All posts tagged LifeStyle

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

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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

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

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

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

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.

Japanese women face a future of poverty #ศาสตร์เกษตรดินปุ๋ย

Published January 19, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

Japanese women face a future of poverty

Jan 19. 2020
A child and her mother look at a diorama of Tokyo at night made with Lego toy bricks at the Lego Land Discovery Center Tokyo on June 14, 2012. MUST CREDIT: Bloomberg photo by Tomohiro Ohsumi.

A child and her mother look at a diorama of Tokyo at night made with Lego toy bricks at the Lego Land Discovery Center Tokyo on June 14, 2012. MUST CREDIT: Bloomberg photo by Tomohiro Ohsumi.
By Syndication Washington Post, Bloomberg · Marika Katanuma 

At first glance, things seem to be getting better for Japanese women. In an economy that’s historically lagged other developed nations when it comes to female workforce participation, a record 71% are now employed, an 11 point leap over a decade ago.

The Japanese government boasts one of the most generous parental leave laws in the world and recently created a “limited full-time worker” category aimed primarily at mothers looking to balance job and family. And one of the most important needs for working families-child daycare-is slowly being expanded.

A woman walks near the Roppongi Hills complex in Tokyo on Sept. 29, 2017. MUST CREDIT: Bloomberg photo by Akio Kon,

A woman walks near the Roppongi Hills complex in Tokyo on Sept. 29, 2017. MUST CREDIT: Bloomberg photo by Akio Kon,

But even with these advantages, Japanese women-whether single or married, full-time or part-time-face a difficult financial future. A confluence of factors that include an aging population, falling birth rates and anachronistic gender dynamics are conspiring to damage their prospects for a comfortable retirement. According to Seiichi Inagaki, a professor at the International University of Health and Welfare, the poverty rate for older Japanese women will more than double over the next 40 years, to 25%.

For single, elderly women, he estimated, the poverty rate could reach 50%.

In Japan, people live longer than almost anywhere else and birth rates are at their lowest since records began. As a result, the nation’s working-age population is projected to have declined by 40% come 2055.

With entitlement costs skyrocketing, the government has responded by scaling back benefits while proposing to raise the retirement age. Some Japanese responded by moving money out of low-interest bank accounts and into 401(k)-style retirement plans, hoping investment gains might soften the blow. But such a strategy requires savings, and women in Japan are less likely to have any.

Japan’s gender pay gap is one of the widest among advanced economies. According to the Organisation for Economic Cooperation and Development, Japanese women make only 73% as much as men. Japan’s demographic crisis is making matters worse: Retired couples who are living longer need an additional $185,000 to survive projected shortfalls in the public pension system, according to a recent government report.

A separate study did the math for Japanese women: They will run out of money 20 years before they die.

Dire pension calculations published by Japan’s Financial Services Agency in June 2019 caused such an outcry that the government quickly rejected the paper, saying it needlessly worried people. But economic observers said the report was dead-on: Japan’s pension system is ranked 31st out of 37 nations due in part to underfunding, according to the Melbourne Mercer Global Pension Index.

Takashi Oshio, a professor at the Institute of Economic Research at Hitotsubashi University in Tokyo, said private pensions and market-based retirement investments are now much more important than they once were. Machiko Osawa, a professor at Japan Women’s University, was more blunt: The days of being “totally dependent on a public pension” are over.

But there are additional obstacles for Japanese women. Although 3.5 million of them have entered the workforce since Prime Minister Shinzo Abe took office in 2012, two-thirds are working only part-time.

Japanese men generally see their compensation rise until they reach 60. For women, average compensation stays largely the same from their late 20s to their 60s, a fact attributable to pauses in employment tied to having children or part-time, rather than full-time, work. Since the mid-2000s, part-time employment rates have fallen for women in more than half the countries that make up the OECD. But in Japan, the trend is reversed, with part-time work among women rising over the past 15 years.

One of Abe’s stated goals is to encourage more women to keep working after giving birth, part of his so-called Womenomics initiative. But according to a recent government study, almost 40% of women who had full-time jobs when they became pregnant subsequently switched to part-time work or left the workforce.

