $4,500; magnetic resonance imaging costs $15,000; and joint replacements cost $100,000.

President Donald Trump has talked about the burden of health care costs since his first campaign, but he has signaled that his administration’s regulators are less inclined than his predecessor’s to intervene in health mergers.

This summer, he revoked President Joe Biden’s 2021 directive that all federal agencies make sure markets remain competitive, reversing course from Biden’s more expansive interpretation of antitrust law. And in a scathing statement upon taking over the Federal Trade Commission, Trump-appointed chair Andrew Ferguson blasted his predecessor, Lina Khan, implying that she had overstepped the agency’s legal authority, as well as criticizing what he called her “clumsy” and “breathless” rhetoric and her focus on the incursion of private equity into health care.

What this will mean in practice is unclear.

In an interview with KFF Health News, Daniel Guarnera, the director of the FTC’s Bureau of Competition, said that the leadership at the FTC and the Justice Department has endorsed guidelines issued by the Biden administration, which he characterized as a “framing device” for companies contemplating a merger.

The expanded merger guidelines, issued in 2023, focused for the first time on a wide variety of new types of anti-competitive practices that had become common in health care, such as hospitals and private equity firms buying doctors’ practices and insurers owning what are known as specialty pharmacies to dispense complicated and often expensive drugs.

Guarnera noted that regulators’ strongest enforcement tool is convincing a judge that mergers violate the Clayton Antitrust Act, a statute that is the foundation of antitrust law. But administrations can interpret this statute differently, and it’s unclear what cases the Trump administration’s FTC will choose to bring.

“The Biden administration tried to be more innovative,” said Erin Fuse Brown, a professor of health services, policy, and practice at Brown University’s School of Public Health. “The Trump administration has signaled a more traditional approach — that it’s unwilling to push the envelope.”

In the battle for profits between insurers and providers, each side insists it needs to grow bigger to hold sway in the negotiations that determine health care prices. But evidence shows the prices that make sense in industry-level dealmaking have little to do with the actual value of the services involved. Instead, they’re merely a data point in large-scale calculations that, at best, reflect the power balance between opposing parties.

Under Trump, the FTC has already sued to block two mergers of medical-device makers and has continued the Biden administration’s challenges of individual drug patents.

“Helping improve the health care system though ensuring that there is more and better competition are very, very high priorities for us at the FTC,” Guarnera said, noting that health care has “enormous effects on both Americans’ pocketbooks as well as well-being.”

But it is far more difficult to take on the more massive entities, and though the number of new mergers dipped early this year as companies navigated the uncertain effects of tariffs and interest rates, consolidation continues.

A recent Becker’s Hospital Review article identified “28 large health systems growing bigger,” noting, “This is not an exhaustive list.”

For example, in May, Northwell Health of New York merged with Connecticut’s Nuvance to become a 28-hospital behemoth with over 1,000 outpatient clinics. That was a more traditional merger, where hospitals in the same region joined to extend their reach and increase their market power.

Meanwhile, companies are creating powerhouses not previously seen in health care, by racking up smaller purchases that aren’t expensive enough to trigger federal review. They include what are known as vertical mergers, which combine companies that provide different functions in the same industry — most commonly, hospital systems or insurers buying doctors’ practices or specialty pharmacies.

For instance, UnitedHealth Group, the world’s largest health care company, now owns health insurance plans; physician practices and other providers; data and analytics services; payment processors; a pharmacy benefits manager; and pharmacies themselves. Jonathan Kanter, the competition czar in Biden’s Justice Department, has likened the UnitedHealth amalgamation to Amazon.

Likewise, hospital systems and private companies — often private equity firms — are increasingly expanding their reach to different regions, gobbling up hospitals, medical practices, and surgery centers. This kind of consolidation, known as a cross-market merger, allows companies to accumulate huge collections of doctors — and significant market power — across the country in particular specialties, such as gastroenterology, ophthalmology, pediatrics, or obstetrics.

Research shows a change in ownership means a change in prices. While pediatrics and obstetrics have traditionally been poorly paid specialties, for instance, they represent a land of opportunity to investors because parents are willing to pay more when it comes to care for their kids.

