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More than 122 million Americans have high blood pressure, which can lead to heart disease and stroke.

Fortune

More than 122 million Americans have high blood pressure, which can lead to heart disease and stroke. Here’s how to get your numbers under control

Wändi Bruine de Bruin – February 21, 2023

Stunning as it may sound, nearly half of Americans ages 20 years and up – or more than 122 million people – have high blood pressure, according to a 2023 report from the American Heart Association. And even if your numbers are normal right now, they are likely to increase as you age; more than three-quarters of Americans age 65 and older have high blood pressure.

Also known as hypertension, high blood pressure is a major risk factor for heart disease and stroke.

Our research has found that most Americans don’t know the normal or healthy range for blood pressure – yet strikingly, they think they do. And that is cause for serious concern.

We are a health communications expert and a cardiologist. Together with our health communication collaborators, we surveyed more than 6,500 Americans about their knowledge of blood pressure. They were recruited through the Understanding America Study, a nationally representative sample of U.S. residents.

In our new study, published in January 2023, we found that 64% expressed confidence in their understanding of blood pressure numbers – but only 39% actually knew what normal or healthy blood pressure is. A healthy diet, more exercise and less salt and alcohol are all ways to improve your blood pressure numbers.

False confidence, deadly consequences

Such false confidence can be harmful because it may prevent people from seeking care for high blood pressure. After all, if you think it’s normal, why bother talking to your doctor about your blood pressure?

Part of the reason for this overconfidence begins in the doctor’s office. Typically, a nurse brings over a blood pressure cuff, straps it on your upper arm and takes a reading. The nurse may announce the result, remove the cuff and record it for the doctor.

When the doctor arrives, the session may well move on to other matters without a word about the blood pressure reading. This likely happens because your doctor wants to focus on how you’re feeling and why you’re there. But as a result, you may leave your appointment thinking your blood pressure is fine, even if it’s not.

About 70% of Americans will have high blood pressure in their lifetimes. What’s more, only 1 in 4 patients with hypertension have their blood pressure under control. And because high blood pressure usually has no symptoms, you can have it without knowing it.

To lower your risk of heart attacks and strokes, it’s critical to understand your blood pressure readings. This is especially true for patients with conditions such as heart disease, kidney disease and diabetes.

What the numbers mean

Blood pressure is reported with two numbers. The first number is your systolic blood pressure; it measures the pressure in arteries when the heart beats. The second number, your diastolic blood pressure, measures the pressure in your arteries between heartbeats.

Normal or healthy blood pressure is less than 120/80 millimeters of mercury (mm Hg) for adults. This is a unit of measurement that stems from early blood pressure monitors, which looked at how far your blood pressure could push a column of liquid mercury. For most patients, lower tends to be better.

Stage 1 hypertension, which is the lower stage of high blood pressure, begins at 130/80. Stage 2 hypertension, which is the more severe stage of high blood pressure, begins at 140/90. Both numbers are critically important, because every increase of 20 millimeters of mercury in systolic blood pressure, or 10 in diastolic blood pressure, doubles a person’s chances of dying from a heart attack or stroke.

10 tips for healthier blood pressure

To avoid false confidence, ask about your blood pressure at every doctor’s visit, and find out what the numbers mean. If your blood pressure is above the normal or healthy range, then the American Heart Association recommends the following 10 tips.

Talk with your doctor. If your blood pressure is high, ask your doctor about strategies for lowering it, and how you can track your blood pressure at home.
Eat a heart-healthy diet. Vegetables, fruit, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and olive oil are all good for your heart. Red meat, saturated and trans fats and ultraprocessed foods are unhealthy for your heart.
Cut back on salt, which increases blood pressure. The Dietary Guidelines for Americans recommend no more than 2,300 milligrams of sodium per day – that’s less than one teaspoon – but the U.S. Food and Drug Administration reports that the average American takes in about 3,400 milligrams daily, roughly 50% more than recommended. Even if you don’t add any salt to your meals, you may still get too much from ultraprocessed foods. One serving of canned chicken noodle soup has 680 milligrams of sodium. One Big Mac from McDonald’s has 1,010 milligrams of sodium.
Limit your alcohol use. Whether it’s beer, wine or spirits, alcohol increases your blood pressure. It’s better to not drink alcohol, but if you do, observe the limits recommended by the Dietary Guidelines for Americans. For women, that’s one drink per day at the very most. For men, it’s two drinks per day at most. One drink is 12 ounces of beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits.
Be more physically active. Just two and a half hours per week of physical activity can help lower blood pressure. For example, that’s a 30-minute walk five days a week. You might also switch up your physical activity by swimming, lifting weights, doing yoga or going dancing.
Maintain a healthy weight. Even losing a few pounds can help manage high blood pressure in people who are overweight. Ask your doctor about a healthy approach to weight loss.
Manage stress, which is bad for your blood pressure. While stress relief doesn’t always lower blood pressure, bringing down your stress level can help you feel better. The Mayo Clinic recommends several ways to manage stress, including learning to say no sometimes, spending time with family and friends and meditating.
If you smoke, vape or both: Quit now. Both are bad for your heart and blood vessels and contribute to high blood pressure. Quitting smoking may reduce your heart disease risk to nearly the same level as people who never smoked. And the benefits of quitting start right away. A recent study found that after just 12 weeks, people who quit had lower blood pressure than when they were still smoking. The Centers for Disease Control and Prevention has recommendations for programs and medication that can help you quit.
Take medication, which is often recommended for people with stage 2 hypertension, and for some with stage 1 hypertension, including those who also have heart disease, kidney disease or diabetes. Most patients need two to three medications to lower blood pressure to normal or healthy levels. A recent meta-analysis demonstrated that lowering systolic blood pressure by 5 mm Hg through medication reduces the risk of major cardiovascular events by about 10%, irrespective of baseline blood pressure or previous diagnosis of cardiovascular disease.
Track your blood pressure at home. The American Heart Association recommends an automatic, validated cuff-style monitor that goes on your upper arm. A record of readings taken over time can help your doctor adjust your treatments as needed.

High blood pressure is a silent killer. Being proactive and knowing your numbers can be a lifesaver.

Wändi Bruine de Bruin, Professor of Public Policy, Psychology and Behavioral Science, USC Sol Price School of Public Policy, USC Dornsife College of Letters, Arts and Sciences and Mark Huffman, Professor of Medicine, Washington University in St Louis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Putin lashes out at Russian oligarchs with their ‘elite real estate’ and ‘yachts’: ‘They just got robbed in the West’

Fortune

Putin lashes out at Russian oligarchs with their ‘elite real estate’ and ‘yachts’: ‘They just got robbed in the West’

Chris Morris – February 21, 2023

Russian president Vladimir Putin, who has previously had a friendly relationship with the country’s oligarchs, has seemingly changed his mind about the country’s richest citizens.

In his address to Russia’s parliament, Putin took a rancorous tone to the elites, saying the sanctions they have faced since the start of the Ukraine war are the price tag for their Western relationships and labeled them as traitors to the Russian state.

“Instead of creating employment here, this capital was spent buying elite real-estate, yachts,” he said, according to CNBC. “Some came to Russia, but the first wave was spent on consuming Western goods.…The latest events have demonstrated that the West was just a ghost in terms of being a safe haven. Those who saw Russia as just a source of income and were planning to live abroad, they saw that they just got robbed in the West.”

Sanctions by the U.S. and other countries led to $95 billion in losses for oligarchs last year. Putin, though, showed no sympathy for the rich, saying “none of the simple citizens of this country were sorry about those who lost massive bank accounts in the West.”

Sanctions against Russian oligarchs have resulted in several high-profile seizures in the past year, including megayachts worth $300 million and $325 million, but a $500 million boat managed to escape seizure.

