BEAUTY

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The wild ride of East Africa’s favorite stimulant #ศาสตร์เกษตรดินปุ๋ย

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380783?utm_source=category&utm_medium=internal_referral

The wild ride of East Africa’s favorite stimulant

Jan 19. 2020
A worker shows the miraa leaves he picked at a farm near Maua. MUST CREDIT: Photo for The Washington Post by Luis Tato

A worker shows the miraa leaves he picked at a farm near Maua. MUST CREDIT: Photo for The Washington Post by Luis Tato
By The Washington Post · Max Bearak 

MAUA, Kenya – It’s an unassuming little red-and-green leaf, but the powers unlocked by chewing it have hooked millions of people around the world, made it one of Kenya’s leading exports and gotten it banned in the United States and much of Europe.

Known as miraa in Kenya and Somalia and qat, or khat, in Arabic, its users say munching it for a few hours makes them alert and talkative, much like coffee would. But the potency of the leaf starts to wane as soon as it is picked off the tree, presenting a major challenge to suppliers in this more than $400-million-a-year industry: how to get it from the hills of central Kenya – the miraa heartland – to Nairobi, Mogadishu and other hubs of its biggest fans – the Somali community – without delay.

A picker works under the rain picking miraa from a farm located near Maua, Kenya in November 2019. MUST CREDIT: Photo for The Washington Post by Luis Tato

A picker works under the rain picking miraa from a farm located near Maua, Kenya in November 2019. MUST CREDIT: Photo for The Washington Post by Luis Tato

The answer lies in a breakneck production cycle in which the leaves are plucked, sorted, bundled and shipped in wildly careening pickup trucks to distribution centers in Nairobi, 180 miles away, in just a few chaotic hours.

Workers bundle miraa for distribution in a storehouse near Maua. MUST CREDIT: Photo for The Washington Post by Luis Tato

Workers bundle miraa for distribution in a storehouse near Maua. MUST CREDIT: Photo for The Washington Post by Luis Tato

The business, which is legal in Kenya, is run by trade organizations that operate like mafias. Numerous suppliers have been investigated for allegedly using unlicensed planes to fly miraa to Somalia from Nairobi, as well as allegedly using the trade as a front for money laundering. The Washington Post witnessed evidence of child labor in one miraa sorting warehouse in Maua.

Farmers arrive to sell their fresh miraa to resellers in Maua. MUST CREDIT: Photo for The Washington Post by Luis Tato Photo by: Luis Tato — For The Washington Post

Farmers arrive to sell their fresh miraa to resellers in Maua. MUST CREDIT: Photo for The Washington Post by Luis Tato Photo by: Luis Tato — For The Washington Post

The United States, Britain and other European countries have banned the leaf, classifying it as a drug even though its addictiveness has not been proved. Producers say the bans are absurd, even racist. Half a million Kenyans rely on miraa for their livelihood, according to the Kenyan government. Daniel Ngolua, a miraa farmer, calls it a “cultural treasure for us.”

A motorbike driver leaves a market in Maua carrying miraa bunches. MUST CREDIT: Photo for The Washington Post by Luis Tato

A motorbike driver leaves a market in Maua carrying miraa bunches. MUST CREDIT: Photo for The Washington Post by Luis Tato

The bundles of delicate miraa leaves are packed in sturdier banana leaves and loaded by the ton into the beds of pickup trucks.

The ride to Nairobi from Maua is a three-hour roller coaster along winding country roads, speeding constantly at 100 mph without touching the brakes, through busy towns and villages, flying over speed bumps, running dozens of cars and pedestrians off the road along the way. Bystanders cheer the drivers on like action-movie heroes. Drivers say they are always balancing the risks with the payoff.

Benjamin Karenga speaks with clients while speeding his way to Nairobi to deliver fresh miraa. MUST CREDIT: Photo for The Washington Post by Luis Tato

Benjamin Karenga speaks with clients while speeding his way to Nairobi to deliver fresh miraa. MUST CREDIT: Photo for The Washington Post by Luis Tato

Benjamin Karengea, 30, has done the drive from Maua to Nairobi once a day, every day, for eight years. “It is a very dangerous work but, what can I do? It provides for me and my family,” he said. “I am Christian and I have faith. The only thing I can do before taking off is pray.”

At the end of the drive, miraa is unloaded at a market in Nairobi. MUST CREDIT: Photo for The Washington Post by Luis Tato

At the end of the drive, miraa is unloaded at a market in Nairobi. MUST CREDIT: Photo for The Washington Post by Luis Tato

Many of the trucks head for Nairobi’s Little Somalia, Eastleigh, while the rest goes straight to the international airport for shipment to Somalia.

The Post was granted access by the Kenya Airport Authority to witness the loading process, but hesitant traders and cargo operators blocked a photographer from taking photos.

Why laws may thwart some directives on dementia #ศาสตร์เกษตรดินปุ๋ย

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380782?utm_source=category&utm_medium=internal_referral

Why laws may thwart some directives on dementia

Jan 19. 2020
Susan Saran, a longtime Buddhist, often drives to a nearby monastery to practice her faith. Saran is fighting her retirement community over her right to determine how she will die - even though she has made her wishes known in writing. MUST CREDIT: Photo by Heidi de Marco of Kaiser Health News

Susan Saran, a longtime Buddhist, often drives to a nearby monastery to practice her faith. Saran is fighting her retirement community over her right to determine how she will die – even though she has made her wishes known in writing. MUST CREDIT: Photo by Heidi de Marco of Kaiser Health News
By Special to The Washington Post · JoNel Aleccia · NATIONAL, FEATURES, HEALTH 

ITHACA, N.Y. – When she worked on the trading floor of the Chicago Board Options Exchange, long before cellphone calculators, Susan Saran could perform complex math problems in her head. Years later, as one of its top regulators, she was in charge of investigating insider trading deals.

Today, she struggles to remember multiplication tables.

Seven years ago, at age 57, Saran was diagnosed with frontotemporal dementia, a progressive, fatal brain disease. She had started forgetting things, losing focus at the job she had held for three decades. Then tests revealed the grim diagnosis.

“It was absolutely devastating,” Saran, 63, said. “It changed everything. My job ended. I was put out on disability. I was told to establish myself in an [extended] community before I was unable to care for myself.”

So Saran uprooted herself. She sold her home in 2015 and found a bucolic retirement community in rural New York whose website promised “comprehensive health care for life.”

And now, she is fighting with that community over her right to determine how she will die – even though she has made her wishes known in writing. Similar fights could ensnare millions of Americans with dementia and similar end-of-life directives in coming years.

In 2018, after two brain hemorrhages, Saran conferred with a lawyer and signed an advance directive for dementia, a controversial new document that instructs caregivers to withhold hand-feeding and fluids at the end of life to avoid the worst ravages of the disease.

“It’s not something that I am willing to endure,” she said. “I don’t want my life prolonged beyond the point where I’m participating in life.”

But when Saran submitted the document to her New York continuing care retirement community, Kendal at Ithaca, where she has spent more than $500,000 to live, officials there said they could not honor her wishes.

In a letter, lawyers told Saran that the center is required by state and federal law to offer regular daily meals, with feeding assistance if necessary. No provision exists, the letter said, for “decisions to refuse food and water.”

When asked about Saran, Kendal’s executive director, Laurie Mante, wrote in an email: “We recognize the great complexity in balancing our residents’ wishes with what is required of us. We have a dedicated team who works to balance those interests, and, when appropriate, work with our residents and their families to seek alternative paths.”

