Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Eilon Caspi, Assistant Research Professor of Health, Intervention, and Policy, University of Connecticut

Fri, January 21, 2022

Conflicts between residents with dementia occur often in long-term care settings. CasarsaGuru/E+ via Getty Images

Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” wrote a former student. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.”

But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later.

The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, the agency determined. “There were no interventions implemented, no strategies developed,” the report stated.

Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001. 

Theresa Piccolo, CC BY-NC-ND

As a gerontologist and dementia behavior specialist, I’ve written a book on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “Fighting for Dignity.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes.
Reporting and stigmatizing

Resident-to-resident incidents are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.”

These incidents are prevalent in U.S. nursing homes. But they are largely overlooked by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents remain untracked, understudied and largely unaddressed.

An elderly man with severe injuries, including cut marks and bruises, across his face and forehead.

These interactions don’t just result in injuries and deaths among residents. They also leave behind devastated families who then must fight for answers and accountability from nursing homes.

Making matters worse, government reports, research studies and media coverage commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to label the incidents as “abuse,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on the phenomenon in Canada, the Toronto Star called it “abuse.”

Getting to the root of the real problem

Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require.

Two of every three residents involved in these incidents have dementia. One study found that the rate of these episodes was nearly three times higher in dementia care homes than in other long-term care homes. A recent study also found an association between residency in a dementia care home and higher rates of injurious or fatal interactions between residents.

But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that “push-fall” episodes constitute nearly half of fatal incidents.

Another U.S. study found that as residents’ cognitive functioning declined, they faced a greater likelihood of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents.

The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents is not abuse. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on fatal incidents in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.”

How incidents often occur

In one study, researchers examined situational triggers among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body.

That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. My own work and a different Canadian study came to similar conclusions.

Other research shows that when residents are bored or lack meaningful activity, they become involved in harmful interactions. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. Conflicts between roommates are also common and harmful.

Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents. Morsa Images/DigitalVision via Getty Images

A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that higher caseloads among nurses’ aides were associated with higher incident rates.

And with poor staffing levels in up to half of U.S. nursing homes, staff members do not witness many incidents. In fact, one study found that staff members missed the majority of unwanted bedroom entries by residents with severe dementia.
Residents with dementia are not to blame

In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents.

Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations.

Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control.

Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “duty to protect” Piccolo. “They did not keep my husband safe as they are required to do,” she said.

This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Eilon Caspi, University of Connecticut.

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I am a founding member and board member of Elder Voice Family Advocates in Minnesota.

I worked in reproductive healthcare, and ‘abortion’ is not a dirty word | Opinion



Monica Skoko Rodriguez
Thu, January 20, 2022

A dear friend called me out of the blue a few years ago. As a born and bred millennial, I know that a phone call without advance warning means something serious. On this phone call, she told me she was pregnant and asked me if I thought she should have an abortion.

At the time, I was working as a nurse for Planned Parenthood of South, East and North Florida (PPSENFL) helping to provide dignified abortion access to patients. I started blabbing about the safety of abortions. I got on my soapbox about how the movies get it all wrong — the majority of patients are incredibly confident in their decisions and that most abortions are either induced at home after consultation with a physician or take just a few minutes in a simple procedure.

I mentioned the hundreds of abortions I had assisted on and that not one had required care that wasn’t easily managed in clinic. I even threw in the trite statement that pregnancy is far riskier than abortion. I rambled that abortion will not affect fertility in the future nor the health of future pregnancies, nor will it increase risks of getting cancer — all these being frequent enough questions I had gotten from patients.

My friend stopped me during this dissertation and asked again, directly, if she should have an abortion. I answered with a question. “Do you want a child right now?”

Her “no” came swiftly and resolutely but her voice wavered with a follow up.

“But is it bad for me to have an abortion?”

This question shattered me. The existence of her question did not mean that she was unsure of what she wanted for herself, her future and her health, but that she was unsure that the world we live in would allow her to want it.
Lawmakers chipping away

Jan. 22, 2022, marks the 49th anniversary of the Roe v. Wade decision that ruled a pregnant person has the liberty to decide to have an abortion without excessive restriction, and yet here we are half a century later fighting about what that means. When I began working in reproductive health, I imagined a United States where the protections guaranteed by this decision were the floor, not a ceiling. I thought of myself working toward making reproductive healthcare more affordable and accessible and less stigmatized. This year, conservative lawmakers are resolved to chip away at the rights of patients to have autonomy over their bodies and their healthcare until the entire justice system caves in around us.

At PPSENFL, abortion nurses worked intake, procedure room or recovery room. We all rotated but recovery was my favorite by far because most patients would come out of the procedure room bathed in a glow of relief. Relief from the physical representation of a traumatic event. Relief that they can prioritize the children they currently have and attend school plays or pay for ballet lessons instead of taking on another job. In many cases, it meant they would still continue to struggle to make ends meet without figuring out how to feed one more mouth. I would see relief that they drove hours or flew to Miami and were able to access care.

Many times though, the relief had no tear-inducing story of difficult choices. The story was simply that a person wanted an abortion and got one because that is their right.
No caveats needed

We must roar as loudly as we can to deafen the stigma anti-abortion zealots have concocted and we need to shout as often as we can that abortion is healthcare and should be made unrestrictedly and equitably available, and fully funded.

“Abortion” is not a dirty word. Abortion does not need to be followed by caveats, explanations or shame. Everyone knows and loves someone who has had an abortion. From an aunt of mine who was secretly bused into the city in the 60’s and met in an alley by a stranger, to my friend who had projected society’s unfounded puritanism onto her bodily autonomy — may we continue to love them and continue to fight against those who refuse to respect or acknowledge the privilege and right of their decisions.