Some oligarchs have been increasingly vocal against the Ukraine war, which could have been the root cause of the rift with Putin. Several oligarchs have been found dead since that criticism started, including two last April within 48 hours of each other. In both of those cases, their family was found dead as well.

A Year of Putin’s Wartime Lies

The New Yorker – Comment

A Year of Putin’s Wartime Lies

Every credible analyst of the invasion of Ukraine has been stunned by the scale of the Russian President’s folly—and his failure extends well beyond the battlefield.

By David Remnick – February 19, 2023

Illustration by João Fazenda

On February 24, 2022, Vladimir Putin, the Russian President, ordered the invasion of Ukraine, unleashing the full force of his military on an unthreatening neighbor, and the full force of his propagandists on his own population. He had little doubt about his prospects. For years, he had been regarded in the world press as a singularly cunning strategist; at the same time, he methodically crushed civil society in his country and sidelined any dissenting voices in the Kremlin.

So who was going to stop him on the road to Kyiv? Hadn’t Donald Trump, during his Presidency, exposed and deepened the fissures in the nato alliance? Under Joe Biden, the United States seemed finished with foreign adventures—humiliated by its chaotic withdrawal from Afghanistan and distracted by its internal divisions. And what of Ukraine itself? It was a pseudo-nation, hopelessly corrupt and led by Volodymyr Zelensky, a former sitcom actor with an approval rating south of thirty per cent. Putin’s serene presumption was that, within a week, his forces would overrun Kyiv, arrest Zelensky and his advisers, and install a cast of collaborators. Putin was counting on historians to celebrate his rightful restoration of Imperial Russia.

A year later, the ramifications of his delusions are enormous and bloody. We do not know the precise number of dead and wounded, though it is certainly more than a quarter of a million. Unmoved by the losses on his own side, much less on Ukraine’s, Putin has sent his minions to the provinces to scoop up more human material for the meat grinder of his war. And what of his strategic mastery? For years, the Kremlin leadership advertised the modernization of its post-Soviet military, the sophistication of its “asymmetric” fighting doctrine. But every credible analyst of the invasion has been stunned by the scale of Putin’s folly—the miserable planning and poor intelligence, the lack of training and logistics, the lawlessness of his officer corps. His strategy, it turned out, was of the most primitive and criminal variety: the deliberate targeting of civilian structures—schools, hospitals, apartment buildings, power plants, bridges. In Bucha, Kherson, Izyum, and elsewhere, Russian forces and mercenaries have carried out acts of torture, which have been well documented by journalists and human-rights organizations.

In a year’s time, what has Putin achieved? To set the stage for this full-scale invasion—it should be recalled that the first act of aggression came in 2014, when Russian soldiers took Crimea and infiltrated the Donbas––he issued a long, historically perverse manifesto that asserted what he had been telling foreign leaders for years: that there is no such thing as Ukrainian nationhood. But by invading Ukraine, and doing so with such brutality, he has unified Ukrainians in their hatred of Russia and in their resolve to create a future as a free, independent, and European nation.

Russian propagandists (much like the propagandists of the G.O.P.) refer to President Biden as a doddering hack, incapable of making it through a coherent sentence, let alone putting up an effective resistance to the Russian armed forces. Yet, in the past year, Biden has conducted a foreign policy of competence and moral clarity, skillfully balancing strength, diplomacy, and restraint. After having publicly predicted Putin’s intention to invade, Biden won congressional support to send nearly thirty billion dollars in assistance to Ukraine, supplying its armed forces with crucial air-defense systems, mobile multiple-rocket launchers, and, most recently, M1 Abrams tanks. Biden has recognized and advertised the immense stakes of the conflict, but he has taken pains not to provoke a direct conflict with Russia. The Europeans have acted with similar determination. The opposition in Congress to supporting the Ukrainian cause has so far been limited mainly to the right wing of the Republican Party, with an assist from its attendant media outlets.

Putin’s failure extends well beyond the battlefield. He has isolated Russia from much of the world, undermining its reputation, its economy, and its prospects. Hundreds of thousands of Russians—often the best and the brightest in tech, academia, and the arts—have left the country. With Putin’s most compelling political opponent, Alexey Navalny, languishing in a prison camp, and independent media outlets shuttered, it may seem that Putin has secured the bovine indifference of all his subjects. And yet there are signs of disaffection: protests, individual acts of defiance reported on Telegram and other social media. One of the top-selling books of the past year in Russia has been George Orwell’s dystopian novel “1984.” Not long after the invasion, police in the city of Ivanovo arrested two people who were handing out free copies on the street. Sales are so high, and the implications so obvious, that Maria Zakharova, the spokesperson for the foreign ministry, felt compelled to reject the notion that the novel resembles Putin’s rule in any way. “In school, we were drilled that Orwell was describing the horrors of totalitarianism,” she said. “This is one of those global fakes.” Instead, the novel “depicted how liberalism would lead humanity to a dead end.”

Although the anniversary of Putin’s invasion is a moment to pay solemn tribute to the dead and to celebrate the astonishing resilience of Ukraine, it cannot be one of heedless overconfidence. This is a war that could go on for a very long time. As Dara Massicot, an expert on the Russian military, writes in the latest issue of Foreign Affairs, “The Russian armed forces are not wholly incompetent or incapable of learning.” Her article deftly anatomizes Russia’s failures, but also goes into alarming depth about how the military leadership can call on hundreds of thousands of recruits, and better exploit the resources of a vast country to inflict greater pain on Ukraine. Crucially, Putin seems not to care about casualties in his ranks. Just recently, hundreds of his soldiers were, according to a leading Russian officer, killed “like turkeys at a shooting range” in the town of Vuhledar, in eastern Ukraine. Putin responded laconically to the debacle. His 155th Marine Brigade, he said, was “performing as it should.”

One of the many gifts that Zelensky and the Ukrainian people have provided in the past year is the example of their valor and their sanity. In the most heroic terms, they have drawn the line against delusion. Putin told Ukraine that it is not a nation. Ukraine has given its response. As Orwell wrote in his novel, “There was truth and there was untruth, and if you clung to the truth even against the whole world, you were not mad.”

Published in the print edition of the February 27, 2023, issue, with the headline “Wartime Lies.”

How the Russian economy self-immolated in the year since Putin invaded Ukraine

Fortune

How the Russian economy self-immolated in the year since Putin invaded Ukraine

Jeffrey Sonnenfeld, Steven Tian – February 20, 2023

A year after Putin’s invasion of Ukraine, some cynics lament that the unprecedented economic pressure campaign against Russia has not yet ended the Putin regime. What they’re missing is the transformation that has happened right before our eyes: Russia has become an economic afterthought and a deflated world power.

Coupled with Putin’s own misfires, economic pressure has eroded Russia’s economic might as brave Ukrainian fighters, HIMARS, Leopard tanks, and PATRIOT missiles held off Russian troops on the battlefield. This past year, the Russian economic machine has been impaired as our original research compendium shows. Here are Russia’s most notable economic defeats:

Russia’s permanent loss of 1,000+ global multinational businesses coupled with escalating economic sanctions

The 1,000+ global companies who voluntarily chose to exit Russia in an unprecedented, historic mass exodus in the weeks after February 2022, as we’ve faithfully chronicled and updated to this day, have largely held true to their pledges and have either fully divested or are in the process of fully separating from Russia with no plans to return.

These voluntary business exits of companies with in-country revenues equivalent to 35% of Russia’s GDP that employ 12% of the country’s workforce were coupled with the imposition of enduring international government sanctions unparalleled in their scale and scope, including export controls on sensitive technologies, restrictions on Russian elites and asset seizures, financial sanctions, immobilizing Russia’s central bank assets, and removing key Russian banks from SWIFT, with even more sanctions planned.