It’s a cruel quandary for Saran and other Americans who have turned to dementia directives that have been created in recent years. Even when people document their choices in these directives – while they still have the ability to do so – no guarantee exists that those instructions will be honored, said Stanley Terman, a California psychiatrist who advises patients on end-of-life decisions.

“It is, in my opinion, a false sense of security,” Terman said.

That may be especially true for the 2.2 million people who live in long-term care settings in the United States. People with dementia are most likely to die in nursing facilities, according to new research from Duke University and Veterans Affairs Boston Healthcare System.

“If you’ve got the resources, where you’ve got family and paid caregivers at home, you’re all set,” said Karl Steinberg, a California geriatrician and hospice physician who has written extensively about dementia directives. If you’re living in a facility, he said, “it’s not going to happen.”

One key question is whether patients with dementia – or those who fear the disease – can say in advance that they want oral food and fluids stopped at a certain point, a move that would hasten death through dehydration.

It is a controversial form of VSED – voluntarily stopping eating and drinking – a practice among some terminally ill patients who want to end their lives. In those cases, people who still have mental capacity can refuse food and water, resulting in death within about two weeks.

Many states prohibit the withdrawal of assisted feeding, calling it basic “comfort care” that must be offered. Only one state, Nevada, explicitly recognizes an advance directive that calls for stopping eating and drinking. And that’s via a little-known law that took effect in October.

Critics of such documents, however, say they could lead to forced starvation of incapacitated people. The directives may be biased, reflecting a society prejudiced against age, disability and cognitive change, said James Wright, medical director of three long-term care facilities in Richmond and lead author of a recent white paper advising facilities not to honor dementia directives.

Based on his years of clinical experience, Wright said many people with dementia become content with their situation, even when they never thought they would be.

“To enforce an advance directive on someone who may have had a complete turnaround on what they think of a life worth living is unethical and immoral,” Wright said.

The dementia directives offered in the past few years are aimed at filling what experts say has been a major gap in advance-care planning: the gradual loss of capacity to make decisions about one’s care.

One version, published in 2018 by Barak Gaster, a professor of medicine at the University of Washington, was downloaded 130,000 times after being mentioned in a New York Times story and continues to be retrieved about 500 times per week.

“This is an issue that people have really thought a lot about,” Gaster said. “They worry about it a lot. They’re so eager and excited to have a structured opportunity to make their wishes known.”

Traditional advance directives focus on rare conditions, such as a persistent vegetative state or permanent coma, Gaster said. “And yet the No. 1 reason a person would lose ability is dementia,” he said.

In addition to Gaster’s document, directives drafted in New York and Washington state have drawn hundreds of users. The aid-in-dying advocacy group Compassion & Choices released a dementia directive in December.

As the U.S. population ages, more people – and their families – are grappling with dementia. By 2050, nearly 14 million Americans 65 and older may be diagnosed with Alzheimer’s disease, according to the Alzheimer’s Association.

“We are right now experiencing the very first upswing of the giant wave of dementia that’s heading our way,” Gaster said.

Saran is on the crest of that wave.

Divorced, with no close family, she turned to Kendal – with its 236 independent units and 84-bed health center – as her final home. During her four years there, she has noticed some decline in her mental clarity.

“Even some of the simplest mathematical problems, like even seven times seven, I can’t think of it now,” Saran said.

Still, she is able to manage her affairs. She cooks her own food and cares for her three cats – Squeaky, Sweetie and Pirate, a one-eyed tabby. A longtime Buddhist, she often drives to a nearby monastery to practice her faith.

In late summer, Saran invited visitors to her small cottage at Kendal, where tapestries hang on the walls and bookshelves are filled with tomes on religion, death and dying.

Frontotemporal dementia affects about 60,000 people in the United States, and patients often die within seven to 13 years. But Saran’s disease appears to be progressing more slowly than expected.

“I think I have great capacity,” said Saran, who wears her silver hair long and favors jeans, linen shirts and turquoise jewelry.

She chain-smokes, lighting up the Seneca cigarettes she buys for $3 a pack from a nearby Indian reservation. She thought about quitting but decided it was not worth the effort and continues to indulge her habit. “If you had my diagnosis, wouldn’t you?” she said.

When Saran was hospitalized after her strokes, she suddenly understood what losing her abilities might mean.

“I realized, oh, my God, I might get stuck in a situation where I can’t take any independent action,” she recalled. “I better make sure I have all my paperwork in order.”

She was stunned to learn it might not matter, even after her local lawyer, Chuck Guttman, drafted health-care proxy documents and a power of attorney. “I thought this was it,” she said. “I thought I’d move here and everything was taken care of, everything was settled. And now it’s not.”

Mante, Kendal’s executive director, declined to comment on Saran’s specific situation, even after Saran authorized her to do so. “As with all of our residents,” she wrote, “we are working diligently to provide for an enriching, quality living environment that honors her independence and wishes.”

Saran said no one from Kendal has yet reached out to discuss an “alternative path.”

Not all dementia directives include instructions about assisted feeding. Gaster said he and his colleagues had “heated conversations” before deciding to leave that issue off their popular document.

Instead, he said, his option helps more people by addressing general goals of care for each stage of the disease. The most important thing, he said, is for people to consider their choices and share their desires with their loved ones.

The debate, Gaster said, boils down to whether “assisted feeding is basic support” or “a medical intervention that can be declined in advance.”

“There’s still a very wide perspective of viewpoints on that,” he said.

Backed by statute and practice, facilities say they are bound to offer food to all residents willing to eat, and to assist with hand-feeding and fluids if a person needs help. The controversy centers on the definition of those terms.

Wright says late-stage dementia patients who show any interest in food – a flick of the eyes, grunting or gestures, opening the mouth – should be fed until they refuse it. Steinberg and others contend the default should be “don’t feed unless they ask for it.”

It is always going to be “somewhat of a guess,” Wright said, about whether hand-feeding someone is help – or force. “I’ve not seen any guidelines that can faithfully give good unbiased guidance,” he said. “I feel that I personally can determine when food means something to my patients and when it doesn’t.”

The growing efforts to use advance directives were inspired, in part, by high-profile cases of dementia patients who were spoon-fed against their apparent wishes. In Oregon and in British Columbia, courts ruled that food and water were basic care that could not be withdrawn.

But so far, there has been no court case that says a clear advance directive for VSED “may or must be honored,” said Thaddeus Mason Pope, a professor at the Mitchell Hamline School of Law who studies end-of-life decisions.

Pope said he has heard of many people who move out – or their families move them out – of long-term care facilities to avoid assisted feeding in the last stages of dementia.

Saran has considered that, too.

“I should probably just leave,” she said, although that would mean losing the nonrefundable investment she already has made. She thinks about moving out every day, but then what? Hospice might be a solution, but only if there is room when she needs it, she said.

Saran said her situation should be viewed as a cautionary tale. She wishes she had asked more questions before moving into her community and insisted on answers about how she would die once her dementia progressed.

“I didn’t realize I was signing away my right to self-determination,” she said. “I am appalled that my future demented self takes precedence over my competent current self.”

The day I told my son about the donor egg #ศาสตร์เกษตรดินปุ๋ย

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380780?utm_source=category&utm_medium=internal_referral

The day I told my son about the donor egg

Jan 19. 2020
By Special to The Washington Post · Caren Chesler 

As my 8-year-old son and I drive past the cow pasture near our house, he asks, “Why do they have to have bulls in there?” “So the cows can have babies,” I say. “They need a boy and a girl, a male and a female,” I correct myself, “to have babies.”

Borrowing what little I know about human anatomy and applying it to the animal kingdom, I tell him how women have eggs and men have sperm – which are like tadpoles – and that the sperm try to bust their way into the egg to fertilize it so the cow can have a baby. Humans are much the same, I say.