Machiko Nakajima’s employment trajectory is typical of this state of affairs. Nakajima, who used to work full time at a tourism company, left her position at age 31 when she became pregnant.

“I had no desire to work while taking care of my kid,” she said in an interview. Instead, Nakajima spent a decade raising two children before returning to work. Now 46, the mother of two works as a part-time receptionist at a Tokyo tennis center. Though her husband, who also is 46, has a full time job, Nakajima said she fears for her future, given the faltering pension system.

“It makes me wonder how I’m going to live the rest of my” life, she said.

– – –

According to government data, the monthly cost of living for a Japanese household with more than two people is 287,315 yen ($2,650). Some 15.7% of Japanese households live below the poverty line, which is about $937 per month.

More than 40% of part-time working women earn 1 million yen ($9,100) or less a year, according to Japan’s Internal Affairs and Communications Ministry. The lack of benefits, job security and opportunity for advancement-hallmarks of full-time employment in Japan-make such women financially vulnerable, particularly if they don’t have a partner to share expenses with.

Yanfei Zhou, a researcher at the Japan Institute for Labor Policy & Training and author of a book on the subject, “Japan’s Married Stay-at-Home Mothers in Poverty,” contends there’s a gap of 200 million yen ($1.82 million) in lifetime income between women who work full-time and women who switch from full-time to part-time at the age of 40.

“It’s not easy to save for retirement as a part-time worker,” she said. Single mothers need to make at least 3 million yen annually, or about $27,600-numbers you can’t hit “if you work part-time.”

In Japan, public pensions account for 61% of income among elderly households. The system provides basic benefits to all citizens and is funded by workers from age 20 to age 59-and by government subsidies. Many retirees get additional income from company pension plans.

While widows can claim some portion of a deceased spouse’s pension, the number of unmarried Japanese is steadily rising, having more than tripled since 1980. The latest survey showed the rate for women is 14% versus 23% for men.

One “reason why women’s retirement savings is lower than men’s is that the lifetime salary is low,” said Yoshiko Nakamura, a financial planner and president of Alpha and Associates Inc. “Traditionally, many women chose to limit their workload in order to take advantage of social security spousal benefits, and that created many ‘women’s jobs’ that pay less than 1 million yen.”

Japan has historically created incentives for married women to limit their employment to such non-career track jobs; lower pay means they (and their husbands) can take advantage of spousal deduction benefits. For example, the government gives a 380,000 yen ($3,133) tax deduction to a male worker if his wife earns less than about 1.5 million yen ($13,700) per year.

The private sector does it, too. Many companies give employees a spousal allowance as long as their partner earns less than a certain amount. Some 84% of private companies in Japan offer workers about 17,282 yen per month ($159) as long as their spouse earns less than a certain amount annually-usually 1.5 million yen, though the ceiling is lower for most companies.

Yumiko Fujino, who works as an administrative assistant, should have been happy when the government raised the minimum wage. But she wasn’t: In order for her husband to keep receiving spousal benefits, she had to cut back on her hours.

These limits are known among married women in Japan as the “wall.” Unless a wife is making enough money on a part-time basis to afford income taxes and forgo spousal benefits, it doesn’t make sense to work additional hours. But to work those kind of hours means less time for kids, which is usually the point of working part-time in the first place.

Women who qualify for the spousal benefit, Fujino said, “think less about retirement security and more about the current cost of living.”

Abe’s government is considering changes that would require more part-time workers to contribute to the pension program and mandate that smaller companies participate as well. Takero Doi, professor of economics at Keio University, said the expansion would be a small step toward giving women a financial incentive to work more.

Yoko Kamikawa, a former gender equality minister, agreed that the current pension system-last updated in the 1980s-should be expanded to include part-time workers. Forty years ago, single-income households made up the overwhelming majority in Japan. Since then, Kamikawa said families have become more diverse.

Machiko Osawa, a professor at Japan Women’s University, went farther, saying social security should be based around individuals, not households. “Marriage doesn’t last forever,” she said. “Women used to rely on their husbands for financial support, but now there’s the danger of unemployment, and more men are in jobs where their pay doesn’t rise.”