Monica Skoko Rodriguez is a former Planned Parenthood nurse and holds a master’s degree in public health from Johns Hopkins University. She is currently pursuing her doctorate in nursing practice from Duke University. She is the executive director of the Miami-Dade County Commission for Women and a board member of Ruth’s List Miami.

Cannabis CBD Might Be Highly Effective at Preventing COVID


Neel V. Patel
Fri, January 21, 2022

Unsplash

From the outset of the pandemic, the prospect that weed might be used to fight COVID-19 was tantalizing. After all, many people across the planet were getting high to pass the time during lockdown, and there is a long history of governments shunning the idea that cannabis might have health benefits, research be damned.

Still, the FDA and other health authorities were quick to say as far back as April 2020 there was no science to back up claims that weed was going to be useful in warding off the deadly disease.

That may have been premature. New, peer-reviewed research published Thursday in Science Advances suggests the popular non-psychoactive compound in cannabis known as cannabidiol, or CBD, can help prevent the novel coronavirus from replicating in human cells, reducing the chances of a full-blown infection. Another arm of the study also found that real-world patients who were prescribed CBD experienced lower rates of COVID-19.

Weed and Seven Benadryl: The Wild Lengths COVID Docs Are Taking to Get Sleep

“We just wanted to know if CBD would affect the immune system,” Marsha Rosner, a cancer biologist and expert in cell stress at the University of Chicago and a senior author of the new study, said in a statement. “No one in their right mind would have ever thought that it blocked viral replication, but that’s what it did.”

Rosner and her colleagues don’t yet recommend consuming CBD products—nor do they believe CBD could be a substitute for vaccination (still by far the best way to protect yourself). But the authors do advocate launching clinical trials soon to more rigorously probe whether it could be used as an additional therapeutic to prevent or slow down breakthrough COVID, an especially urgent task in light of the Omicron variant’s seemingly relentless spread.

In the first part of the study, authors exposed human lung cells in the lab to CBD for a couple hours before exposing the same cells to SARS-CoV-2 (the virus that causes COVID-19). They found that while the virus was still able to enter the cells, CBD inhibited the virus from hijacking the human cell machinery to replicate its own viral genome—an essential step for an infection to spread. The authors believe CBD boosts the production of an antiviral cell protein and other host cell responses that basically put a lockdown on gene replication.

The effects were the same in tests of two other types of human cells, for three different SARS-CoV-2 variants altogether (unfortunately big variants like Omicron and Delta were not tested). The team also treated live mice with CBD for a week before exposing them to COVID-19, and witnessed the same suppression of infection.

The second part of the study was a survey of 1,212 human patients who’ve been prescribed an oral CBD solution for the treatment of epilepsy, and showed only 6.2 percent had returned positive tests for COVID-19, compared to 8.9 percent of similar patients not taking CBD. Among patients who reported taking CBD the day they went in for a COVID-19 test, only 4.9 tested positive, compared to 9 percent in the control group.

Could There Be a Non-Vaccine COVID Cure?

But don’t go making plans to stock up on weed gummies or other cannabis products to protect yourself from COVID. Rosner specifically emphasized that “the commercially available CBD powder we looked at, which was off the shelf and something you could order online, was sometimes surprisingly of high purity but also of inconsistent quality.”

Still, it’s becoming less and less tenable to oppose deeper study of the relationship between cannabis and COVID. The new findings come just a week after Canadian researchers published their own study finding that other cannabis compounds exhibited anti-COVID effects as well.

“We are very eager to see some clinical trials on this subject get off the ground,” Rosner said. “Especially as we are seeing that the pandemic is still nowhere near the end, determining whether this generally safe, well-tolerated, and non-psychoactive cannabinoid might have antiviral effects against COVID-19 is of critical importance.”

Buffett Eyes Largest Wind Power Project Ever In U.S.


Thu, January 20, 2022

Warren Buffett’s investment firm Berkshire Hathaway has proposed a plan for a renewable energy project comprising wind and solar power that would cost $3.9 billion to build.

The Wind Prime project, according to BloombergNEF analyst Ethan Zindler, stands to potentially be the single largest wind project ever built in the United States. However, Zindler told Bloomberg, there have been such massive projects before that had never gotten to the finish line, so “there’s a long way to go for this project.”

The Wind PRIME project will include over 5 GW of wind power and some 50 MW of solar power, to be built in Iowa, Berkshire Hathaway subsidiary MidAmerican Energy said in a statement.

The capacity of the project would be enough to power some 600,000 households, according to Bloomberg.

“Iowa is a renewable energy leader, thanks in large part to MidAmerican Energy’s proven track record of clean energy commitments and investments that are a true competitive advantage for our state,” said Iowa Governor Kim Reynolds.

“MidAmerican’s Wind PRIME is a commitment and investment on a whole new level, cementing Iowa’s clean energy leadership for many years to come.”

MidAmerican Energy said in its statement that since 2014 it had invested some $14 billion in Iowa renewable energy projects. Now, besides the $4-billion wind-and-solar combo, the company also plans to invest in feasibility studies on other low-carbon energy technology, including carbon capture, energy storage, and modular nuclear reactors.

Wind power is already a significant energy source in Iowa, contributing over 40 percent of the state’s total energy output in 2019. As of the same year, Iowa’s nameplate wind power capacity stood at close to 10 GW.

Wind power in Iowa is also already a big business for Berkshire Hathaway—and Buffett himself noted how wind power had made the electricity bills of the company’s customers in Iowa much lower than those for electricity supplied by competitors.

“The extraordinary differential between our rates and theirs is largely the result of our huge accomplishments in converting wind into electricity,” Buffett said back in 2020, as quoted by Forbes.