“So girls lay eggs, like chickens?” he asks.

“Well, they don’t lay them,” I say. As we travel down this path, I sense an opportunity to tell him something I’ve been meaning to tell him for some time. “Sometimes the girl’s eggs don’t work, so they have to use eggs from another girl.”

And then I tell him I am one of those girls.

I had my son using a donor egg. We used my husband’s sperm, and we tried to use my sister’s eggs to keep my DNA in the mix, but it didn’t work. So we used the eggs from a 20-something ballerina. The fertilized embryo was then placed inside me, and nine months later, I had my son.

Fertility clinics advise parents to tell donor egg children how they were conceived by the time they are 4 or 5, but I refused. I already thought my son and I had a tenuous – OK, nonexistent – biological bond, given that he has none of my genetic matter. I feared that telling him another woman had provided the egg from which he was made would make him feel like she – and not I – was his real mother, even though I carried him in my belly like any other “birth mother.”

For me, the notion that my son might view me as the adoptive mother and some other woman as his “real” mother is so dizzyingly painful, I haven’t wanted to tell him how he was conceived. (Honestly, until now, I couldn’t imagine how he would even understand it).

Some women are good with situations like that. They have open adoptions and encourage their kids to have a relationship with their birth mother.

I’m not. I’m aware this doesn’t say much about my self-confidence. I blame it on birth order. As the oldest of four, I was never satisfied to have my parents love all of us the same. I wanted them to love me more, because to love me equally was somehow the same as not loving me at all.

I almost got into a fistfight with a friend last year when she told me that the husband of a couple she knew – who also had a child by donor egg – wanted to tell the child the identity of a woman he believed was the egg donor. He didn’t know for sure, but he thought he’d figured it out. His wife didn’t want him to say anything.

My friend agreed with the father: The child was now old enough and “has a right to know,” she said.

A right to know a donor egg was involved, I replied. But the child “doesn’t have a right to know the donor,” I argued, unless the child “wants it – and the donor wants it. But that’s not what’s happening here.”

Besides that he might be wrong about the donor’s identity, I argued that the father had no right to drag the woman into their family, particularly when, as was apparently the case, the child had shown only minimal interest and his wife was averse to bringing the donor into their lives.

It was a matter of biological background and identity, my friend countered.

“Identity? What does that even mean?” I asked.

I went to bed, all riled up, my heart pounding, a part of me knowing what she meant. We’ve all heard the stories about twins separated at birth who find each other and instantly see similarities in their personalities, or the mother who reunites with her son and feels that bond of love instantly, as they are united by their sameness.

But I put my 47-year-old body through the ringer to have my son, subjecting myself to biweekly blood tests and weeks of daily injections of progesterone to prepare my womb and aid implantation of the embryo, even though I’m afraid of needles.

Once pregnant, I was utterly exhausted. I threw up Indian food on the street in Toronto. I was stung by a bee at a county fair, blowing up like a balloon and fearing it would hurt the baby. I developed placenta previa and had to have a Caesarean section at 38 weeks. During that surgery, my heart rate fell and I was given ephedrine, which made me puke and my heart rate spike. One of my ovaries was so misshapen and covered with endometrial tissue the doctors sent it for a biopsy.

Carrying and delivering this child may have been the hardest thing I’ve ever done.

Once I got my son home I had a difficult time breast-feeding, as my son wasn’t gaining enough weight, so I would breast-feed during the day and stay up until 2:30 a.m., watching “Frasier” reruns and pumping, to keep up, or increase, my milk production.

And I sidelined my writing career while I took care of a little boy, who would repay me sometimes by crying, stomping his feet and lashing out if he didn’t get what he wanted. And after all that work, he may want to go find his real “egg donor mother” anyway?

It reminded me of the poem by Billy Collins, called “The Lanyard,” where he writes about how his mother gave him life, “a breathing body and a beating heart, strong legs, bones and teeth, and two clear eyes to read the world,” and in return, he gave her a lanyard that he made in camp.

After the heated conversation I had with my friend, I looked up the word “identity.” The Cambridge English dictionary defined identity as “who a person is, or the qualities of a person or group that make them different from others.” No mention of genes.

Regardless, I knew I’d have to tell my son one day how he was conceived. He had a right to know, and not just for medical reasons. A person has a right to know how he came to be. And after seeing the bull in the pasture, that seemed like a good opportunity.

I told my son about how I wanted a baby so badly, but even though I tried very hard my eggs didn’t work, so I used some eggs from someone else, mixed them with daddy’s sperm, and we had you.

“So I was adopted?” he said.

“Why do you think you were adopted?” I asked.

“Because if you didn’t need the egg, she would have had me,” he said.

Children have the clarity of a box cutter.

“But the egg isn’t you,” I said. “The egg needs a sperm, too.”

I was using my husband to bail me out.

“She would have had a sperm,” he said. He only learned the word sperm today. I’m not sure how he was such an authority.

“Right, but that sperm wouldn’t have been daddy’s. Did you ever hear people say you look like daddy? Like you’re a mini-him? That’s because we used daddy’s sperm,” I said. “She would have been with somebody else and used her eggs with that person’s sperm. That would’ve made a whole different person.”

I was using semantics not even I could follow.

“The baby is just as much where it grows up in the belly, too. You grew in my belly,” I said. “We just used different seeds. Or eggs. Adopted kids don’t grow in their mothers’ bellies. You know what I mean?”

“Yeah,” he said weakly. “I didn’t really get it at first.”

He yawned.

“Do you get it now?” I asked. I had more invested in the conversation than he did.

“Yeah,” he said.

“So what do you think?”

“You didn’t adopt me,” he said.

I felt like I’d beaten him into submission.

That night, I sat on the porch and looked out onto the lake behind our house. A family of ducks glided over to my neighbor’s raft and climbed on top. There was a mother and five babies. I wondered if all those babies were from the same mother, and what would happen if a duck from another mother climbed on top of the raft. Would the mother duck accept him? Would he accept the mother?

A few weeks later, some friends took me out to dinner for my birthday. When I got home, there was a sign on the front door in my son’s distinctive hand that said: “Mom, folloe the messeges.”

I walked in to find a path of cardboard signs that ran along the floor and up the stairs, leading to his room, each with a note that read either, “I miss you, Mom,” or “I missed you,” followed by a little heart. I loved both. I ducked my head into his bunk bed and kissed him several times on his forehead.

It seems the problem is not how much he loves me. It’s me finding that to be enough.

Fake drugs kill people and fund terrorism. African leaders hope to do something about it. #ศาสตร์เกษตรดินปุ๋ย

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380776?utm_source=category&utm_medium=internal_referral

Fake drugs kill people and fund terrorism. African leaders hope to do something about it.

Jan 19. 2020
By The Washington Post · Danielle Paquette · WORLD, AFRICA

LOMÉ, Togo – The pills tend to come surreptitiously from China, India and Nigeria. They’re packaged like cures for fever and rashes. They land on street corners – sometimes in plain view – and promise to ease suffering at a fraction of the cost.

But fake drugs kill tens of thousands of people each year in a global counterfeit trade worth an estimated $200 billion, thwarting progress in the fight against malaria and other life-threatening diseases, experts say, while funding organized crime.

The scourge is particularly alarming in West Africa, where authorities say knockoffs are thought to comprise more than half of pharmaceutical sales in areas where many cannot afford prescription treatments.

“You are poor, and you are spending your money on something that is going to kill you,” Faure Gnassingbé, the president of Togo, told The Washington Post in the country’s presidential palace. “Yet it is not treated as a crime.”