Plummeting energy revenues thanks to the G7 oil price cap and Putin’s punctured natural gas gambit

The Russian economy has long been dominated by oil and gas, which accounts for over 50% of the government’s revenue, over 50% of export earnings, and nearly 20% of GDP every year.

In the initial months following the invasion, Putin’s energy earnings soared. Now, according to Deutsche Bank economists, Putin has lost $500 million a day of oil and gas export earnings relative to last year’s highs, rapidly spiraling downward.

The precipitous decline was accelerated by Putin’s own missteps. Putin coldly withheld natural gas shipments from Europe–which previously received 86% of Russian gas sales–in the hopes freezing Europeans would get angry and replace their elected leaders. However, a warmer-than-usual winter and increased global LNG supply mean Putin has now permanently forfeited Russia’s relevance as a key supplier to Europe, with reliance on Russian energy down to 7%–and soon to zero. With limited pipeline infrastructure to pivot to Asia, Putin now makes barely 20% of his previous gas earnings.

However, Russia’s energy collapse is also triggered by savvy international diplomacy. The G7 oil price cap has achieved the once unimaginable balance of keeping Russian oil flowing into global markets while simultaneously cutting into Putin’s profits. Russian oil exports have held amazingly consistent at pre-war levels of ~7 million barrels a day, ensuring global oil market stability, but the value of Russian oil exports has gone from $600 million a day down to $200 million a day as the Urals benchmark crashed to ~$45 a barrel, barely above Russia’s breakeven price of ~$42 per barrel.

Even countries on the sidelines of the price cap scheme, such as India and China, ride the coattails of the G7 buyers cartel to secure Russian supply at deep discounts of up to 30%.

Talent and capital flight

Since last February, millions of Russians have fled the country. The initial exodus of some 500,000 skilled workers in March was compounded by the exodus of at least 700,000 Russians, mostly working-age men fleeing the possibility of conscription, after Putin’s September partial mobilization order. Kazakhstan and Georgia alone each registered at least 200,000 newly fleeing Russians desperate not to fight in Ukraine.

Moreover, the fleeing Russians are desperate to stuff their pockets with cash as they escape Putin’s rule. Remittances to neighboring countries have soared more than tenfold and they rapidly attracted ex-Russian businesses. For example, in Uzbekistan, the Tashkent IT Park has seen year-over-year growth of 223% in revenue and 440% growth in total technology exports.

Meanwhile, offshore havens for wealthy Russians such as the UAE are booming, with one estimate claiming 30% of Russia’s high-net-worth individuals have fled.

Russia will only become increasingly irrelevant as supply chains continue to adapt

Russia has historically been a top commodities supplier to the world economy, with a leading market share across the energy, agriculture, and metals complex. Putin is fast making Russia irrelevant to the world economy as it is always much easier for consumers to replace unreliable commodity suppliers than it is for suppliers to find new markets.

Supply chains are already adapting by developing alternative sourcing that is not subject to Putin’s whims. We have shown how in several crucial metals and energy markets, the combined output of new supply developments to be opened in the next two years can fully and permanently replace Russian output within global supply chains.

Even Russia’s remaining trade partners apparently prefer short-term, opportunistic spot-market purchases of Russian commodities to capitalize on depressed prices rather than investing in long-term contracts or developing new Russian supply.

It appears Russia is well on its way toward its long-held worst fear: becoming a weak economic dependent of China–its source of cheap raw materials.

The Russian economy is being propped up by the Kremlin

The Kremlin has had to prop up the economy with escalating measures, and Kremlin control is increasingly creeping into every corner of the economy with less and less space left for private sector innovation.

These measures have proven costly. Government expenditures rose 30% year-over-year. Russia’s 2022 federal budget has a deficit of 2.3%–unexpectedly exceeding all estimates despite initially high energy profits, drawdowns and transfers of 2.4 trillion rubles from Russia’s dwindling sovereign wealth fund in December, and asset fire sales of 55 billion yuan this month.

Even these measures of last resort have been insufficient. Putin has been forced to raid the coffers of Russian companies in what he calls “revenue mobilization” as energy profits decline, extracting a hefty 1.25 trillion ruble windfall tax from Gazprom’s corporate treasury with more raids scheduled–and forcing a massive 3.1 trillion ruble issuance of local debt down the throats of Russian citizens in the autumn.

More can be done

Although 2023 will exacerbate each of these trends and further batter the Russian economy, there is even more that can be done to grease the skids.

A crackdown on sanctions evasion and smugglers, perhaps through secondary sanctions in the case of Turkey and other chronic offenders, will ensure that bad actors do not feed Putin’s war machine.

Sanctions provisions across technology, financial institutions, and commodity exports can be escalated. Pressure on companies remaining in Russia to fully and immediately exit the country must be maintained. Some $300 billion in frozen foreign exchange reserves could be seized and committed to the reconstruction of Ukraine

Tightening these screws will help improve the chances that before this time next year, Russia will realize it does not need Putin, just as the world has already realized it does not need Russia.

Only then will the Russian economy and people stand a chance of returning to prosperity.

Jeffrey Sonnenfeld is the Lester Crown Professor in Management Practice and Senior Associate Dean at Yale School of Management. Steven Tian is the director of research at the Yale Chief Executive Leadership Institute.

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

Putin’s Ukraine gamble seen as biggest threat to his rule

Associated Press

Putin’s Ukraine gamble seen as biggest threat to his rule

Andrew Katell – February 20, 2023

Russian President Vladimir Putin attends an Orthodox Easter service in the Christ the Savior Cathedral in Moscow, Russia, on Sunday, April 24, 2022. Putin sent forces into Ukraine on Feb. 24, 2022, appears determined to prevail -- ruthlessly and at all costs. (AP Photo, Pool, File) — Russian President Vladimir Putin attends an Orthodox Easter service in the Christ the Savior Cathedral in Moscow, Russia, on Sunday, April 24, 2022. Putin sent forces into Ukraine on Feb. 24, 2022, appears determined to prevail — ruthlessly and at all costs. (AP Photo, Pool, File)

Riot police detain demonstrators at a protest in Moscow, Russia, on Wednesday, Sept. 21, 2022, after Russian President Vladimir Putin ordered a partial mobilization of reservists, effective immediately. Putin sent Russian troops into Ukraine on Feb. 24, 2022, and appears determined to prevail -- ruthlessly and at all costs. (AP Photo, File) — Riot police detain demonstrators at a protest in Moscow, Russia, on Wednesday, Sept. 21, 2022, after Russian President Vladimir Putin ordered a partial mobilization of reservists, effective immediately. Putin sent Russian troops into Ukraine on Feb. 24, 2022, and appears determined to prevail — ruthlessly and at all costs. (AP Photo, File)

Vladimir Putin says he learned from his boyhood brawls in his native St. Petersburg: “If you want to win a fight, you have to carry it through to the end, as if it were the most decisive battle of your life.”

That lesson, cited in the most recent biography of the Russian president, seems to be guiding him as his invasion of Ukraine suffers setbacks and stalemates. The Kremlin strongman, who started the war on Feb. 24, 2022, and could end it in a minute, appears to be determined to prevail, ruthlessly and at all costs.

Stoking his countrymen this month on the 80th anniversary of the Battle of Stalingrad that turned around Moscow’s fortunes in World War II, he said: “The willingness to go beyond for the sake of the Motherland and the truth, to do the impossible, has always been and remains in the blood, in the character of our multiethnic people.”

But so far, Putin’s gamble in invading his smaller and weaker neighbor seems to have backfired spectacularly and created the biggest threat to his more than two-decade-long rule.