By Charles Kennedy for Oilprice.com

"It's the most horrifying thing that can happen to you as a musher": Truck strike kills and injures sled dogs in Willow


Zachariah Hughes, Anchorage Daily News, Alaska
Fri, January 21, 2022, 7:47 AM·4 min read

Jan. 21—UPDATE: On Friday morning, Foucher wrote on Facebook that her dog Felicity had returned home.

Jaye Foucher doesn't know the name of the man whose truck ran through her dog-team, severing the gangline and dragging half the animals four or five truck-lengths up the Parks Highway before coming to a stop.

The collision was a series of accidents, leaving one dog dead, several injured, another loose, and Foucher distraught, reconciling with the lengthy and uncertain road to recovery ahead.

"I'm definitely running on fumes. I haven't really been able to eat. I'm shattered," Foucher said on Thursday. "I'm just kind of alternating between numb and devastated. It's the most horrifying thing that can happen to you as a musher."

She was on a training run early Wednesday afternoon in Willow, about a mile from where she and her team have been staying this winter, mushing the same trails they've been using since the fall. A snowmachine trail beside the highway was buried under thick snow sloughed off by recent road plowing that made it hard for her dogs to run.

"They thought it was a little too deep and decided the road looked much more appealing to them," Foucher said.

She called them back, trying to get them off the highway. A pickup truck hauling a flat snowmachine trailer was heading toward them. Foucher frantically waved her arms at the driver to get him to stop or swerve.

"I don't know how he didn't see us," she said. "He just kept barreling toward the team full blast."

She estimates the vehicle was moving at 50 miles per hour when it tore through her line of dogs.

In the aftermath, Foucher said the older couple in the truck helped her regain control of her animals, as did another driver and other mushers who happened upon the accident. One dog was killed instantly. Others were badly injured and Foucher was desperate to get them to the nearest emergency veterinarian, an hour away, as fast as she could.

"I was also pretty hysterical," she said.

In the commotion, she did not get the name or information of the driver, assuming he would stick around until the Alaska State Troopers arrived at the scene. She left to bring her dogs to the animal clinic.

"We have no idea who the driver of the truck was. I really wish they would come forward," Foucher said.

An online report from the Department of Public Safety said the driver stayed to help after the accident. Alaska State Troopers had not released the name of the driver as of Thursday evening, and spokesman Austin McDaniel said no citation or charges had been filed. It wasn't clear from his response whether troopers spoke with the vehicle owner.

Foucher was running the 11 dogs she'd planned on mushing in the upcoming Willow 300 race next week. Seven were released from the veterinary clinic on Wednesday evening, some totally unharmed and three or four with minor injuries. Two more underwent surgery overnight and remain in serious condition, including one of her main leaders, who's tail had to be amputated and faces an uncertain mushing future. Another leader, Noddy, died at the scene. As of Thursday afternoon, a 35-pound cream-colored dog named Felicity is still loose.

"(I'm) just praying she finds her way to someone's kennel in Willow," Foucher said.

At her dog yard on Thursday, there was a pile of straw and food bowl beside the front door in case Felicity came back. Foucher worked hard to control raw feelings recounting Wednesday's tragedy, but broke into tears as pointed out an empty dog house belonging to Noddy.

She is still processing what the accident means for a race season she'd long planned out. A former rock musician who lives in New Hampshire, Foucher relocated her team to Alaska to train for a rookie run at this year's Iditarod.

"I'm just taking it a day at a time," she said.

Donations have poured into the clinic where her dogs are being treated to cover their care. A friend set up a Go Fund Me to help pay for the future costs she'll incur as her dogs are further rehabilitated. Someone in her native New Hampshire even sent a DoorDash delivery of coffee and donuts to the veterinary techs taking care of her team.

"I'm floored and really touched," Foucher said.

Daily News photographer Emily Mesner contributed to this story from the Mat-Su.

Steelmaker CEO Warns North America Market a ‘Falling Knife’




Joe Deaux
Thu, January 20, 2022, 

(Bloomberg) -- The North American steel market is in for some rough months ahead, with excess supplies, rising inventories and shrinking demand, according to the head of Stelco Holdings Inc. Steelmaker shares fell.

“It’s a falling knife,” Stelco Chief Executive Officer Alan Kestenbaum said Thursday in an interview. “The question is when does it go the other way and where are we in the economic cycle? I think it turns at some point, but I don’t know where it bottoms out.”

The grim view for 2022 follows a stellar year for the industry, with the largest U.S. steelmakers expected to post record full-year earnings after domestic steel prices surged as much as 94% to an all-time high of nearly $2,000 a short ton. Kestenbaum was the first steel CEO to publicly sound the alarm two weeks ago when he warned investors that his company’s steel shipments are taking a hit as the rapid spread of omicron accelerates absenteeism internally and even more among customers’ work crews.

Shares of Stelco fell alongside the major U.S. steelmakers following Kestenbaum’s comments. The Canadian producer fell 6.3% in Toronto, while Nucor Corp., U.S. Steel Corp., Cleveland-Cliffs Inc. and Steel Dynamics Inc. erased gains for the day. An index of 14 steel companies dropped 3.5% and is on pace for the biggest weekly decline since June.

The situation is especially negative delivering into the automotive and construction sectors, with those industries reporting inventories are rising and customer demand is drying up, the head of the Hamilton, Ontario-based steelmaker said.

“When I spoke two weeks ago, there was a lack of visibility. Now we have vastly more and it’s pretty clear what’s happening: significant oversupply and significant shrinkage of demand right now and you’re seeing it in the inventory numbers,” he said

Steel shipments in the U.S. and Canada have plunged 17% since August and inventories have climbed 15% in the same period, according to data from the Metals Service Center Institute. Benchmark steel prices are down more than 26% since touching an all-time high at the end of August. And analysts at Bloomberg Intelligence said inflationary pressures and demand slowdown could make it harder for steel sector stocks to outperform in 2022.