The Togolese leader hosted his counterparts from Senegal and Uganda on Saturday in the capital city, Lomé, where the presidents proposed new laws to strengthen a collective crackdown on trafficking.

Representatives from Ghana, Congo, Niger and Gambia also signed a pact to ramp up intelligence sharing and security at the borders, among other efforts.

Peddling fake drugs is illegal in most countries, but enforcement is shaky. One raid on markets, shops, warehouses and factories across West Africa three years ago turned up more than 41 million counterfeit pills. About 150 people were arrested for selling a blend of toxic or useless tablets, Interpol reported.

Dignitaries flocked to Lomé this week for a summit on counterfeit medicine, including a member of the British royal family, Prince Michael of Kent.

Armed police officers in trucks patrolled the city of roughly 830,000. Helicopters whirred overhead. Yet people still hawked boxes of unverified antibiotics on the street.

Amele Louise Assogba, 49, used to visit roadside vendors for pills to soothe headaches and nagging coughs. Drugs at pharmacies, she said, cost three times more.

“I needed to save money for my children,” said the Togolese mother of four, who supports her family by cooking for neighborhood families.

Then she caught the flu, bought an informal remedy and landed in the hospital for an emergency blood transfusion.

Assogba considers herself lucky – at least she made it to a doctor on time.

About 122,000 children die each year on the continent from fake antimalarial drugs, estimates the Brazzaville Foundation, a London group focused on the issue. In some areas, as many as 60% of drugs sold are thought to be counterfeit, the nonprofit said.

“This abject trafficking generates enormous profits for criminals and terrorists, destabilizing some of the most fragile countries in the world,” said Jean-Yves Ollivier, the foundation’s president, in a statement.

Counterfeit goods have long been linked to criminal gangs, with studies tying knockoff sales to terrorist organizations that exploit child labor.

Shipments often slip through porous borders, authorities say, and encourage corruption when traffickers pay off customs agents.

Officials aim to end this income stream at a time when Islamist violence is surging across West Africa’s Sahel region, with attacks increasing fivefold since 2016.

Extremists who have professed loyalty to the Islamic State and al-Qaeda have seized remote corners of Mali, Niger and Burkina Faso.

Those militants fund the war by ambushing towns and stealing livestock, taking over artisan gold mines and kidnapping people for ransom, officials have said.

They also profit from counterfeit drugs, said Gnassingbé, the Togolese president.

“Terrorists,” he said, “are living on fake medicine traffic.”

Judge allows new liver transplant policy to take effect #ศาสตร์เกษตรดินปุ๋ย

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380767?utm_source=category&utm_medium=internal_referral

Judge allows new liver transplant policy to take effect

Jan 19. 2020
By The Washing Post · Lenny Bernstein · NATIONAL, HEALTH

A federal judge has cleared the way for a new method of distributing livers to transplant patients, a plan that will shift more of the scarce organs to people in metropolitan areas where demand is highest and away from some rural regions where they are easier to obtain.

In a case she called “difficult and wrenching,” U.S. District Court Judge Amy Totenberg refused Thursday to permanently block new rules for allocating livers that were approved by the federal government in December 2018. In response to a lawsuit, she had temporarily halted the plan last May while she considered a request for a permanent injunction.

Totenberg, an Atlanta judge appointed by President Barack Obama, wrote that the government and the nonprofit agency that runs the U.S. transplant system had provided the plaintiffs due process and an opportunity to have their views heard, even if the new policy did not work in their favor.

Those patients and hospitals, in places such as Georgia, Kentucky, Kansas and Virginia, have said they would face the prospect of fewer available organs under the new rules, as more livers are taken by transplant centers in cities with greater demand and higher insurance payments.

Supporters of the change had argued that the current method of distributing most livers in the same regions where they are donated had created a large and arbitrary geographical disparity in availability of the organs. Recipients in some cities waited much longer, and became much sicker, before receiving a liver than patients in less populated areas, they said.

Put another way, a moderately ill patient in Kansas had a 60% chance of receiving a liver within 30 days, while a similar patient in California had just a 1% chance, they said.

The U.S. transplant system has struggled for decades to find a fair way to distribute livers, kidneys, hearts and other organs because of a severe shortage of donors. That has created a waiting list of about 113,000 people, even as the number of transplanted organs continues to grow slowly. Nearly 8,900 livers were transplanted in 2019, but about 13,000 people are waiting for one. Most people on the waiting list are seeking kidneys.

The United Network for Organ Sharing, the nonprofit agency that operates the transplant system under contract to the Department of Health and Human Services, said in a statement that Totenberg’s decision “will allow a national liver transplant policy to begin saving more lives and increasing fairness in the donor matching process.” A spokeswoman said the new rules would be implemented in coming weeks.

Motty Shulman, an attorney who sparked development of the new plan when he filed suit in 2018 over the geographic-based rules, said in a statement that “the new liver allocation policy will benefit all liver wait list candidates, and we are pleased to be a driving force in bringing equitable organ allocation to patients across the country.”

Attorneys for the plaintiffs declined to comment.

For many years, transplant centers had first shot at livers procured from deceased donors in their regions. The new plan gives patients as far as 500 nautical miles away from a donor’s hospital access to a liver, depending on how sick they are.

When they filed their lawsuit in April, the plaintiffs said they faced a loss of 256 livers as a result, which they said would cause more deaths in their regions.

A top YouTube makeup artist revealed she’s transgender. She said she was blackmailed into it. #ศาสตร์เกษตรดินปุ๋ย

Published January 15, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380578?utm_source=category&utm_medium=internal_referral

A top YouTube makeup artist revealed she’s transgender. She said she was blackmailed into it.

Jan 15. 2020
By The Washington Post · Lateshia Beachum 
A top YouTube makeup artist revealed she’s transgender. She said she was blackmailed into it. Makeup-obsessed YouTube fans were rocked last night with a video from one of the most influential makeup artists on the platform – and it had nothing to do with the latest foundation launch.

Nikkie de Jager, 25, better known as NikkieTutorials to her 12 million-plus subscribers, revealed that she’s a transgender woman in a video that was trending on Twitter on Monday night and continues to be the most-watched video on YouTube on Tuesday afternoon, approaching 20 million views.

The Dutch makeup artist disclosed her gender identity after facing blackmail threats by people who wanted to take her story to the media for profit, she said. Announcing her transgender identity was a way for her to reclaim her power, she said.”It feels good to finally do it. It is time to let go and be truly free,” she said with her palms pressed together and glittery nails pointing toward the camera. “When I was younger, I was born in the wrong body – which means that I am transgender.”

Since uploading her first video nearly 12 years ago, de Jager has amassed a cultlike following of makeup enthusiasts and artists alike who watch her videos for tips about how to perfect winged eyeliner, reviews on new cosmetic releases and marvel at her makeup artistry. Her passion for makeup and knowledge of how products should perform for consumers has led to collaborations with top cosmetics brands such as Too Faced and Orfra to makeup-transforming videos with elite celebrity makeup artists on her channel.

Her accomplishments were all achieved without any questions surrounding her gender identity – an intentional choice, she told viewers.

“I always wanted to live in a world where I saw myself as me, as Nikkie, as a woman, as a girl, as a boss lady,” she said into the camera.

The YouTube star has been transitioning into the woman she is for years.

“Ever since I was born I always thought that I was a girl,” she said, explaining her affinity for toys and styles of dress associated with little girls. “All of me was girly.”

She was already dressing and styling herself as a girl by 7 or 8, she said.

De Jager was already taking hormone blockers and growth stoppers to help her transition by age 14 with support she received from her mother and schoolteachers, she said. By age 19, de Jager said she was “fully transitioned,” hinting that she possibly received gender affirmation surgery.