However, one of the biggest reforms proposed by Abe, “limited full-time worker” status, doesn’t always work as advertised. “Limited full-time” employees often face the same workload they would if they were full-time. Junko Murata, 43, a mother of two, said juggling both work and taking care of her children proved too difficult, so she eventually returned to a part-time job with spousal benefits.

While an increasing number of companies have been giving women the opportunity to work more flexible hours after they return from maternity leave, some women complain of being marginalized, with few opportunities for career growth and advancement.

A government survey released last year offered a bleak outlook. It showed no improvement in gender equality in the workplace, with some 28.4% of women saying they are treated equally at work, up only 0.2 percentage points since 2016.

Yasuko Kato, 42, returned to work as limited full-time accountant three years ago, but said there’s been little change in her responsibilities.

Because she drops off and picks up her kids, she works from 9 a.m. to 4:30 p.m. “I have no extra time at work,” she said. But because of a chronic staff shortage, she doesn’t get any help from full-time employees. As a result, Kato said “it’s difficult to raise my hand for a new role.”

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

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.”

An unlikely parrot love story #ศาสตร์เกษตรดินปุ๋ย

Published January 5, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

An unlikely parrot love story

Jan 05. 2020
Suzie, a military macaw, left, and Kirby, harlequin macaw, groom each other at TC Feathers Aviary on Jan. 2, 2020. Their offspring may be the first cross between the types of macaws. MUST CREDIT: Washington Post photo by Jahi Chikwendiu

Suzie, a military macaw, left, and Kirby, harlequin macaw, groom each other at TC Feathers Aviary on Jan. 2, 2020. Their offspring may be the first cross between the types of macaws. MUST CREDIT: Washington Post photo by Jahi Chikwendiu

WASHINGTON – When they met, Kirby and Suzie differed in ways that went beyond what people usually notice first about them, their color.

Kuzie, a hybrid, with his parents in the background, at TC Feathers Aviary on Jan. 2, 2020. MUST CREDIT: Washington Post photo by Jahi Chikwendiu

Kuzie, a hybrid, with his parents in the background, at TC Feathers Aviary on Jan. 2, 2020. MUST CREDIT: Washington Post photo by Jahi Chikwendiu

He was large. She was small.

He had spent most of his life in a loving home. She had been abandoned when she was young.

He was bold and a gifted talker. She was sweet and more selective with her words.

Tammy Morgan says she would never have thought of pairing the two – and yet, she saw how they quickly gravitated toward each other, how they soon started sneaking off to be alone and how he now watches over her, ever ready to place himself between her and any perceived danger.

Kuzie at four weeks old. MUST CREDIT: TC Feathers Aviary Photo by: TC Feathers Aviary — The Washington Post Location: Chantilly United States

Kuzie at four weeks old. MUST CREDIT: TC Feathers Aviary Photo by: TC Feathers Aviary — The Washington Post Location: Chantilly United States

“They fell in love,” Morgan says.

There are love stories, and then there is the love story of Suzie and Kirby. Theirs is a rare pairing, one that both defies nature and resulted from it. The two are species of parrots that don’t normally mate: Kirby is a harlequin macaw and Suzie is a military macaw.

In the wild, they likely wouldn’t have come together. In a Virginia aviary, they are inseparable.

They are also parents. About a year ago, their firstborn hatched from an egg, leaving the aviary with a unique quandary: What do you call a species that doesn’t seem to exist anywhere else?

Morgan, who owns TC Feathers Aviary in suburban Virginia along with her wife, Carey Morgan, says the two never intended to breed macaws. It is difficult work even under the best of conditions, says Tammy Morgan, who has bred cockatiels, conures and caiques.

Macaws usually want a quiet, secluded area to mate.

“Not these two,” she says.