“I don’t think there will be a choice but for people to acknowledge in the next couple weeks we’re in a difficult environment,” Kestenbaum said.

A well-supplied North American steel market sits in stark contrast to other industrial metals that are currently surging in price. Investors are worried supplies of aluminum, nickel and copper are dwindling across the globe, leaving consumers without material necessary to make enough of everything from beer cans to washing machines and automobiles. The price of steel, currently about $1,440 a ton, is still well above recent historical levels of about $840 a ton.

(Updates with closing share prices in fourth paragraph and base metals performance in final paragraph)

Most Read from Bloomberg Businessweek

Worker was scheduled as ‘Black boy,’ suit says. Now Louisiana meat company must pay up



Hayley Fowler
Thu, January 20, 2022, 3:29 PM·3 min read

A specialty meat supplier in southern Louisiana will pay a former employee $67,500 to settle allegations of pervasive racial discrimination at its two facilities outside Lafayette, federal officials said.

Don’s Specialty Meats, a purveyor of Cajun favorites like Boudin and Cracklin, is accused of allowing its general manager to routinely use derogatory language and racial slurs against a Black worker — one of two out of 79 employees, the Equal Employment Opportunity Commission said in federal court filings.

The EEOC is the federal agency tasked with enforcing anti-discrimination laws in the workplace and filed the lawsuit on the former employee’s behalf.

“Harassment based on race and the use of racial slurs is intolerable, and an employer must act to assure that harassment of this kind is prevented and, if it happens, is vigorously addressed,” EEOC trial attorney Peter Theis said in a news release announcing the settlement.

Lawyers and a representative from Don’s Specialty Meats did not immediately respond to McClatchy News’ request for comment on Thursday, Jan. 20.

Under the terms of the agreement, Don’s Specialty Meats has agreed to pay the employee $50,000 in damages and $17,500 in back pay, according to court documents. The company is also barred from discussing the litigation if asked for a job reference regarding the former worker and must wipe it from his personnel file.

Employees will additionally undergo training on anti-discrimination laws, and the company will revise its written anti-discrimination policies and provide compliance reports to the EEOC.

The federal agency first reached out to Don’s Specialty Meats in August after the former employee filed a charge of discrimination and the EEOC determined there was reasonable cause to believe the company had discriminated against him.

But attempts to resolve the dispute outside of court failed, the EEOC said, and a federal complaint was filed in the Western District of Louisiana on Sept. 24.

According to the lawsuit, Don’s Specialty Meats hired the now-former employee in 2018. He worked first at its facility in Scott, Louisiana, and later at its original location in nearby Carencro. Don’s was started in 1993 and opened a second location in 2005, according to its Facebook page. The meat supplier is famous for its Boudin, a mixture of rice, ground pork and seasonings stuffed into sausage casing.

The employee, whom the EEOC described as African American, was one of just two Black workers employed by Don’s Specialty Meats at each facility during his tenure.

The general manager repeatedly referred to him as “Black boy,” “the Black boy” or “little Black guy,” the EEOC said, and he was listed on the work schedule as “Black boy” while his non-Black colleagues were identified by name.

Racial slurs were also common at Don’s Specialty Meats, according to the lawsuit. The general manager was accused of routinely using the n-word and referring to another Black employee’s baby as such. When Don’s was looking for new hires, the employee was told applicants “just can’t be Black,” the EEOC said, and if trash needed to be picked up on the roadside, it was always “the Black boy” who was assigned to do it.

Things came to a head in early July 2020, when a supervisor repeatedly called the employee a racial slur and other insulting names in front of his coworkers, the complaint states.

The employee complained to management and was subsequently dismissed for the day, the EEOC said. When he returned to work, he was reportedly told the supervisor would not be punished. According to the lawsuit, the general manager then told the employee he loved him and referred to him by the same derogatory name the supervisor had used.

He quit the following day, the EEOC said, and the only discipline his supervisor ever faced was being told she couldn’t wear her Don’s Specialty Meats T-shirt for a day.

Ukraine got a signed commitment in 1994 to ensure its security – but can the US and allies stop Putin's aggression now?

Lee Feinstein, Founding Dean and Professor of International Studies, Hamilton Lugar School, Indiana University 

 Mariana Budjeryn, Research Associate, Harvard Kennedy School

Fri, January 21, 2022,

A Ukrainian soldier uses a periscope to view the positions of Russian-led forces on Dec. 12, 2021, in Zolote, Ukraine. Brendan Hoffman/Getty Images

Russia’s illegal annexation of Ukraine’s Crimean Peninsula in 2014 was the first change of internationally recognized borders in Europe through military force since World War II.

Russia proceeded to instigate and fuel a war in eastern Ukraine that has claimed some 14,000 lives so far. Last year, Russia began massing a force of more than 100,000 troops along Ukraine’s eastern and northern border and in the occupied Crimea, and taking other provocative actions. U.S. President Joe Biden said on Jan. 19, 2022, about Putin: “Do I think he’ll test the West, test the United States and NATO, as significantly as he can? Yes, I think he will.”

Ukraine as an independent state was born from the 1991 collapse of the Soviet Union. Its independence came with a complicated Cold War inheritance: the world’s third-largest stockpile of nuclear weapons. Ukraine was one of the three non-Russian former Soviet states, including Belarus and Kazakhstan, that emerged from the Soviet collapse with nuclear weapons on its territory.

The U.S., in a burst of diplomatic energy and at a time of unmatched global influence, worked to prevent the unprecedented collapse of a nuclear superpower from leading to history’s largest proliferation of nuclear weapons.