The Netherlands has been a global leader on LGBTQ rights and was the first country to allow transgender people to openly serve in its armed forces in 1974, CNN reported. It was also the first country to legalize same-sex marriage in 2001.

The country made it legal for transgender citizens to change their gender designation on identity documents in July 2014, removing requirements for hormone therapy, gender affirmation surgery and sterilization.

Much of de Jager’s change was documented to an unsuspecting following.

“I transitioned while on YouTube,” she said. “I have literally grown up and transformed into me.”

She said she always wanted to reveal her transgender experience, but being blackmailed forced her own personal timeline.

“It was frightening to know there are people out there who are so evil that they can’t respect someone’s true identity,” she said of her extortionists before flipping them off with a middle finger that showed off a squared, sparkling acrylic nail.

Her revelation doesn’t change anything about her, she said, before briefly expressing concerns over how people would receive her news.

The response to de Jager’s announcement has received mostly praise from the beauty influencer community.

Makeup maven Nikita Dragun, who’s documented her makeup techniques and gender transition on her channel, tweeted that de Jager’s “coming out” moved her to tears.

Julie Vu, a Canadian YouTuber better known as PrincessJules who has also detailed her transition for her subscribers, made a reaction video expressing shock and pride in de Jager’s decision to share something personal.

Vu, a lifestyle vlogger and makeup devotee, said she could relate to being outed based on her own experience of being identified as transgender in dance clubs, and admonished de Jager’s alleged blackmailers.

“Transgender people get killed all the time for being themselves,” she said. “When you out somebody, you put their life in danger and that is not okay. Someone’s life is not a joke.”

At least 22 transgender or gender-nonconforming people were killed last year in the United States, according to a report from the Human Rights Campaign, which tweeted its support of de Jager.

De Jager said she hoped that her public acknowledgment of her gender identity would help younger children who might also feel out of place or not like who they truly are, she said.

“I don’t know if people are going to hate me or accept me,” she said toward the end of her video. “All I know is that I haven’t changed. You’re still seeing the same Nikkie now.”

Five myths about diabetes #ศาสตร์เกษตรดินปุ๋ย

Published January 4, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30380113?utm_source=category&utm_medium=internal_referral

Five myths about diabetes

Jan 04. 2020
Heather Ferris is assistant professor of medicine at the University of Virginia. She cares for patients with diabetes and studies the impact of diabetes on the brain.

Heather Ferris is assistant professor of medicine at the University of Virginia. She cares for patients with diabetes and studies the impact of diabetes on the brain.
By Special To The Washington Post · Heather Ferris · OPINION

More than 100 million U.S. adults are living with diabetes or prediabetes, making the disease one of the most serious health risks in modern society: It is a major cause of blindness, amputation and kidney failure, as well as a contributor to heart disease and stroke.

Yet despite its prevalence and severity, misconceptions about diabetes abound. Here are five of the most persistent.

Myth No. 1: Only kids get Type 1 diabetes.

One myth is reflected (if only residually) in the name of a major advocacy group combating diabetes: The stated goal of JDRF, formerly known as the Juvenile Diabetes Research Foundation, is to help find a cure for Type 1 diabetes – which is still often called “juvenile diabetes,” pegging it as an affliction of children and teenagers. This myth persists even within the medical community. One woman who developed Type 1 diabetes in her 40s wrote on the blog of the Diabetic Journey website that her severe flulike symptoms, frequent urination and intense thirst initially led to a misdiagnosis by her doctors of Type 2 diabetes “because of my age.” The mistake led to an emergency-room visit.

But of the approximately 64,000 Type 1 cases diagnosed in the United States each year, less than half – about 27,000 – occur in people under the age of 20, typically when they’re between 10 and 14. The other 37,000 are adults between 20 and 65. And it’s not unheard of for someone in their 70s or 80s to receive a new diagnosis.

Type 1 diabetes is an autoimmune disease that causes a person’s body to attack its pancreas, destroying its ability to produce insulin, a hormone that regulates the processing of glucose. The only way to treat it is with insulin injections or an insulin pump. (With Type 2 diabetes, patients generate insulin but are resistant to its effects.) If untreated, Type 1 can cause the sometimes-fatal condition diabetic ketoacidosis: The body can’t use the sugar in the blood, so it breaks down fats for fuel, generating dangerous acid levels as a byproduct.

We still have a lot to learn about who develops Type 1 and why. Genes are an important risk factor, yet environmental influences, such as a viral or bacterial infection, probably also play a role.

Myth No. 2: ‘Walmart insulin’ is just as good as the expensive kind.

The price of the most popular types of insulin has roughly tripled in the past decade, inspiring politicians to explore policy solutions and people with diabetes to search for cheaper options. A vial of Levemir, one of the newer insulins, retails for about $380, and many people need more than one vial per month. In September, Minnesota state Rep. Jeremy Munson posted a video to Facebook showing himself purchasing a vial of insulin at Walmart for $24.88. “There’s affordable options out there,” he said. A blogger for FDAReview, a project of the libertarian Independent Institute, similarly argued that Americans should “Trust Walmart’s Insulin to Save Lives.”

But the insulins sold at Walmart are not the same as the modern insulins that people with Type 1 or Type 2 diabetes rely on. They’re not worthless, but they aren’t a feasible option for many people.

Over-the-counter insulin has been around since the 1980s, when scientists first learned to program bacteria to produce human insulin. And while they are far better than the insulins extracted from cow and pig pancreases that they replaced, using them safely requires an incredibly strict diet and exercise regimen. (Imagine planning all your meals and snacks to have the same number of calories, never missing a meal, and exercising at the same time and level of intensity every day.)

There are more than a half-dozen brands of modern insulins introduced in the 1990s and 2000s. These allow patients to eat late or skip a meal with fewer episodes of dangerous – and potentially fatal – low blood sugar. They’re infinitely more forgiving when you’re trying to live a normal life. But for reasons the pharmaceutical companies can’t adequately justify, these drugs have become fearsomely expensive.

Myth No. 3: Eating sugar gives you diabetes.

Eating lots of sugar is bad for your energy levels and weight,says a column posted on the website Best Health Guide, but “what it’s absolutely worst for, is your risk of diabetes.” Meanwhile, a writer for Healthline who has the disease wearily reported hearing a co-worker joke, “I just ate so many cupcakes, I got diabetes.”

Because monitoring sugar levels plays such an important role in managing diabetes, many people assume that sugar is also its cause. But as an autoimmune disorder, Type 1 diabetes develops as a result of genetic risk and an unclear trigger; it’s not caused by eating sugar – or anything else.

The story for Type 2 diabetes is a bit more complicated. Obesity and inactivity play huge roles in the risk for the disease, but genetics are also a factor, even more so than for Type 1. Many people eat diets laden with fat and sugar but never develop diabetes because their pancreases are able to produce large amounts of insulin on demand; others are not so lucky. Too much sugar, per se, won’t give you diabetes. But it can make you overweight, increasing your risk for Type 2.

Myth No. 4: You can’t eat sweet foods if you have diabetes.

“Avoid doughnuts, toasted pastries, and other bakery sweets,” a Health.com column advises people with diabetes – and take a pass on melons and bananas, too. “Skip sugary foods like sweets and soda,” says Everyday Health. Misconceptions about which foods are completely off limits for people with the disease – especially sweets – are so common that the website The Mighty helpfully suggests 26 snappy comebacks for when others offer uninformed “advice.”

Granted, eating too many sweets isn’t a great idea for someone with diabetes – but it isn’t good for someone without diabetes, either.