In their case, it seems, nature stepped in, threw her arms up and said, “Eh, what rules?” Quiet and secluded does not describe the aviary. It also serves as a store, so it often is a cacophony of birds squawking and customers talking, but that didn’t deter Suzie and Kirby from taking their affection to another level. Around 3:30 p.m. each day, the two would make their way from a backroom, where birds perch on makeshift trees and in cages, to the front of the store, where the cash register sits.

The staff always knew they were coming because as the two waddled, their talons clicked against the tile.

The staff also knew where they were headed. Each day, the two picked the same unlikely place for an avian rendezvous – a cat carrier. The carrier sits against a wall near the front door and is basically a large open cage lined on the bottom with a plush, pink bed. It provides the cats that live in the store (and keep the mice away) a place to lounge.

But when Suzie and Kirby showed up, any cat that happened to be in that carrier knew enough to leave. Everyone knew what was about to happen for the next 20-or-so minutes.

“It would be one thing if they were quiet, but they’re so loud,” Morgan says. “So finally, I put them in the same cage. It was better there than in front of the store, in a cat carrier.”

Morgan first started taking care of Suzie more than a decade ago after she and two other macaws were left in front of her house by a man who lived with his parents and realized he couldn’t take care of the birds. The aviary sees that situation often enough that the staff warns people who come to purchase pets about the responsibility. If someone comes in saying they want a bird that talks or that matches their furniture, that person will leave with instructions to go home and do some research.

“It’s not buying a goldfish,” Morgan says. “Some of these animals are going to live 60 to 70 years. That’s a 60- to 70-year commitment and one you have to be ready for.”

You have to be ready for a pet that is as demanding as it is stunning. I first learned about the aviary, which used to exist under a different name and at a different address, when my husband and I walked in to pick out two newborn cockatiels. Those birds are now two affectionate 8-year-olds with their own personalities and (loud) ways of telling us what they want.

On a recent afternoon, the volume in the backroom of the aviary is deafening. It is almost time for Morgan to feed some of the birds by hand, and they aren’t feeling patient.

Meanwhile, Suzie and Kirby sit quietly on nearby branches of the same makeshift tree.

When Suzie first came to live at the aviary full-time a few years ago, she had suffered a loss. She had paired up with another macaw that died, and “she was really missing” him, Morgan says.

Kirby had been raised since he was young by Morgan’s wife and was one of several male macaws living at the aviary at the time. He was also the biggest bird in the place and had developed a reputation of being rude to other macaws in group situations. With Suzie, though, he was gentle.

They would clean each other’s feathers with their beaks, which is called preening and requires a level of comfort and trust.

When the two began sharing a cage, no one knew what to expect. What they didn’t expect, though, were fertile eggs.

Morgan says Suzie laid two separate sets of egg at the bottom of the cage, but she didn’t know how to take care of them. Instead of sitting on them, she sat next to them, so they didn’t develop properly.

The next time she laid a set of eggs, Morgan pulled them from the cage and placed them in an incubator. Two didn’t make it.

But from the third egg, on a day when the store was crowded with people for the aviary’s inaugural Parrot Fest, came a tiny lump of a bird.

The aviary took suggestions from customers for a name and settled on “Kuzie,” a combination Suzie and Kirby.

The aviary’s staff, along with their friends, relatives and customers, also started researching whether a military macaw and harlequin macaw, which is a hybrid mix between a green-wing macaw and a blue-and-gold macaw, had ever produced an offspring.

They couldn’t find another.

Kuzie, they realized, wasn’t just the product of an unusual love story. He was product of an unusual love story that might have created a one-of-a-kind species.

Unsure what to call this new type of bird, and unable to find a name that already existed, the aviary again took suggestions. And they again picked one that gave a nod to both parents: “miliquin macaw.”

Morgan describes the days and weeks following Kuzie’s birth in October 2018 as both thrilling and scary. She didn’t know if he would survive. For five months, she woke up every 90 minutes in the night to make him formula and feed him.

She did the same in May 2019 when another egg hatched. This time it was a girl and she was named Millie.

Both Kuzie and Millie have lighter beaks than their parents, which they get from one side of their father’s genetics. They also seem to share his ease with words. Kuzie is fond of saying, “peekaboo.” And as Millie nuzzles against Morgan that recent afternoon, she says, “I love you.”