This diplomatic activity manifested in security assurances for Ukraine embedded in what has become known as the Budapest Memorandum. With the entrance of Ukraine into the international order as a non-nuclear state, Russia, the U.S. and the U.K. pledged to “respect the independence and sovereignty and the existing borders of Ukraine.” The memo reaffirmed their obligation to “refrain from the threat or use of force against the territorial integrity or political independence of Ukraine.” The signatories also reaffirmed their commitment to “seek immediate” UN Security Council action “to provide assistance to Ukraine … if Ukraine should become a victim of an act of aggression.” These assurances upheld obligations contained in the U.N. charter and the 1975 Helsinki Final Act.

Ukraine, in turn, gave up the nuclear weapons within its borders, sending them to Russia for dismantling.

In light of Russia’s annexation of Crimea and its current threat to Ukrainian sovereignty, it’s fair to ask: What is the significance now of the Budapest Memorandum?

A soldier wearing a face mask and large helmet and carrying a rifle.

Ukrainian regrets

The memorandum, signed in 1994, is not legally binding.

Nonetheless, it embeds and reaffirms the solemn assurances that are the hallmark of the international system. These include respect for state sovereignty, the inviolability of international borders and abstention from the threat or use of force.

Ukraine’s decision to give up nuclear weapons signaled its desire to be seen as a member in good standing of the international community, rather than an outlier.

The decision was not just symbolic. While Ukraine did not inherit a fully fledged nuclear capacity – Russia still held important parts of the nuclear infrastructure – Ukraine had the necessary technological and industrial ability to close the gaps.

Many in Ukraine feel that the country’s 1994 decision to give up its nuclear arms was a mistake.

Popular support for nuclear rearmament rose to a historic high of nearly 50% in the wake of Russia’s invasion in 2014. Since then, that view has been supported by some Ukrainian public figures.

Vladimir Putin in a winter coat with a fur collar, speaking into a microphone at a rally and looking excited and happy.

‘No changing of borders by use of force’

Russia has blatantly violated the Budapest Memorandum. And the initial response to the annexation of Crimea by the other signatories, the U.S. and U.K., was hesitant and restrained.

The U.S. has committed more than US$2.5 billion in military assistance since 2014 to Ukraine, including lethal defensive arms. Legislation pending in Congress would increase military aid. The Biden administration has also threatened severe economic sanctions in the event of Russian aggression, backed by sustained efforts to build support among allies. The adminstration’s resolute approach is consistent with the security assurances of the Budapest Memorandum.

We are both foreign policy scholars; one of us is a former U.S. ambassador to Poland. The strong defense of the fundamental principle of the international system – no changing of borders by use of force – has consequence for all of Europe, for U.S.-Russia relations and for other potential flash points, including China and Taiwan.

Whether the strong actions – such as the promise of military support for Ukraine and the threat of sanctions on Russia, backed by diplomacy by the United States and its allies – will be enough to deter Russia is uncertain and, many say, unlikely.

The size and scope of Russian military buildup are deeply troubling: Shifting 100,000 troops across Russia’s vast territory is a costly operation. The Kremlin is unlikely to pull back that kind of force without any diplomatic or military wins, such as closing the door to Ukraine’s future membership in NATO, which the United States has ruled out.

International law matters, but it does not determine what states do. Strong deterrence, diplomacy and international solidarity can influence Russian decision-making. The U.S. is also actively working with Ukraine, an essential element to a successful diplomatic and deterrence strategy.

Ultimately, however, the de-escalation decision is Russia’s to make. The role of the U.S., its NATO allies, and Ukraine is to make sure the consequences of Russia’s decisions are clear to the Kremlin and that they can be carried out with strong and united Western backing in the event Russia chooses the path of war.


This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Lee Feinstein, Indiana University and Mariana Budjeryn, Harvard Kennedy School.

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Still think voter suppression is a myth? This Republican bill proves otherwise

Elvia Díaz, Arizona Republic
Thu, January 20, 2022

Arizona Rep. Walt Blackman has proposed a bill to scale back 

early voting and ratchet up the ID requirements to vote.

Arizona state Rep. Walt Blackman is busting the Republican narrative that voter suppression is just a myth.

There are a flurry of bills being introduced at the Arizona Legislature that Republicans say deal with “election integrity” but are just tools to make it a lot harder for people to vote.

Don’t believe me? I give you Exhibit A.

Blackman is proposing that early voting occur only by request, and that non-early voting must to take place in a polling place or a center.

Blackman also wants to require a new voter ID card, which would require a passport or citizenship certificate and other documents, to vote. On top of that, anyone voting in person would also need either fingerprints or a “unique security code” issued to the voter.

It's a hurdle to keep people from voting

Don’t tell me this isn’t a blatant hurdle to discourage people, especially minorities, the poor and Native Americans from voting.

The proposed legislation, House Bill 2577, would replace existing voter ID requirements, including driver’s licenses and all forms of tribal IDs.

Arizona already doesn’t issue driver’s licenses to undocumented immigrants, which means none of these people could vote illegally, as some Republicans have falsely claimed.

But even if we were to give them the benefit of the doubt and agree to extra layers of security, requiring fingerprints and a passport or naturalization papers is just over the top and nothing more than a hurdle to voting.

Why is this voter suppression if the requirements apply to everyone? Because so many people of color don’t have equal access to these types of ID.

Unfortunately, too many minorities still need multiple jobs to make ends meet and are more likely to rely on public transportation to go anywhere. They don’t have money to spare for a passport or may not even know how to navigate the system to get one.

Rural voters and Native Americans are particularly vulnerable to these types of hurdles. Arizona has 22 tribes, many in remote areas where residents already have to travel long distances just to vote.

And now, Blackman is proposing to invalidate their tribal ID card for the purpose of voting. You don’t call that voter suppression?