People with Type 1 or Type 2 already pay close attention to their blood sugar levels, monitoring such things as sugar intake, carbohydrate content, total calories, exercise levels and insulin administration. When you’re doing all that, the occasional large dessert is fine. If you take insulin, you’ll take a bit more to offset the chocolate cake. If you take medication, like metformin, to manage Type 2, a walk around the block might suffice.

It turns out that fat, not sugar, is what really makes blood sugars hard to control for many people with diabetes. In my clinic, when I see a high blood-sugar reading from a patient whose numbers are usually in the normal range, my first question is whether they had pizza or Chinese takeout the night before.

Both are high-fat, high-carbohydrate meals that make for a challenging combination for someone with diabetes: Fat slows the absorption of the carbohydrates and increases the body’s insulin resistance, raising blood sugars. The slow food absorption throws off normal insulin timing; the result is often low blood sugar levels (as the insulin kicks in before digestion) followed by high blood sugar levels (as the insulin wears off while the carbohydrates from the meal linger).

Myth No. 5: You can treat Type 1 diabetes without insulin.

There are endless dubious stories about people with Type 1 diabetes who manage, through some dietary trick, to avoid the need for insulin. In 2016, the website Diabetes.co.uk reported on the case of a 9-year-old Hungarian boy who supposedly avoided insulin injections for 24 months by following a “paleo” diet that “consisted only of animal meat, fat, offal and eggs.” In 2007, there were reports that Halle Berry had reversed her Type 1 diabetes with a healthy diet (“I’ve managed to wean myself off insulin,” the actress said).

But when you hear of someone with Type 1 who doesn’t need insulin, invariably they’ve either just been diagnosed – or have been misdiagnosed or are confused about which type they have.

People with newly diagnosed Type 1 diabetes can sometimes come off insulin soon after their blood sugars are brought under control. This is what’s known as a “honeymoon period,” in which patients can keep their symptoms largely in check through diet, weight loss and exercise. In some cases, the honeymoon period can last months or (rarely) years. But this isn’t a reversal of their condition: The patients have just reduced the burden placed on their weakened pancreas. Inevitably, they will end up back on insulin as their immune system continues to attack their pancreas.

The other “cured” group are the misdiagnosed. Berry, for instance, still says a keto diet helps her diabetes, but she has since clarified that, in fact, she has Type 2. Since people with Type 2 diabetes can produce insulin, it’s not surprising if they don’t need an external supply.

Traveling the loneliest road #ศาสตร์เกษตรดินปุ๋ย

Published December 22, 2019 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30379718?utm_source=category&utm_medium=internal_referral

Traveling the loneliest road

Dec 22. 2019
Marlene Kennedy visits her husband at Emerald Nursing & Rehab in Cozad, Neb., more than 50 miles from their home in Broken Bow. Earl Kennedy, 88, has Parkinson's disease. MUST CREDIT: Washington Post photo by Michael S. Williamson

Marlene Kennedy visits her husband at Emerald Nursing & Rehab in Cozad, Neb., more than 50 miles from their home in Broken Bow. Earl Kennedy, 88, has Parkinson’s disease. MUST CREDIT: Washington Post photo by Michael S. Williamson
By The Washington Post · Eli Saslow 

 

282 Viewed

BROKEN BOW, Neb. – She had been waiting more than a week for the black ice to melt and the farm roads to clear, but Marlene Kennedy, 84, was unwilling to wait any longer.

Marlene Kennedy, left, and her daughter Deb Kennedy at Emerald Nursing & Rehab in Cozad, Neb., after visiting Marlene's husband and Deb's father, Earl Kennedy, a resident there. MUST CREDIT: Washington Post photo by Michael S. Williamson

Marlene Kennedy, left, and her daughter Deb Kennedy at Emerald Nursing & Rehab in Cozad, Neb., after visiting Marlene’s husband and Deb’s father, Earl Kennedy, a resident there. MUST CREDIT: Washington Post photo by Michael S. Williamson

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The family-owned Evans Feed in Broken Bow, Neb., is opposite the grocery store where Earl stocked shelves for 47 years. MUST CREDIT: Washington Post photo by Michael S. Williamson

The family-owned Evans Feed in Broken Bow, Neb., is opposite the grocery store where Earl stocked shelves for 47 years. MUST CREDIT: Washington Post photo by Michael S. Williamson

She changed into snow boots, tucked her heart medication into her purse, and stepped out to the porch. She held onto a railing with one hand and to her daughter with the other, inching down the frozen walkway toward her garage, trying not to think about her husband’s slip and fall, which had shattered his hip and eventually forced him into a nursing home located more than an hour away.

Marlene helps Earl play bingo at Emerald Nursing & Rehab, his new care home. She now faces long trips to see her husband. MUST CREDIT: Washington Post photo by Michael S. Williamson

Marlene helps Earl play bingo at Emerald Nursing & Rehab, his new care home. She now faces long trips to see her husband. MUST CREDIT: Washington Post photo by Michael S. Williamson

It had been 10 days since her last visit to see him, the longest they’d been apart in 63 years of marriage. He had Parkinson’s disease, which made it impossible for him to talk on the phone. She’d called the nursing staff for daily updates, and they said her husband seemed quiet, and he was losing his appetite.

“Why is it still so bad out here?” Marlene asked. Her feet skidded on the ice, and she wrapped her arm around her daughter’s shoulder as they moved closer to the car.

“Maybe it would be easier in a few hours, once the sun warms up,” said her daughter, Deb Kennedy, 51.

“No. I’m at the end of my rope already,” Marlene said. “Poor Earl’s probably wondering if we left him alone down there.”

In the first months after her husband’s fall, Marlene had helped Earl Kennedy move into a nursing home three minutes from their house in Broken Bow, a town of 3,000, close enough that she could visit him twice a day. But then that nursing home went bankrupt and closed in May, one of more than 260 rural nursing facilities across the country to shut down for financial reasons in the past three years, sending another family on a desperate search for the basic medical care that is disappearing from rural America.

Marlene tried to get Earl into the only other nursing home in Broken Bow, but that facility had managed to stay solvent in part by limiting the number of residents on Medicaid, as Earl was, because the federal program pays nursing homes in Nebraska about $40 less per day than the cost of providing care. The nursing homes in Ainsworth and Minden had already closed, and the one located next to a grain elevator in Callaway was running a waiting list. The best option Marlene could find was a shared room in the town of Cozad, more than 50 miles away down remote two-lane roads, and Marlene had been making the trip back and forth several times each week ever since.

This time, Deb had offered to drive her, and they rode away from the single-story house where Marlene and Earl had raised four children, and then past the grocery store where he had stocked shelves for 47 years. They continued beyond the feedlots on the outskirts of town, dense with cattle covering the hillsides. The road narrowed through a maze of cornfields. Frozen snow crunched beneath the tires and wind beat against the windows as they drove for miles without seeing another car.

“There’s a dip coming up here,” Marlene told her daughter, as the road climbed over a frozen creek.

“Where? I don’t see it.”

“Believe me. It’s there,” she said. “I’ve done this enough to know.”

She and Earl had rarely traveled outside of Nebraska, and they’d never been on an airplane. Many of their trips together in recent years had been medical trips, the escalating cost of a life spent in rural America, which in the past decade has lost at least 250 maternity wards, 115 hospitals, 3,500 primary care doctors, 2,000 medical specialists and hundreds of nursing homes. Marlene and Earl had traveled together to Lincoln for a heart operation, Kearney for an ankle, Grand Island for a hip, Omaha for corneal transplants, and then finally to Cozad in the back of a nursing home transport van for what Marlene feared would be Earl’s final trip. He was almost 88, and he could no longer walk or eat solid foods. Marlene had already paid for their adjacent cemetery plots in Broken Bow, where Earl had spent his entire adult life, but there was no place left in town where he could live safely until he died.