HISTORY AND MODERN ROADBLOCKS

He began the “special military operation” in the name of Ukraine’s demilitarization and “denazification,” seeking to protect ethnic Russians, prevent Kyiv’s NATO membership and to keep it in Russia’s “sphere of influence.” While he claims Ukraine and the West provoked the invasion, they say just the opposite — that it was an illegal and brazen act of aggression against a country with a democratically elected government and a Jewish president whose relatives were killed in the Holocaust.

Putin laid the foundation for the invasion with a 5,000-word essay in 2021, in which he questioned Ukraine’s legitimacy as a nation. That was only the latest chapter in a long obsession with the country and a determination to correct what he believes was a historical mistake of letting it slip from Moscow’s orbit. He reached back three centuries, to Peter the Great, to support his quest to reconquer rightful Russian territory.

But rectifying history soon hit modern roadblocks.

“Literally everything that he set out to do has gone disastrously wrong,” said British journalist Philip Short, who published his biography, “Putin,” last year.

Despite armed interventions in Chechnya, Syria and Georgia, Putin overestimated his military and underestimated Ukrainian resistance and Western support. Russian media try to boost his authority with images of a bare-chested Putin riding a horse, shooting at a military firing range and dressing down government officials on TV, but the war has exposed his shortcomings and the weakness of his military, intelligence services and some economic sectors.

Ukrainian forces have liberated more than half the territory Russia seized. The war has killed tens of thousands on both sides, caused widespread destruction, and induced not only Ukraine but Sweden and Finland to seek NATO membership. It has increased the security threat to Russia and scuttled decades of Russia’s integration with the West, bringing international isolation.

Increasingly, Putin seems to be improvising in a conflict much longer and more difficult than he expected. For example, he’s threatened to use nuclear weapons, then backed off. The strategy is familiar from his lifelong passion, judo: “You must be flexible. Sometimes you can give way to others if that is the way leading to victory,” Putin recounted in flattering 2015-17 interviews with American director Oliver Stone.

In Putin’s view, an aggressive West wants to crush Russia. His narrative, along with increasingly repressive measures to stifle domestic dissent, has galvanized patriotic support among many of his countrymen. But it runs up against an inefficient, top-down power structure inherited from the Soviet Union, against the interconnected world’s porous borders, and against the sacrifices Russians are suffering firsthand.

AN ERRATIC BUT DETERMINED LEADER

In interviews with The Associated Press, Short, other analysts and a former Kremlin insider describe the 70-year-old Putin as an erratic, weakened leader, rigid and outdated in his thinking, who overreached and is in denial about the difficulties.

They say he seems concerned about waning, though still strong, domestic public opinion — albeit from unreliable polls. Mostly isolated due to COVID-19 concerns and his personal security, Putin speaks with a small set of advisers, but they appear reluctant to provide honest assessments.

Observers see a long, grinding war that Putin is determined to win, with his way out hard to predict.

“It’s not Putin that rules Russia. It’s circumstances which rule Putin,” said Tatiana Stanovaya, senior fellow of the Carnegie Endowment for International Peace.

Short believes the Kremlin leader “has painted himself into a corner. … He will be looking for ways to push ahead, but I don’t think he’s found them.” Giving up is unlikely, Short said, recalling that “his character was always to double down and fight harder.”

Fiona Hill, who served in the past three U.S. administrations and is a senior fellow at the Brookings Institution, believes Putin wanted to win quickly in Ukraine, install a new president in Kyiv and force it to join Belarus in a Slavic union with Russia. A successor would run Russia, she said, with Putin elevating himself to lead the larger alliance.

But now, according to Stanovaya, “It feels like there is not any hopes that the conflict can be solved any other way than militarily. And this is scary.”

WHAT’S AHEAD

Analysts see several scenarios for Putin, depending on battlefield developments. The scenarios, not mutually exclusive, range from what could be his biggest nightmare — a coup or uprisings like those he saw as a KGB agent in East Germany in 1989, in the USSR in 1991 or Ukraine in 2004 and 2014 — to winning reelection next year. That would extend what is already the longest rule of any Kremlin leader since Josef Stalin.

Dmitry Oreshkin, a political analyst and professor at Free University in Riga, Latvia, said Putin could revise his goals in Ukraine, declaring he achieved them by establishing a land corridor from Russia to Crimea and taking over the Donetsk and Luhansk regions in the east. Then he could announce, “We punished them. We showed them who is the boss in the house. We have defeated all NATO countries,” Oreshkin added.

But Kyiv has shown no willingness to cede territory, and for Putin to sell this as a victory, Orsehkin believes “he needs to convince himself that he defeated Ukraine. And he understands better than anyone that, in fact, he lost.”

As military setbacks mount, Russians are withdrawing morally and psychologically, and thinking, “Yes, we see that something is wrong in the war, but we do not want to know,” according to Oreshkin.

Such tuning out, along with economic hardships, could blow back on Putin, he said, perhaps this spring, as Russians ask, “You promised victory, so where is it?”

Former Putin speechwriter Abbas Gallyamov said the Russian president doesn’t admit mistakes or defeats, and “desperately needs a victory just to prove the point that he’s a strongman.”

Even some in the military are turning critical, he said.

“When he becomes hated by more than half — and we’re driving in this direction — the chances for a coup, elite coup, military coup, will increase,” Gallyamov said, giving a timeline of 2024 “plus a couple of years.”

Stanovaya and Short believe no uprising is imminent.

“Even if people are suffering, and they can be discontented and angry, there is no way to make it political,” Stanovaya said.

Gallyamov sees a way out for Putin if he can gain recognition of “new territories, plus a declaration of NATO that it stops expansion, for example, or Ukrainian introduction into their constitution of their neutral status … or their declaration that Russian will be the second official language.”

DEATH OR SUCCESSION

Another possibility is Putin dying in office, but CIA Director William Burns is skeptical.

“There are lots of rumors about President Putin’s health, and as far as we can tell, he’s entirely too healthy,” Burns, a former U.S. ambassador to Moscow, told the Aspen Security Forum in Colorado in July.

Short said Putin has established such tight security controls and rival power centers that he’s more likely to suffer “a totally unanticipated heart attack than to be overthrown by the people around him.”

He and Hill believe Putin will eventually look for a successor. Gallyamov lists “technocrats” such as Moscow Mayor Sergei Sobyanin and Prime Minister Mikhail Mishustin as possibilities. Hill said Dmitry Medvedev, whom Putin tapped as president from 2008 to 2012, “seems to be auditioning for that role again.”

For the moment, Putin remains very much in charge. In his authorized 2000 biography, he noted: “There are always a lot of mistakes made in war. … You have to take a pragmatic attitude. And you have to keep thinking of victory.”

When a reporter asked him in December if his “special military operation” in Ukraine has been taking too long, Putin replied with a Russian idiom about big goals being achieved incrementally: “The hen pecks grain by grain.”

Greater Idaho is a pipe dream, a symptom of a deeper problem: the urban-rural divide

Idaho Statesman – Opinion

Greater Idaho is a pipe dream, a symptom of a deeper problem: the urban-rural divide | Opinion

Bryan Clark – February 20, 2023

The Idaho House last week voted to advance a resolution in support of so-called Greater Idaho, which would redraw the border between Oregon and Idaho to somewhere in the vicinity of Bend, chopping off most of the red portions of the Beaver State and tacking them onto the Gem State.

Doing so, proponents say, would free the vast rural areas of eastern Oregon from the oppressive rule of Portland and other urban population centers, and join it to rural, culturally similar Idaho.

The easy thing to say about Greater Idaho is that it’s ridiculous — and that’s true. The interstate compact required would need to get through Congress, as well as both the Oregon and Idaho legislatures.