This isn't about 'election integrity'

Blackman’s legislation has nothing to do with “election integrity” and everything to do with keeping certain segments of the population from voting.

Republicans in Arizona and across the nation will keep invoking Trump’s “Big Lie” that the 2020 presidential election was stolen from him to push through restrictive election laws.

They’re free to do so after the U.S. Senate failed this week to approve sweeping federal legislation that would have overridden state voter suppression bills.

Blame Democratic Sens. Kyrsten Sinema of Arizona and Joe Manchin of West Virginia for that. They joined the 50 Senate Republicans in opposing changing the filibuster to approve the federal voting legislation.

Democrats like Arizona House Minority Leader Reginald Bolding are vowing to keep fighting, but the near future is bleak.

“History will remember those who chose to silence the voice of voters for their own political gains,” Bolding, who also is running for secretary of state, said in a statement about the U.S. Senate’s failed attempt to pass voting legislation.

“But like those before us, we cannot give up. We cannot sit down. We cannot tolerate the efforts by the Right to take away our most sacred American right, our freedom to vote.”

That sounds great. Meanwhile, though, Republicans like Blackman are free to try anything to discourage people from casting a ballot – the cornerstone of any democracy.

Indiana bill proposal seeks ivermectin as COVID treatment. Why pharmacists are up in arms


Shari Rudavsky, Indianapolis Star
Thu, January 20, 2022, 

An Indiana lawmaker has proposed a bill that would open the door for the use of a controversial medicine to prevent and treat cases of COVID-19.

Under House Bill 1372, a doctor or advanced practice registered nurse could write a standing order for ivermectin, an anti-parasitic drug, that would allow pharmacists to dispense the drug. The legislation also stipulates that the pharmacist must not provide information that discourages using ivermectin to treat COVID-19.

Approved to treat infections caused by worms, ivermectin has gained popularity in some circles as a prophylactic treatment against COVID-19. The Food and Drug Administration, however, says that ivermectin should never be used to treat or prevent COVID-19 and says that its incorrect use has required some to seek medical treatment.

But others believe that many doctors are overlooking ivermectin’s potential as a therapy for COVID-19.

"The risks are low and the potential gains are high,” said Rep Curt Nisly, R-Goshen, the bill’s author, in an emailed statement. “Why wouldn't we make this available, especially if we want Hoosiers to stop using horse paste. Hoosiers should be able to care for their health safely and effectively."

COVID-19 cases: Indiana schools buckling under weight of eye-popping new record

Some people who have been unable to get a doctor's prescription for ivermectin have opted instead to self-medicate, using medicine designed for horses and cows rather than humans.

Noting that the drug is available over the counter in some countries, Nisly cited Wisconsin physician Pierre Kory, who has said that a treatment that includes ivermectin could reduce COVID-19 deaths by about 75%. Kory himself later contracted COVID-19 though that did not shake his belief in ivermectin.

At this point, Kory is an outlier in the medical community. Both the government and major medical groups are warning against its use and ivermectin-related poisonings skyrocketed in 2021.

The bill also protects any health care provider who prescribes ivermectin from disciplinary action for doing so. The Federation of State Medical Boards in a statement last summer issued a thinly veiled threat that doctors who spread misinformation about COVID-19 are risking disciplinary action from their state medical boards. At least one Washington State physician assistant had his license suspended after he promoted the use of ivermectin.

While the bill has been assigned to the House Committee on Public Health, at this point it looks unlikely to advance.

'Everyone is so tired': Inside IU Health Methodist as it is overwhelmed by COVID patients

Some people are ingesting these two horse dewormers that contain the controversial drug ivermectin as a prevention against COVID-19.

 TOM E. PUSKAR/TIMES-GAZETTE.COM

Both the Indiana Pharmacists Association and the Indiana State Medical Association decried the bill as “dangerous,” particularly the part that would prohibit providers from discouraging patients from using the treatment.

“Pharmacists, and all health care professionals, should be free from government interference in the professional advice they provide patients,” the Indiana Pharmacists Association’s executive vice president Darren Covington said in an email. “This bill would set a dangerous precedent by having the government substitute its own medical advice for that of a trained, health care professional. “

In a similar vein, ISMA President Dr. Elizabeth Struble said in an emailed statement that she found the proposed legislation concerning.

“A health care provider prescribing an unproven therapy can be dangerous for the health of Hoosiers,” said Struble, a family practice physician with the Lutheran Health Network in North Manchester: What’s even more dangerous is legislating the creation of a very broad standing order mechanism so pharmacists can freely dispense an unproven therapy, preventing patients from receiving accurate information about the risks of that unproven therapy and insulating the health care providers who facilitate patients receiving this unproven therapy.”

Some ivermectin supporters have tried other avenues to access the drug. In September a woman sued Ascension St. Vincent, asking the courts to intervene and require the doctors to prescribe ivermectin for her mother. A few weeks later she dropped the suit after her mother started improving without the drug.

'An extraordinary disruption': Hoosiers struggle as COVID shutters schools and businesses

Nisly also pushed unsuccessfully to end Gov. Eric Holcomb's orders to close many businesses during the initial year of the COVID-19 pandemic and pushed to limit the governor's authority in such emergencies.

He was one of two lawmakers who declined to wear masks during the ceremonial start of the 2020 legislative session at the Statehouse before vaccines were available. At the time, all Hoosiers were under an order from the governor to wear masks when in public spaces, though the governor said he did not have such authority over lawmakers at the Statehouse.

‘Like witnessing a birth in a morgue’: 

the volunteers working to save the

 Joshua trees


Max Ufberg, with photographs by Kovi Konowiecki

Thu, January 20, 2022, 

The trees are not exactly imposing. Slim and spiny, with limbs that grip small poms of sharp leaves, they look like something a child might dream up. Or maybe Salvador Dalí. Even the name, Joshua tree, sounds kind of awkward.