Deb slowed to pass a tractor. Marlene waved to the driver and then stared out the window, where rolling hills went on for miles. The prairie was empty except for hay bales and a few pieces of farming equipment left out in the snow.

“You all right?” Deb asked. “You seem quiet.”

“This drive always feels long,” Marlene said. “You spend your whole life tied up right next to somebody, and then you don’t get to be there for the hardest parts. It doesn’t seem natural.”

“You didn’t have a choice,” Deb said.

“No, but that doesn’t stop me from worrying about him,” Marlene said, because that was what she’d been doing for much of the past week and a half as she waited for the weather to improve. She’d worried that Earl’s bed was pressed too close to the window on subfreezing nights, and that the khakis she’d bought for him to wear weren’t thick enough, and that he was losing too much weight to keep himself warm, and that if he wasn’t warm he wouldn’t be able to sleep. She’d worried about what he might be doing if he wasn’t sleeping, since his eyesight made it difficult for him to read or watch TV or do much of anything except move back and forth from his bed to his wheelchair, in which case 10 days might have felt to him like forever. She’d worried he felt confused by her absence, or upset, or scared, or even abandoned.

“I’d be with him every day if I could,” Marlene said. “He knows that, right?”

“Of course. He knows we all want to be there,” Deb said. She drove by a large grain elevator and turned into the town of Cozad, parking in front of a small nursing home. She opened the passenger door and reached down to help her mother out of the car. “I bet you’ll feel better once you get a chance to visit with him,” she said.

“I don’t like being a visitor,” Marlene said. “I’m not a visitor to him.”

– – –

They walked down a tiled hallway with fluorescent lighting to a small room with an American flag taped beside the door. Marlene stepped into the front half of the room, which for the past 15 years had belonged to Earl’s new roommate, Oscar. He waved from his wheelchair, and then Marlene pulled back a curtain to reveal the back half of the room, where Earl was in the same position as she’d last seen him, 10 days earlier. He sat in his wheelchair with his body bent over to the right, wearing a baseball cap on his head and a kerchief to protect his shirt. He faced a TV that wasn’t on and a window with a view of snow-covered recycling bins. Marlene put her hand on his shoulder and leaned down to kiss his forehead.

“I missed you, Earl,” she said. “I missed you so bad I couldn’t stand it.”

He smiled at her and nodded. He reached over to his bed and picked up a holiday card he’d received from one of their great-grandchildren. He’d shown it to Marlene on her last visit, and now he handed it to her again.

“Isn’t that something,” she said, rubbing his back, pulling over a chair until it was pressed right up against his. She set the card down and rested her head against his shoulder.

“I missed you, Earl,” she said again. “Did you miss me?”

“Well,” he said. His lips tried to form more words, but they wouldn’t come. He’d been working with a speech therapist to fight back the advance of Parkinson’s and maintain his ability to eat, swallow and speak, but lately Marlene thought he had fewer good days than bad. She leaned in and tried to read his lips, smiling at him, waiting for him to talk as she rubbed his shoulders. His mind was still sharp, and some days his sentences came more easily as time went along. She believed the kind and respectful thing to do was to stay patient and wait through the silence, until after a few moments of watching Earl struggle, she decided the kinder thing was to break it.

“I wanted to come just about every day, but this weather had other ideas,” she told him. “You missed me, though, Earl. Didn’t you?”

“Well,” he said again. He smiled and reached over to wrap his arm around her shoulder.

“Yeah, I knew it,” she said. “You missed me. And what all did I miss here?”

“Well, the usual,” he said, beginning to find his voice. He pointed out toward the weekly schedule that was posted on the wall: a resident social hour at 8 a.m., three pureed meals in the cafeteria each day, bingo on Wednesdays and Fridays, Bible study on Tuesdays, “Wheel of Fortune” in the community room each night. Five residents had died in the past few weeks, and each time the nursing staff had made up the bed with a red rose and a copy of the same poem on the pillow: “I am home in heaven, dear ones; Oh so happy and so bright!”

“I suppose you didn’t miss much,” Earl said. “Life in a rest home. We rest.”

Marlene laughed. “You never were much of a complainer,” she said.

“No,” he said. “I guess not.”

They sat together holding hands as Marlene straightened Earl’s hat and smoothed the wrinkles out of his khakis. Sometimes during their visits, she took him into the cafeteria to play board games or read to him aloud from Philippians, but they spent most of their time together in silence.

“I like sitting with you like this,” Earl said.

His half of the room was barely large enough to fit a bed, a chair, and a handful of mementos. There were photos on the wall of his friends, his grandchildren, and his great-grandchildren, many of whom lived near Broken Bow and were too far away from Cozad to make regular visits. There was a prayer book from the country church where he’d met Marlene in 1954, and a few awards from the grocery store where he’d started out making $60 a week and then stayed on for nearly five decades.

“A life lived right,” read one of those employee plaques, which the store had given to him to commemorate his retirement at age 76, and Earl believed that declaration to be true. He’d raised four successful children, taught Sunday school, worked at the store six days each week, and come home most afternoons to eat lunch with Marlene. Their family had never earned more than $35,000 in a year, but somehow they had managed to send the children to college, stay out of debt, pay off their house, and even build up some savings – most of which had vanished in less than two years to pay for Earl’s nursing care in Broken Bow.

After that he was forced to rely on Medicaid, which meant that like most rural Nebraskans, he was dependent on a nursing system that was collapsing and scattering the poorest residents across the plains. Some of his friends from the home in Broken Bow had ended up in Omaha, Wyoming or North Dakota, and Earl had been moved out of a town where he knew almost everybody to a place where he knew almost nobody, and where the one constant was Marlene.

“It’s getting to be that time,” she said, as she looked out the window. They’d been sitting together for a few hours. The sun dipped down toward the cornfields, and the wind picked up and started whipping snow off the ground. Soon it would be dusk, when the roads started to refreeze and deer began to dart across the prairie.

“You should go,” Earl said. “I’m okay.”

“Another minute,” she said. She held his hand, and she thought she could feel it beginning to shake. She’d noticed that sometimes his Parkinson’s symptoms seemed to worsen at the end of their visits. “I’ll be back soon,” she said. “The weather coming up looks pretty good.”

“When you can,” he said. “I’ll be all right.”

“Soon,” she said again.

“Well,” he said. He patted her arm. He tried to say something more, but his hands were shaking harder now, and the words weren’t coming. Marlene leaned in and waited, watching his lips. “I’m okay,” he said again. “It’s okay,” he said, until finally Marlene squeezed his hand, forced herself up, and started walking out toward the car.

– – –

Earl watched out the window as the sky turned dark. His room was quiet, but in the hallway he could hear the sounds of oxygen machines and beeping call lights. Nurses wheeled residents into the cafeteria for bingo, and the food staff prepared creamy potatoes for dinner.

By all appearances, the nursing home was a place of routine and stability, but in fact it was facing the same financial pressures that had shut down 31 nursing homes in Nebraska in the past several years. A few months before, it had come within days of being the 32nd, after failing to meet payroll and making plans to transfer all 65 residents. The facility had been rescued out of bankruptcy at the last moment by a new ownership group from New York, and now the staff was trying help the nursing home save money however it could.

Lately, one strategy involved making trips to the shuttered nursing home in Broken Bow to salvage whatever supplies were left inside.