Occasionally someone will ask whether the siblings are for sale, and each time the answer is the same.

“At this point, everyone is so attached, not only us, but also our customers,” Morgan says. “They’re not going anywhere.”

If they produce more miliquins, those will be for sale.

When that time comes, she has just one hope: that Suzie and Kirby will figure out what comes after making those eggs.

“If they could figure out how to take care of their own children,” she says, “I would appreciate that.”

Five myths about diabetes #ศาสตร์เกษตรดินปุ๋ย

Published January 4, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

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 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 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.

5 kitchen resolutions that you can actually stick with in the new year #ศาสตร์เกษตรดินปุ๋ย

Published January 4, 2020 by SoClaimon

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation

5 kitchen resolutions that you can actually stick with in the new year

Jan 04. 2020

Tackle one spot - like that

Tackle one spot – like that “miscellaneous drawer” full of tools you use and tons you don’t – when you have 10 or 15 minutes and feel the burden lift. MUST CREDIT: Photo for The Washington Post by Tom McCorkle; food styling for The Washington Post by Lisa Cherkasky
By The Washington Post · Becky Krystal · FEATURES
It’s Jan. 3! Have you already ditched your totally unrealistic, pie-in-the-sky New Year’s resolutions?

Sure, the pressure to make dramatic changes in your life can be a bit daunting, especially if it has to do with food. But let’s take a step back and dial down the stress. Let’s focus on incremental, attainable goals that will help you – and even the planet – in subtle but substantial ways.

Feeling a little less anxious? Good. Now here’s where to start.

1. Organize.

There are a few universal chaos locations in the kitchen. You know, under the sink where you stash all the plastic bags you promise to recycle soon, the cabinet with all the mismatched storage containers and that “miscellaneous drawer” full of tons of tools you use – and tons you don’t. Tackle one spot at a time when you have 10 or 15 minutes and feel the burden lift. Thin out the gadgets you never or rarely reach for (how many digital thermometers do you really need?), and you’ll be much more likely to find and use the ones you do. The same goes for the spice cabinet.

2. Learn to take better care of your tools.

Your kitchen is full of equipment and tools that can last forever as long as you treat them right. So, learn which items are best washed by hand – knives, pots and skillets are at the top of the list – and how to do that best. Keep your knives sharp (and safe). Keep your cast iron seasoned, and don’t let it sit around wet to develop rust. Don’t use your nonstick cookware on high heat. Don’t heat an empty enameled cast-iron Dutch oven on the stove top. When in doubt, read the manual.

3. Use less plastic and disposables.

Granted, this may be the hardest one on this list. If you’re a plastic wrap and aluminum foil addict, try to eliminate, or at least reduce, your habit. You can find reusable options for almost any kitchen staple these days, whether it’s beeswax wraps, silicone bags, cotton or mesh produce pouches, metal straws and food covers. Shopping the bulk bins to fill your own containers with exactly what you need cuts back on both packaging and food waste.

4. Store your fruits and vegetables better so they get eaten and not tossed.

Produce is essentially a living, breathing thing. If you think you can just toss it in your fridge and assume it will be OK, you’ll be disappointed. Learn which foods benefit from humidity (generally, fruit needs less and vegetables more) and which should not be stored together (separate ethylene-producing items from ethylene-sensitive items). Some – potatoes, onions – shouldn’t be stored in the refrigerator at all. With just a few small adjustments, you’ll save money and food.

5. Keep your kitchen cleaner.

This is always an admirable goal. Whether you’re a clean-as-you-go or clean-at-the-end, you never want to walk away from the kitchen without having tidied up. Procrastination here does not pay off, especially if there are dishes to wash and messes to wipe up. Of course, the kitchen is full of annoying little cracks and crevices, and stubborn stains. Inexpensive tools like wooden skewers, a Magic Eraser scrubber, and toothbrushes are among cheap tools to help you get the job done. You’d also do yourself a favor to spend a few bucks on a canister of Bar Keepers Friend.

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