Getting Congress to do much of anything has been virtually impossible for about a quarter-century or so, absent full one-party control. And Oregon would have to agree to cede more than half of its landmass, an unthinkable proposition.

So it’s a joke. But there is a serious problem contained within this persistent idea.

Greater Idaho is an embodiment of the pipe dream that we can all retire to our corners, where everyone agrees with us and nobody proposes anything we don’t like. It is a kind of political childishness. It’s the idea that you don’t need to build bridges across political divisions; you just need a new map.

It’s dangerous not as a policy, but as a political effect. And it’s spreading.

Rising calls for secession

The interesting question isn’t: Will Greater Idaho happen? It won’t.

The interesting question is: Why has such an effort arisen now?

Because it isn’t just here where there are proposals to redraw state or national borders to build ideologically homogeneous units. There’s a movement advocating for the secession of Texas. There’s an effort for rural parts of Illinois to secede from the urban areas around Chicago. There’s a movement to break up California. Last year, New Hampshire held hearings on seceding from the United States to become its own country.

Each of these proposals is as unserious as Greater Idaho. But there are common threads among them. They’re led by conservatives. They draw their support from rural areas. They promote the notion that they are preserving traditional values and a rural way of life against encroaching urban cosmopolitanism.

This follows a yearslong pattern, advancing since the early 1990s, of geographic polarization.

Urban/rural polarization

In 2020, researchers from the University of Maryland and the University of Washington in St. Louis did a detailed study of how where you live — and specifically how many people you live near — influences your political positions.

As the researchers noted, it was obvious for a long time that there was an urban/rural political division in America, but the general assumption was that this had to do with the differing racial, economic and cultural composition of rural and urban voters. But they found that even after controlling for race, income and a host of other factors, whether you live in a city or the country still has an independent effect on your political views.

And the converse is true, too: Your political views do a lot to determine where you live. The median Democrat lives 12 miles from a city center, the median independent 17 miles and the median Republican 20 miles, according to their findings. The median Republican lives in an area with fewer than 600 people per square mile, while the median Democrat lives in an area with about 1,200 people per square mile.

A 2021 paper by researchers from the London School of Economics and the Arctic University of Norway found that this urban/rural political divide is present in countries throughout the world, though it is much stronger in wealthier countries like the United States than in poorer ones.

In a guest essay last month in the New York Times reviewing a host of recent research, Thomas Edsall warned the cementation of polarized ideological divisions into patterns of living raised serious risks.

“Urban-rural ‘apartheid’ further reinforces ideological and affective polarization,” he wrote. “The geographic separation of Republicans and Democrats makes partisan crosscutting experiences at work, in friendships, in community gatherings, at school or in local government — all key to reducing polarization — increasingly unlikely to occur.

“Geographic barriers between Republicans and Democrats — of those holding traditional values and those choosing to reject or reinterpret those values — reinforce what scholars now call the calcification of difference. As conflict and hostility become embedded in the structure of where people live, the likelihood increases of seeing adversaries as less than fully human.”

We’ve seen plenty of that in Idaho.

From polarization to enmity

One supporter of Greater Idaho said during a committee hearing that he felt liberals in Oregon were taking delight in attacking conservatives and their way of life. He felt there were efforts to make guns impossible to own and to make it impossible to raise livestock.

Liberals in Idaho understand that feeling.

The Idaho Freedom Foundation used to take basically libertarian positions on most issues. It advocated smaller government, for example, but its big fight of 2016 was to make CBD oil, a derivative of hemp, legal. It was a fight against the culturally conservative Republican establishment on behalf of criminalized families.

Now its main enemy seems to be not big government but “wokeness” — not policy but culture. The enemy no longer seems to be state power, but the political minority’s way of life.

Ammon Bundy, known for leading protests outside officials’ homes and leading the armed takeover of the Malheur National Wildlife Refuge — and the Freedom Foundation’s pick for governor — made his biggest splash during campaign season by selling exactly this message. If elected governor, he promised, he’d pay liberals to move out of the state.

The increasing fixation of the Republican supermajority in the Idaho Legislature on the state’s tiny transgender community fits this mold, as well. The raft of yearly policies — trans kids can’t play sports or get gender-affirming medical care, trans people can’t get new birth certificates, books that mention gay people are pornography — comes with the constant rhetorical insistence that there are only two biological sexes, and that they are immutable (a strictly irrelevant point). The aim of the attack seems to be not mainly legal (most of the bills get halted in federal court) but cultural: delegitimizing the very existence of transgender people.

So you could understand why some parts of Idaho might want to be part a majority-Democratic Greater Montana (a proposal jokingly floated by Rep. Colin Nash, D-Boise). But the truth is, these problems can’t be solved by moving borders.

Moving borders solves nothing

The fundamental reason polarization can’t be solved with a new map is that today’s political divisions aren’t like those ahead of the Civil War. You can’t divide people neatly with a line. It isn’t North versus South or East versus West.

The modern American political division is overwhelmingly between urban and rural areas. But there is no conceivable way to collect the rural areas into one set of political divisions and the urban areas into another.

And even if you could, that wouldn’t get rid of the problem.

According to 2018 research by Pew, the average urban county in America had something like a 30-point Democratic lean, while the average rural county had around a 20-point Republican lean. That’s a massive gap. It means no election there will be competitive in a winner-take-all system.

But it still means about one in three urban residents lean Republican, and about two in five rural residents lean Democratic. Polarization extends only so far. More than a quarter of Kootenai and Bonneville counties voted for Joe Biden. One in five people in Custer and Lemhi counties voted for Biden.

No matter where you draw the state’s boundaries, there will remain major divisions within it — which puts you right back where you started. There’s always a very large group of people in the political minority. This isn’t a problem you can solve with a new map.

What the Greater Idaho movement represents is a mix of incredible naïveté and bottomless pessimism. It is the notion that we can all come together to agree that our political differences have become completely irreconcilable.

That is a doomed project, but more than that, it’s a childish urge that needs to be driven out of our political imagination.

Here are the unavoidable facts: We have to live with one another. There’s no way around it. Our coexistence may be peaceful or bitter — that is up to us — but we will coexist. Anyone who tells you something different is lying, either to themselves or to you.

Where do you stand in the Greater Idaho debate?

Bryan Clark is an opinion writer for the Idaho Statesman based in eastern Idaho.

Shrinking water supply will mean more fallow fields in the San Joaquin Valley

Los Angeles Times

Column: Shrinking water supply will mean more fallow fields in the San Joaquin Valley

George Skelton – February 20, 2023

KINGSBURG, CA - APRIL 21: Irrigation along Bethel Ave. on Wednesday, April 21, 2021 in Kingsburg, CA. A deepening drought and new regulations are causing some California growers to consider an end to farming. (Gary Coronado / Los Angeles Times) — Irrigation in Kingsburg, Calif., in 2021. A deepening drought and new regulations are causing serious challenges for some California growers. (Gary Coronado / Los Angeles Times)

Downpours or drought, California’s farm belt will need to tighten up in the next two decades and grow fewer crops.

There simply won’t be enough water to sustain present irrigation in the San Joaquin Valley.

Groundwater is dangerously depleted. Wells are drying up and the land is sinking in many places, cracking canals. Surface water supplies have been cut back because of drought, and future deliveries are uncertain due to climate change and environmental regulations.

We’ve known all this for years, but long-term projections have become even more grim, according to a new study by the Public Policy Institute of California.

“We found that annual water supplies could decline by 20% by 2040,” PPIC experts wrote. That would mean around 3.2 million acre-feet — almost the amount giant Oroville Dam can hold in California’ second-largest reservoir.