“I’ll be back in a few hours,” said Kiley Goff, the head administrator in Cozad, as she left a staff meeting and walked out to her truck to make her fourth trip to Broken Bow in the past month. Her bosses had purchased the building there, given her a key and allowed her to take whatever she needed for the nursing home in Cozad, which turned out to be almost everything. Their facility was almost 70 years old, and some of the rooms still had hand-crank medical beds. For one of her trips to Broken Bow, she’d rented a U-Haul and hired teenagers on the local high school wrestling team to help her load it with a dozen electric beds, a few couches, a washer and dryer, wooden doors, a bathtub, a fireplace, wall art and hundreds of pounds of linens.

This time she was hoping to find water pitchers, dishware and holiday decorations. “Any little thing we find is something we don’t have to buy,” she said.

She was a trained speech pathologist who had recently switched to management, and she’d spent the past year learning the difficult math of nursing home finances. The Medicaid reimbursement rate in Nebraska and most other states had stayed relatively flat for the past several years, even as medical costs rose by more than 20 percent. Her nursing home in Cozad received $152 per day for each Medicaid resident, far short of the $200-per-day cost of providing care. To make up for that loss, nursing homes typically charged much higher rates for people paying with their own money, a strategy that worked in urban areas where about half of residents could afford to pay out of pocket. But in rural Nebraska, only 35 percent of nursing home residents had money to pay for their own care, and in Cozad, it was less than 20 percent.

The result was that urban nursing homes had been able to remain relatively stable even as care disappeared from disproportionately older, poorer and rural areas of the country, where an elderly population that was projected to double in size over the next 20 years would have fewer places to go.

Goff drove by the feedlots on the edge of Broken Bow, stopped at the railroads tracks for a passing coal train, and then parked at a low-slung building across from a hardware store. Snow piled against the doorway and a broken-down medical van sat out front. She pushed open the front door and light streamed into the building. She could see down a long hallway, where medical lights flashed red against the walls and a broken fire alarm kept going off.

The nursing home had emptied out within just a few weeks in May once the closing was announced, as 46 residents and 65 staff members scrambled for places to go, but everything else had remained inside. There were wheelchairs in the front lobby, Bibles left open in the chapel, and plastic Easter eggs scattered in the hall. Goff grabbed an empty plastic bin from the front closet and started walking through the facility, opening closets and drawers to look for holiday decorations she could use in Cozad.

She found a stuffed Santa and some holiday lights in a closet. She went through the physical therapy room, the beauty parlor, and then into the secure memory care wing. “A Safe and Happy Forever Home,” read a framed cross-stitch near the entrance to what had once been the area for residents with Alzheimer’s or dementia, who tended to thrive on consistency, and who had since been uprooted to places all over Nebraska without understanding where or why.

Goff found a small Christmas tree in a closet and a package of unopened tablecloths in the cafeteria. Her phone rang, and she set down her bin to answer.

It was one of her staff members in Cozad, wanting to know when she’d be back. “I’m almost done,” she said. “It always feels weird in here.”

She pressed the phone to her ear, carried the bin of decorations out to her truck, and locked the nursing home’s front door.

“There’s still so much good stuff wasting away in here,” she told her employee. “We’ll need to come back with the trailer.”

– –

A three-minute drive away, in a house at the center of Broken Bow, Marlene was sorting through her own belongings, trying to compile the story of her last 63 years with Earl, just in case. She wanted to pick out photos for his funeral program. She wanted to be prepared with a eulogy. She needed to call their bank and switch all of their joint accounts into her name.

“You’re smart to prepare early,” a banker was telling her now, on the phone. “This way you can do some of it together.”

“Actually, he’s not here,” she said. “It’s just me.”

The walls of her living room were decorated with photos of the grandchildren whom Marlene sometimes felt guilty visiting without Earl, and mementos from the church she didn’t like attending without him, and plaques from the grocery store where she still sometimes expected to see him when she shopped. One picture showed Earl at his retirement celebration, when some former co-workers came back from out of state and the store offered free cake to the entire town. A few hundred people had come through the store that day to say goodbye. “A small town turns out to support one of its own,” read one local news story about that day, but on this day, Marlene was thinking about the things Broken Bow could no longer support, and the closed nursing home, and all of the people Earl was no longer able to see. Aside from their family, she thought he’d had two visitors in the past six months.

She turned on the TV to check the weather report. She put her heart medication into her purse. She inched down the driveway and into their 20-year-old car.

Earl had usually been the one who drove during their marriage, but Marlene had put 14,000 miles on the car in the past several months. She drove out of Broken Bow and past the feedlots on the edge of town. She turned through the cornfields. She went over the frozen creek. She slowed for the dip. She waved to a tractor. She went by the grain elevator. She looked out the front windshield at the rolling prairie and counted off the long miles, until she was parked in front of the nursing home and walking into Earl’s room.

She saw him looking out the window and waiting in his chair, where she’d left him a few days earlier and would soon have to leave him again.

“I’m here,” she said, putting her arm on his shoulder. “I’ll stay for as long as I can.”

As clear as glass: even those with dry skin can achieve a smooth, glowing look

Published December 17, 2019 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30379529?utm_source=category&utm_medium=internal_referral

As clear as glass: even those with dry skin can achieve a smooth, glowing look

Dec 17. 2019
By Thanisorn Thamlikitkul
Special to The Nation
228 Viewed

All the rage in South Korea and growing in popularity in Thailand, “glass skin” in the term used to describe facial skin so smooth, glowing and pore-less that it’s as “clear as glass”. The trend is likely to spread even further next year thanks to the advent of new technology in skin hydrating injectables this year. Here’s how to achieve the look.

As we age, our skin undergoes two important changes – loss of elasticity and loss of hydration. These changes cause our skin to become drier and the pores become more visible. One effective way to combat and slow these effects of ageing is to restore hyaluronic acid to the skin. Hyaluronic acid is a naturally occurring substance in skin that keeps it hydrated and youthful. With age, our hyaluronic acid decreases and that’s where treatment comes in.

Current synthesized hyaluronic acid or HA is designed to come in soft, small molecules and viscous liquidity. A dermatologist will administer tiny droplets of this hyaluronic acid into the dermis or just under the dermis using a serial puncture technique. This technique allow the HA to disperse evenly in the dermis. HA will provide hydration and stimulate new collagen, resulting in firmness, luminosity and potentially reduced pore size. It will improve overall skin quality and enhance the “glass skin” appearance as well.

A recent study published in the journal “Dermatology Times” revealed a 91-per-cent satisfaction rate among treated patients in clinical trials. It’s said that patients like the long-term result (approximately up to 9 months) as well as the idea of internal moisturizer for smoothness, hydration and texture. However, if you want to achieve smoother, dewier and more glowing skin, it is important to only visit clinics with dermatologists highly trained in this treatment.

Siriraj to produce first mite allergen vaccine in Asean

Published December 12, 2019 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

https://www.nationthailand.com/lifestyle/30379303?utm_source=category&utm_medium=internal_referral

Siriraj to produce first mite allergen vaccine in Asean

Dec 11. 2019
By The Nation

1,405 Viewed

The Siriraj Dust Mite Centre for Services and Research recently said it would produce dust mite on semi-industrial scale which will further be used as the initial substance in mite allergen vaccine, after more than 20 years of research.

They were granted mite allergen vaccine certification by the Thai Food and Drug Administration on October 31. The mite centre now provides the know-how to the private sector and aims to become the central hub for R&D on dust mite allergy in the Asean region to produce more mite allergen-friendly products or suggest improvement or advice to the private sector or nongovernmental organisations, such as anti-mite mattress and air-conditioning.

Prof Dr Anchalee Tungtrongchitr, the director, said that “Another service provided here is anti-mite effectiveness in product testing, to protect consumers from pseudo-science-backed products.”

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