On a wet and chilly December morning, I stood at a makeshift encampment in the Mojave national preserve in San Bernardino county, California, listening as a group of strangers fretted over the trees’ precarious future. Within the preserve is Cima Dome, a broad-sloping mound that, until recently, contained the densest Joshua tree forest in the world.

That changed in August 2020, when a lightning storm ignited the Dome fire, which ripped through over 43,000 acres of Cima Dome and burned about 1.3m Joshua trees. Given that Joshua trees – which technically are not trees but a species of desert succulent – are native only to the south-western US, the Dome fire represented an outright disaster to their survival.

Looking out that morning, I saw seemingly endless fields of the trees’ scorched and tortured carcasses. This was a terrible harbinger of things to come: a 2019 Ecosphere journal study determined that, if carbon emissions stay at current levels, just 0.02% of the species would survive.



The August 2020 Dome Fire in the Mojave national preserve burned more than 1m Joshua trees to varying degrees.

Now, a year and a half later, a wide-ranging group of volunteers are working alongside the National Park Service, which manages the preserve, to replant Joshua trees.

When I visited in early December, the plan was to plant 1,500 seedlings over the next several weeks. The 18 people spending their day (or days, in some cases) with the trees included civilians from all walks of life, members of the Arizona and Nevada Conservation Corps, and a group of women who brought along two pack camels to help carry baby Joshua trees through some of the more treacherous terrain. Joshua trees typically have a lifespan of 150 years; if all goes according to plan, these saplings will become a fixture of the preserve for a long, long time.

Among those assembled was Brendan Cummings, the conservation director with the Center for Biological Diversity, a national non-profit focused on saving imperiled plants and animals. Tall and wiry with a thick head of salt and pepper hair and a pensive demeanor, Cummings is spearheading an attempt to list the tree under the state-level Endangered Species Act. “What they’re doing could be the model for what climate restoration will look like,” he told me on the phone a few weeks prior.

In December 2021, a group of volunteers traveled to the Mojave national preserve to plant 1,500 eastern Joshua tree seedlings

The threat isn’t just wildfires. The climate crisis, invasive grasses and poor migration patterns for the trees’ seeds all contribute to the species’ imperilment. Human development – the trees have been cleared out to build anything from new neighborhoods to solar farms – isn’t helping matters. Because the threats are so varied, it can be difficult to calculate exactly how many trees are in danger (something land developers love to point out).

But Cummings believes that fact is beside the point. “You don’t need to know whether there were 500 passengers or 2,000 passengers on the Titanic to know that the entire population was threatened when they hit an iceberg,” he said as we stood near the basecamp on that frigid winter day.

A western Joshua tree in the Mojave Desert. About 40% of the western varietal is on private land that will probably be developed.

After about an hour’s wait – the camels were ultimately unwilling to saddle the load of supplies, “living up to the stereotype of being recalcitrant”, as Cummings put it – the volunteers were split into small groups and directed to designated sites. There they would plant the spiky green seedlings that, if all went according to plan, would over the course of a few decades replace the blackened husks of trees that now line the landscape.

•••

Though they look pretty similar, there are in fact two different species of Joshua trees: western and eastern. The majority of easterns are located on federal land and are not under threat by developers. Cummings’ work as a conservationist focuses on the western variety. “Most of the range of the eastern species is on federal land, which is never going to get bulldozed,” he said. “About 40% of western Joshua tree habitat is on private land, and most of that will ultimately get developed.”

A solar panel at the Antelope Valley solar ranch in the western Mojave Desert. Solar farms such as this one can contribute to the endangerment of Joshua trees because building them can require forests to be cleared out.

Cummings’ fight to save the western species picked up steam in September 2020, when the California fish and game commission accepted a petition he authored to offer endangered protections to Joshua trees for one year (since extended to May of 2022), during which the agency is conducting research into the plants’ long-term viability. Those protections made it illegal to damage or remove Joshua trees without special permits. (That ban didn’t apply to everyone: the commission approved an exemption allowing solar projects in Kern and San Bernardino counties to continue removing Joshua trees during construction.)

“After the commission receives the report, it can complete the process to make a final determination whether or not to list the Joshua tree as threatened or endangered under the California Endangered Species Act,” said Rachel Ballanti, deputy executive director of California fish and game commission.

Though temporary, the decision was still precedent-setting: it marked the first time a plant species was given protection as a result of a climate crisis threat.

“Climate change is creating a much hotter and much drier desert environment, and that is restricting species’ ability to reproduce,” said Cameron Barrows, one of the Ecosphere study’s authors and an ecologist with the University of California, Riverside. In the case of Joshua trees, drought has left the soil too dry to sustain saplings. As a result, we’re left with a species that skews quite old. It’s sort of akin, as Barrows explained, to a community with a senior center but no elementary school: “You would immediately realize the community has a very short lifespan.”

•••

This isn’t Cummings’ first conservation rodeo. He was also part of the successful push to get the polar bear listed as endangered under the Bush administration. Yet, all these years later, the bear is still on thin ice, with recent estimates warning the species could be wiped out by the end of the century.

I asked Cummings if, given this fact, all the conversation around government protections really matter in the first place. He nodded his head in amusement; clearly he was expecting the question.


Volunteers Brendan Cummings and Chris Clarke plant eastern Joshua tree saplings in the Mojave national preserve.

“If you look at the modeling for say, polar bears in Alaska, if we halt global warming in the next 20 years, even in that optimistic scenario, polar bears have about an 80% chance of extinction,” he said. “However, if you reduce other threats that kill polar bears – oil development in their habitat in the Arctic Refuge, trophy hunting – the extinction risk drops from 80% down to about 50%. You have a significantly greater chance of a species surviving, if you can reduce those other threats.”