For many generations, Californians have taken pride in the state’s bountiful harvests of fruits, vegetables, nuts and wine grapes. We’re envied by the nation for our production of varied foods — from avocados to almonds, from peaches to pistachios, from okra to oranges.

But by the end of this century, will agriculture still be robust?

Agriculture is water intensive. And water is becoming increasingly worrisome in the West, particularly with overuse of the Colorado River. There’s plenty of water off our coast, but we’ve only begun to dip our toe into desalination.

PPIC researchers offered a glimmer of hope for the San Joaquin Valley. With government teamwork — local, state and federal — and agriculture itself, the financial blow could be lightened, they said.

That would mean loosening the rules on farmers selling their entitled water to other growers. There’d also need to be investments in infrastructure to import additional water supplies.

But realistically all that seems iffy given California’s historic water wars. Selling water means taking it from one crop and pouring it on another. And most new supplies would come from other interests — such as farmers to the north or the coastal salmon fishing industry.

Compromising probably would require money — perhaps tax money — to pay farmers to fallow their land and governments to build new canals and repair old ones.

Growers and local irrigation districts would need to write checks.

“Locals need to have skin in the game. Everybody’s always happy to have someone else pay for their crops,” says Ellen Hanak, vice president and director of the PPIC Water Policy Center.

The PPIC found that at least 500,000 acres of San Joaquin Valley cropland will need to be fallowed in the next 20 years. The institute initially calculated that figure four years ago. But now it’s considered a best-case scenario, requiring an additional 1 million acre-feet of water.

“Needless to say, this would be a very heavy lift,” the researchers wrote.

A more likely scenario, the PPIC says, would be to expand water supplies by 500,000 acre-feet annually and wind up being forced to fallow about 650,000 acres.

But even half a million more acre-feet of water seems wishful.

The worst-case scenario would be losing 3.2 million acre-feet of water and fallowing nearly 900,000 acres, one-fifth of currently irrigated land.

Plan on it. Prepare to plant solar panels.

The biggest reason farmers face a severe water shortage is that for decades they’ve over-pumped aquifers. And government didn’t have the guts to stop them.

Finally in 2014, California became the last Western state to begin regulating groundwater use — but very slowly. By law, groundwater usage doesn’t have to become sustainable for 20 years.

Meanwhile, farmers have been drilling deeper and faster to extract water — not necessarily even their own — before they’re restricted by law.

“The real promise of the groundwater act is making sure people are not using groundwater they shouldn’t,” Hanak says. “If you use someone else’s surface water you’re going to court. But with groundwater, no one has been minding the shop.”

Gov. Gavin Newsom and water officials everywhere talk optimistically about recharging aquifers. Great idea. But first you need to find the water for recharging.

That can come from rare mega-storms, as we had in January. But there need to be facilities for moving the rampaging water and rules that permit it.

The water can be pumped onto barren land — storm or not — and allowed to sink into the ground. But a landowner must agree.

Here’s an idea: Turn barren, fallowed cropland into wetlands that recharge aquifers. Nurture wildlife. California lost 95% of its wetlands in the last century.

Climate change may also reduce available surface water.

Hotter, drier air may cause snowpacks to evaporate or soak into the mountaintops before the water can flow down into reservoirs. Or Sierra snow may melt quickly and descend in torrents so fast it can’t be captured in the Sacramento-San Joaquin River Delta.

It’s all guesswork now.

PPIC researchers also predicted increased environmental restrictions on water in an effort to protect salmon and other fish.

I wouldn’t bet on that. Farm interests tend to outmuscle fish interests.

Newsom, for example, is trying to waive environmental rules aimed at keeping juvenile salmon alive in the delta. He wants more water to be stored for farmers.

Some footnotes:

The San Joaquin Valley produces more than half of California’s agriculture. The wetter Sacramento Valley produces nearly one-fourth. Together they make up the Central Valley.

Agriculture uses 80% of California’s developed water. The rest goes to domestic use — business and residential.

But agriculture generates only about 2% of the state’s gross product, down from 5% 60 years ago. It’s 14% of the San Joaquin Valley’s gross domestic product.

Three of my solutions:

Plant fewer thirsty crops, such as almonds that have proliferated.

Expedite groundwater regulations and aquifer recharging.

Get serious about inevitable desalination.

Belly fat is linked to serious health issues… here is how to get rid of it in 2023

The Telegraph

Belly fat is linked to serious health issues… here is how to get rid of it in 2023

Lowenna Waters – February 20, 2023

how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit - PA — how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit – PA

Due to our often sedentary lifestyles and stressful jobs – self-medicated with biscuits and pub trips – belly fat can easily build up.

Fat deposits around the middle have previously been linked to serious health issues, including Type 2 diabetes, high blood pressure and cardiovascular disease.

In its extreme, obesity reduces life expectancy by an average of three to 10 years, depending on severity, according to the NHS. It is also estimated that obesity and being overweight contribute to at least one in every 13 deaths in Europe.

So, with many of us feeling that we have put on a little weight here and there, and with stubborn tummy fat hard to shift – how can you get back in shape in 2023?

How to get rid of fat in 10 easy steps

1. Drink less alcohol

how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit alcohol - iStockphoto — how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit alcohol – iStockphoto

Yes, it can be very tempting to reach for the Merlot at the end of a particularly taxing day, but studies show that alcohol is one of the main offenders when it comes to storing belly fat. Consider this: if you consume just two glasses of wine an evening, that’s an extra 72,000 calories a year, which equates to 20 pounds of fat.

Alcohol contains a very high amount of “empty” calories which don’t have any nutritional value. Women are more likely to store the fat created by these surplus calories on their hips, thighs and arms, whereas men store it on their tummy, hence the “beer belly”.

If you’re keen on reducing your tummy fat quickly, it’s advised that you cut out alcohol from your diet completely. If that sounds too severe, try to at least stay under the NHS-recommended 14 units (spread across three days or more). Aim to cut down your intake by capping your nightly intake to two glasses, and always having several alcohol-free days each week.

2. Eat a high protein diet

protein steak how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit - iStockphoto — protein steak how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit – iStockphoto

There’s a good amount of evidence to suggest that protein is key to losing tummy fat. Firstly, it releases the hormone PYY, which helps to send a message to your brain that you’re full. A good portion of protein in a meal should help you avoid overeating.

Many observational studies prove that people with a higher protein intake have lower levels of belly fat. It also raises your metabolic rate, making you more likely to build muscle during and after exercise. Try to get a serving with every meal: breakfast, lunch and dinner.

3. Reduce your stress levels

Stress causes your body to gain fat because it triggers the release of the stress hormone cortisol, which in turn increases your appetite.

How do you relieve stress? To an extent, the answer is entirely personal – we’re all different – but studies consistently show that getting out in nature and regular bouts of meditation work to reduce our anxiety.

4. Don’t eat a lot of sugary foods

Calorie for calorie, sugar is different to other food groups such as protein, complex carbohydrates, and fat, because it confuses your normal appetite controls and causes your body to produce fat.

Refined sugars are often hidden in a plethora of different products that you wouldn’t expect such as fruit juices. Make sure to check the labels before eating the products.

5. Address food sensitivities

People often have food sensitivities that go unaddressed for years. If you think you may be suffering from an allergy, it’s important that you report it to your doctor who may refer you to a dietitian.

Common food sensitivities include dairy and gluten, both of which can result in an inflammation of the gut, making it even more prone to developing more sensitivities. Addressing these allergies can have dramatic impacts on weight loss, and even mood and behaviour.

6. Build up your strength

resistance training how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit - MBI / Alamy Stock Photo — resistance training how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit – MBI / Alamy Stock Photo

Everyone knows that regular exercise is necessary in order to lose weight; however, not everyone knows that resistance training is one of the best ways to do so.