It used to be relatively simple for regulators to discern when a hospital that merged with its nearby competitor gained monopoly power, rendering it anti-competitive and driving up prices. Health researchers say these new, more complicated types of deals, creating a more complex interplay between insurers and medical providers, have made that tipping point much harder to define.

In health care, even more traditional, vertical consolidation can be problematic, Richman said. “Economic theory says it could be innocuous, like a suit manufacturer opening a store, even though studies show in health care it’s dangerous — higher prices, poorer quality, less choice,” he said.

For example, patients who have Cigna health plans and need an array of more expensive, often injectable prescriptions must use Accredo, the specialty pharmacy the insurer bought in 2018, even though a different pharmacy may have a better price.

Economists have developed computer modeling to predict when patients will experience higher prices and less choice because of these new types of consolidation. But judges who could nix the transactions are so far “not convinced,” said Daniel Arnold, a health economist at Brown’s School of Public Health.

Experts such as Fuse Brown say new laws and enforcement tools are needed.

“The old laws,” she said, “are just not calibrated to the complexity and novel types of mergers.”

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By MARTÍN ADAMES, Associated Press

SANTO DOMINGO, Dominican Republic (AP) — Baseball and bets go hand-in-hand in the Dominican Republic, where professional athletes, musicians and even legislators go public with their wagers.

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But for every legal bet in the Caribbean country, officials say there are countless more illegal ones.

It’s a widespread, multimillion-dollar industry that has come under scrutiny following U.S. federal indictments of Cleveland Guardians pitchers Emmanuel Clase and Luis Ortiz. They are accused of taking bribes from unnamed sports bettors in the Dominican Republic to throw certain pitches and help those bettors win at least $460,000, according to an indictment unsealed Sunday in New York. Ortiz and Clase have both pleaded not guilty.

The accusations have dismayed and embarrassed many in the players’ native country.

“The case of Emmanuel Clase and Luis Ortiz tarnishes the image of Dominican baseball players,” said José de los Santos, a fan of Dominican and Major League Baseball. “Actions of that nature put Dominican and Latino players in the spotlight.”

The DR has 3,500 registered betting shops, and those are just the legal ones

Sports betting shops are widespread in the Dominican Republic, a country of more than 11 million people where baseball is king.

According to data from the Dominican Association of Sports Betting Shops, there are about 3,500 registered businesses, and countless more illegal ones.

Quico Tabar, head of the country’s national lottery who was tasked by the president to regulate gambling, recently stated in a public letter that officials have been working for years to regulate betting shops but that “circumstances beyond our control” have not allowed that to happen. He did not elaborate.

For Raymond Jiménez, a self-described frequent sports gambler, it’s all the same.

He said he chooses the biggest and closest businesses that allow big wagers, regardless of whether they’re legal or not.

“I don’t know of any illegal betting shops,” he said.

Jiménez said most bets in the Dominican Republic focus on sports including MLB, NBA and NFL games.

“I’ve been gambling since 1998, when I was underage,” Jiménez said. “I used to jump the school fence to go into a betting shop at 14 years old. I’ve heard everything, from athletes who sell themselves to gamblers to others who bet against them.”

Gambling persists amid corruption

Legislators in the Dominican Republic are debating a bill that would create a new entity to regulate and oversee gambling and establish penalties for non-compliance.

Meanwhile, chatter about the Clase and Ortiz cases continues to dominate the news and social media, as does the case of Oscar Chalas, the Dominican Republic’s former director of casinos and gambling. He reached a plea deal with prosecutors in late October and admitted responsibility in collecting money from illegal betting shops to allow them to keep operating.

Chalas told a judge that each illegal shop paid up to $100 a month, but that he didn’t remember the total amount collected because there were “so many” of them. He also claimed that a former treasury minister knew and approved of the scheme, according to local media reports.

The pace of legal and illegal gambling is only expected to surge as local teams and fans prepare for the Dominican Republic’s Professional Baseball League final early next year.

One of the country’s most famous public bets involving the local league took place earlier this year. Hall of Famer and former Red Sox star David Ortiz offered fans a 1 million peso ($16,000) wager on social media in favor of the team that went on to win the championship — he ended up with 15 million pesos ($240,000) on the line. That included a 2 million peso ($32,000) bet with Dominican urban singer Bulin 47, but Ortiz forgave him after winning: “You’re good to those who are poor,” he wrote.