The same thing, he explained, applies to Joshua trees.

It’s not exactly a sunny outlook, but coming from a man who’s dedicated his life to the preservation of the natural world, it’s probably the most clear-eyed view we’ve got.

Map of Joshua tree planting sites at a basecamp in the Mojave national preserve.

In the meantime, all he can do is dig. Crouching over a sapling, Cummings and the other volunteers were given a quick run-down on planting the dozen eastern babies they had been assigned: why, for example, it’s important to build a berm around the sapling (it helps to retain water), or why only half of the saplings are encased by small chicken-wire cages (a maze of regulations prohibit the use of fencing, so they’re conducting a mini-field experiment to evaluate whether the barriers will improve life expectancy). “A lot of red tape to navigate,” explained Nic Anderson, the unofficial supervisor and a researcher with the Great Basin Institute, an environmental group working closely with the National Park Service.

Soon enough the volunteers were packing their infant plants into the soil, all under the mournful gaze of the thousands of burned Joshua trees. It was a hopeful sight, but also an eerie one: like witnessing a birth in a morgue.

Left: Chris Clarke and Brendan Cummings place a chicken-wire cage around recently planted saplings. Right: A western Joshua tree in the west Mojave.

I got to talking with volunteer Chris Clarke, an associate director with the National Parks Conservation Association, another environmental group. Clarke explained how the Dome fire didn’t just impact the trees, but also the antelope squirrels that eat their seeds, and the ladder-backed woodpeckers that look for insects in their limbs. And the desert night lizards that seek shelter under their stumps. And tortoises. And jackrabbits. And cottontail rabbits. “There are lots of animals that depend on the Joshua tree forest for food,” he explained. “The Joshua tree is really the linchpin of the ecosystem.”

After about two hours, the group had all 12 of their saplings firmly planted into the ground. By then the rain had picked up and temperatures had dipped into the 40s, and the caravans of tree-huggers decided to head back to base. It was a modest effort, and one that even in the best-case scenario, won’t come to approaching the scale of devastation wrought by the Dome fire. But the process was therapeutic for the humans involved as much as it was restorative for the ecosystem.


Park ranger Sierra Willoughby caresses the burned bark of a Joshua tree.

And maybe the dead trees aren’t so dead after all. Though the Mojave national preserve staff had initially believed every tree was dead, they’d suddenly noticed a handful of natural new growths sprouting from the husks of the charred trees (though it’s macabre, imagine a baby limb on a decaying corpse). As Cummings and I strolled through the forests near the basecamp, he couldn’t help but eagerly point out any unexpected saplings. Even after 16 years living among the trees in the town of Joshua Tree, he’s still amazed by them.

“You walk through the burned Cima Dome and feel a little hopeless,” Cummings said. “But dig a hole and plant a new tree in the ground and suddenly it feels a little less hopeless.”

Canada's Trudeau vows action after four freeze to death in 'mind blowing' tragedy


FILE PHOTO: A sign post for the small border town of Emerson,

 near the Canada-U.S border crossing


Fri, January 21, 2022
By David Ljunggren

OTTAWA (Reuters) -Canada is doing all it can stop people smuggling across the U.S. border after a family of four froze to death in a "mind blowing' tragedy, Prime Minister Justin Trudeau said on Friday.

U.S. authorities have charged a U.S. man with human trafficking after the four - a man, woman, baby and teenager - were found dead in the province of Manitoba, a few yards north of the frontier with Minnesota.

The four have tentatively been identified as a family from India, part of a larger group trying to enter the United States by walking across snow-covered fields in a remote region during blizzard-like conditions.

"It was an absolutely mind-blowing story. It's so tragic to see a family die like that, victims of human traffickers ... and of people who took advantage of their desire to build a better life," Trudeau told a news conference.

"This is why we are doing all we can to discourage people from crossing the border in an irregular or illicit manner."

Canada, Trudeau said, was working very closely with the United States to stop smuggling and help people "taking unacceptable risks."

The four people died about 6 miles (10 km) east of Emerson, a small farming community. David Carlson, head of the local municipal council, said there was no shelter at all in the area.

"It would almost be like a lunar-type landscape and you can become lost or disoriented very quickly in those kinds of conditions, especially as you're beginning to freeze and no doubt panic," he told the Canadian Broadcasting Corp.

"There's no lights up there. You would have probably been in close to zero visibility."

Emerson said the incident was unusual since in the past, people have tried to cross into Canada from the United States, rather than the other way round.

(Reporting by David Ljunggren in Ottawa and Ismail Shakil in BengaluruEditing by Tomasz Janowski and Aurora Ellis)

Letters to the Editor: 

Here's a revolutionary idea to fix

homelessness — lower rent

Fri, January 21, 2022

Recreational vehicles that serve as homes for the unhoused line Main Street in Venice Beach on Tuesday. (Los Angeles Times)

To the editor: I read Steve Lopez's column on L.A. mayoral hopeful Rep. Karen Bass that focused on our favorite complaint here on the Westside — homelessness. While I agree that it's a huge problem, I'm tired of hearing about it.

How about fixing homelessness by fixing rent? If people could afford apartments, they wouldn't be desperate for housing.

I want our local and state politicians to address homelessness on the front end, not just the back. All around me are new housing developments, some comprising hundreds of apartments, including studios that rent for $3,000. How is that helping anyone but the developers and corporate landlords?

Our politicians, from the local to the state level, sidestep legislation to provide affordable housing, continuing to give rich real estate investors great deals in prime locations. What's going to happen when we run out of tax and grant money for alleviating homelessness and still have a problem?

Barbara Pawley, Los Angeles