Resistance training, also known as weight lifting or strength training, is important for improving and maintaining muscle mass. It also helps to spike our metabolisms, which means your body burns fat even after you’ve put the weights down.

However, it’s worth saying that the best possible training plan probably combines a variety of exercises.

7. Get plenty of sleep

sleep how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit

Sleep is one of the most important aspects of your overall health and wellbeing, especially when it comes to managing your weight. A 2013 study by the University of Colorado found that one week of sleeping about five hours a night led participants to gain an average of two pounds.

Easy ways to improve the quality of your sleep are by making sure you don’t look at screens late at night and by doing some gentle yoga before bed.

8. Eat fatty fish every week

Omega-3 fatty acids are lauded with such attractive qualities as delaying ageing and fighting degenerative diseases. However, it’s less well known that eating fatty fish is also excellent for weight loss (when accompanied by a balanced diet and regular exercise, of course).

Foods such as mackerel and herring are high in protein and “good fats” that help to break down some of the more dangerous fats in your body. Try to eat fish two or three times a week.

9. Replace some of your cooking fats with coconut oil

low fat cooking oils coconut how to lose weight diet fitness health issues 2022 uk men women struggling to get rid of belly fat new year resolution fit

Put aside the butter and olive oil and try coconut oil instead.

According to Web MD – and other medically-led sites – the medium-chain fats in coconut oil boost metabolism and decrease the amount of fat you store in response to high calorie intake.

10. Eat plenty of soluble fiber

Soluble fibre is ideal for aiding weight loss because it forms a gel with the food in your digestive tract, slowing it down as it passes through. This type of fibre promotes gut bacteria diversity, which has been frequently linked to a lower risk of belly fat.

Excellent foods to eat to increase your soluble fibre intake include avocados, legumes (try lentils, peas or chickpeas) and blackberries. In a 2021 study, volunteers ate one meal provided by researchers each day – one group ate an avocado, while a control group ate a meal similar in calories, but with the Instagrammer favourite left out.

“Female participants who consumed an avocado a day as part of their meal had a reduction in visceral abdominal fat,” says study leader Naiman Khan, the Illinois professor of kinesiology and community health. “However, fat distribution in males did not change, and neither males nor females had improvements in glucose tolerance.”

Easy exercises to burn belly fat

The best way to burn belly fat is to add around 30 minutes of cardio or aerobic exercise into your daily exercise routine.

Researchers from the Mayo Clinic in Minnesota ranked a variety common exercises based on information obtained from the US National Institutes of Health. The research calculated the number of calories burned during an hour of each exercise, with surprising results. With this in mind, these are some of the best work-outs to try:

Walking

Picking up the pace of your walk can work wonders for burning fat. When it comes to enjoying a brisk walk (3.5mph), you can burn between 314 and 391 calories.

A 2013 study by the University of Michigan also found that walking on uneven terrain while hiking increases the amount of energy your body uses by 28 per cent compared to walking on flat ground.

Skipping

Similarly to the above, skipping can help burn between 861-1,074 calories per hour, and thus burns fat. It is also a weight-bearing exercise so can help to improve bone density, which helps stave off osteoporosis.

Running

It goes without saying that running is a great way to burn calories. Running at 8mph will burn around 861-1,074 per hour (depending on your weight); you can burn 606-755 calories even running at 5mph, and 657-819 by simply running up the stairs.

Additionally, a 2005 study by the British Journal of Sports Medicine found that sedentary women who incorporated stair climbing into their daily activities increased their VO2 max, or maximum aerobic capacity, by 17.1 per cent and reduced “bad” LDL cholesterol by 7.7 per cent. (Read our guide to the best fitness trackers to learn how to track your workouts.)

Swimming

Experts agree that “vigorous swimming” is a full-body workout that is great for your joints. (By vigorous we’re sure they don’t mean splashing about in the shallow end.) It will help burn between 715-892 calories per hour of activity.

Breaststroke is the least beneficial stroke for burning calories, but a much better cardiovascular workout than the other strokes.

This guide is kept updated with the latest advice.

What Happens When You Die? Hospice Workers Share Conversations With Patients as They Near the End of Their Life

Parade

What Happens When You Die? Hospice Workers Share Conversations With Patients as They Near the End of Their Life

Lyssa Goldberg – February 19, 2023

Hospice workers share some of their impactful conversations with patients.

Talking about mortality can definitely be a frightening subject. But for some people, like those who work in hospice, discussing what happens when you die may feel like a more natural conversation to have.

So, what does it feel like to be days from death? And what happens to you when you die? While some of these questions may never be answered, we spoke to several hospice care professionals across the U.S. to find out what they’ve learned from their patients in their final days as they prepared to make a transition from life to death.

“Very few people are afraid of death. They’re afraid of dying, the process leading to death,” says Travis Overbeck, National Director of Patient Experience for Seasons Hospice.

Of course, no one truly knows what comes next, but some patients have a very clear idea of what they believe should happen once they die, says Overbeck. Hospice workers like himself get to explore their patients’ belief systems and ask them what they’d like their death to look like.

For instance, in the Buddhist tradition, there’s an expectation of silence at the time of death, according to Overbeck, and there should not be any wailing or grieving at the individual’s bedside so they can make their way peacefully into the next life.

“I’ve seen so many patients at the time of death. Most often, there’s this sense of peace and calm, and it’s really beautiful,” Overbeck says. “That’s why I do what I do. It’s all about bringing that peace and comfort to our patients at end of life.”

Here are some of the most common themes that have emerged from end-of-life conversations with hospice workers.

“Would you mind praying for me?”

Overbeck, a chaplain who sees patients of all faiths and backgrounds but practices Christianity himself, remembers his final conversations with a Jewish patient in her last days of life. She said, “I know you’re Christian, and I know I’m Jewish, but would you mind praying for me?”

“What would you like me to pray for?” Overbeck replied.

“I pray that when I die, it will be peaceful, and I will be comforted,” was the patient’s request.

After some conversation, they prayed together and the two hit it off. When Overbeck returned to the hospital the next day, the patient’s friend found him in the hallway. She told Overbeck that the patient had become unresponsive—but before she stopped speaking, the patient asked her friend to have Overbeck pray for her again if he returned.

Overbeck entered the patient’s room and, knowing that hearing is typically the last sense to go, he reintroduced himself and said, “I’m going to go ahead and pray for you.” He prayed again for peace and a comfortable transition. And at the end of his prayers, suddenly the patient began to talk.

“I’m going on a journey to a place I’ve never been before,” she started, “and everybody is sparkling, and everybody is smiling at me.” The patient died about 45 minutes later.

“I don’t care what belief system you are or aren’t. At the end of the day, that’s real. That was her experience,” Overbeck says.

Related: 35 Scriptures On Healing

Bringing life closure

Much of Overbeck’s work is dedicated to tying up loose ends and bringing his patients’ life to closure, whether that’s reuniting family members that have become estranged or ensuring the patient’s legacy is preserved. “There’s a process in dying,” Overbeck says. “It’s the opportunities to say, ‘I love you,’ opportunities to say, ‘I forgive you,’ opportunities to ask for forgiveness, opportunities to say, ‘Goodbye.’”

Overbeck recalls another conversation with a patient who was the CEO of a very large, well-known company. “Travis, I had it all,” the CEO told Overbeck. “I had the vacation homes. I was able to send my kids to the finest schools. We traveled the world. But at some point, I lost my focus. I began to value my job and my money more than anything else.”

Along the way, it cost him not only his marriage but his relationship with his kids. In fact, the patient had a grandchild he’d never even meet. Overbeck asked the patient for permission to reach out to his family. A few phone calls later, they were flying into town to visit the hospital.

Overbeck helped facilitate conversations between the patient and his family members, and while he acknowledges it wasn’t easy, he was ultimately able to bring them a feeling of closure. Most importantly, the patient was able to meet his grandchild for the first time. The patient died later that day.

“The biggest realization that I’ve had is that we all have a finite amount of time—it’s about how you’re going to live with that time,” Overbeck says.

Cultivating gratitude

Carolyn Gartner, licensed clinical social worker with Visiting Nurse Service of New York Hospice and Palliative Care, began practicing meditation and studying Buddhism around the same time she started pursuing social work.

Working in hospice care, she’s found her patients hold a perspective of gratitude and acceptance that parallels what she’s been taught through her meditation practice. “I feel my older patients really understand the idea of letting go, and not letting small things bother you,” Gartner says. “We get so caught up in the day-to-day, and I see my older patients are a good role model for how those things pass.”

Related: 100 Benefits of Meditation

Gartner works with a diverse array of patients throughout Brooklyn, from celebrities to patients in public housing. Recently, she and a chaplain from VNSNY Hospice went to visit a Jamaican patient who loves Bob Marley music.

The patient’s daughter told them that her mother had experienced a severe explosion of pain the day before, so Gartner prepared to handle the situation sensitively, thinking perhaps the patient wouldn’t want to listen to music that day.

When they walked in the door, however, the patient was wearing a big smile on her face and said: “Okay, ladies, when are you starting the Bob Marley?’”

“I do think that this work, almost every day, reinforces to me: We are energy. We are light. There is a spirit,” Gartner says.

At end-of-life, people like to reflect on their life story, Gartner says. Patients will take out old photos and share stories of joy and pain all in one session. Having studied screenwriting as an undergrad at New York University, Gartner uses these same storytelling techniques with her patients to learn and listen to their stories.

“My observation is that people will often die the way they live, so it’s really interesting to see how people process what they’ve gone through,” she says.

While the patients may seem ready to accept what comes next, Gartner says it’s the families who often need help coming to terms with it. VNSNY Hospice assists with the pre-bereavement process for family caregivers so they can see beyond the grief and enjoy the time they have left with the patient.

“Patients almost always know what’s going on in their body. It’s the family who doesn’t,” she says.

Related: 50 Gratitude Quotes

Seeing lost loved ones

Over the years, Kalah Walker, patient care administrator for VITAS Healthcare, has seen numerous hospice cases where the patients will call out to their loved ones who’ve passed, as if they’re seeing someone that everyone else cannot.

Often, they look out into the distance, and the hospice worker knows it’s the name of a family member who’s no longer with us. Generally, this happens within the last days of their life, Walker notes.

“You know what they’re seeing when they’re looking off into the distance…,” she said. “Once they do that, they’re able to let go.”

Sometimes, the patients will ask their hospice worker if they can see the family member too. Walker says it’s important to be there in the moment with them, agree, and allow the moment to happen as the patient is experiencing it. “There’s a nurse who gets to be there to bring life into this world, and we get to stand there and hold a patient’s hands or their family’s hands as a life leaves this world,” she says.

Walker says the real work with end-of-life care comes after the patient passes, however. “Hospice isn’t just about death and dying. It’s about learning about what’s really important in life and keeping those memories alive,” Walker said.

VITAS’ staff supports families who’ve experienced loss with programs like gifting them memory bears as reminders of their loved ones or butterfly release ceremonies. At the butterfly release ceremony, families will open a package and release butterflies into the sky, giving them a chance to reflect and experience a feeling of release themselves. “I’ve seen the butterflies sit there in the moment. You notice they kind of hover around, and it’s almost as if that butterfly is the loved one,” Walker says.

Next up, here are six steps to starting a meditation practice.

Sources

Travis Overbeck, National Director of Patient Experience for Seasons Hospice
Carolyn Gartner, licensed clinical social worker with Visiting Nurse Service of New York Hospice and Palliative Care
Kalah Walker, patient care administrator for VITAS Healthcare

US warns China not to send weapons to Russia for Ukraine war

Associated Press

US warns China not to send weapons to Russia for Ukraine war

Lynn Berry – February 19, 2023

U.S. Secretary of State Antony Blinken arrives at Incirlik Air Base near Adana, Turkey, Sunday, Feb. 19, 2023. (Clodagh Kilcoyne/Pool Photo via AP)

China's Director of the Office of the Central Foreign Affairs Commission Wang Yi speaks at the Munich Security Conference in Munich, Saturday, Feb. 18, 2023. The 59th Munich Security Conference (MSC) is taking place from Feb. 17 to Feb. 19, 2023 at the Bayerischer Hof Hotel in Munich. (AP Photo/Petr David Josek) — China’s Director of the Office of the Central Foreign Affairs Commission Wang Yi speaks at the Munich Security Conference in Munich, Saturday, Feb. 18, 2023. The 59th Munich Security Conference (MSC) is taking place from Feb. 17 to Feb. 19, 2023 at the Bayerischer Hof Hotel in Munich. (AP Photo/Petr David Josek)

WASHINGTON (AP) — U.S. intelligence suggests China is considering providing arms and ammunition to Russia, an involvement in the Kremlin’s war effort that would be a “serious problem,” Secretary of State Antony Blinken said.

Blinken said the United States long has been concerned that China would provide weapons to Russia. He pointed to Chinese leader Xi Jinping’s promise to Russian President Vladimir Putin of a partnership with “no limits” when they met just weeks before Putin sent his troops into Ukraine on Feb. 24, 2022. Since then, ties between the two countries have only grown stronger.

“We’ve been watching this very, very closely. And, for the most part, China has been engaged in providing rhetorical, political, diplomatic support to Russia, but we have information that gives us concern that they are considering providing lethal support to Russia in the war against Ukraine,” Blinken said in an interview that aired Sunday, a day after his meeting at a security conference in Munich with Wang Yi, the Chinese Communist Party’s most senior foreign policy official.

“It was important for me to share very clearly with Wang Yi that this would be a serious problem,” Blinken said.

With Putin determined to show some progress on the battlefield as the war nears the one-year mark, Russian forces have been on the offensive in eastern Ukraine.

“The Ukrainians are holding very strong, the Russians are suffering horrific losses in this effort,” Blinken said. He estimated that Russia has 97% of its ground troops in Ukraine.

The Russians also are eager to capture more territory before Ukraine receives the more advanced weapons recently pledged by the U.S. and its European allies.

“But what Secretary Blinken said is big news to me,” said Sen. Lindsey Graham, R-S.C. Graham said the world should “come down hard on China” if it provides lethal weapons to Russia and he advised Chinese leaders not to do anything rash.

“To the Chinese, if you jump on the Putin train now, you’re dumber than dirt,” he said. “It would be like buying a ticket on the Titanic after you saw the movie. Don’t do this.”

Graham said it would be the “most catastrophic thing that could happen to the U.S.-China relationship. … That would change everything forever.”

Tensions between Washington and Beijing have been heightened in recent weeks after the U.S. shot down what it says was a Chinese spy balloon. China insists it was used mainly for meteorological research and was blown off course.

The U.S. ambassador to the United Nations, Linda Thomas-Greenfield, also expressed her concern about any effort by the Chinese to arm Russia, saying “that would be a red line.”

Retired Gen. Jack Keane, a former Army vice chief of staff, said he agreed with the Biden administration’s decision to expose China’s possible readiness to provide some lethal weapons to Russia. He said it may persuade China to hold off.

“And I think coming out and exposing and I would go further and tell them what we think they are attempting to provide, China will pull back likely after that public exposure,” Keane said.

Blinken and Graham were on ABC’s “This Week,” Thomas-Greenfield appeared on CNN’s “State of the Union” and Keane spoke on “Fox News Sunday.”