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Unimaginable pain and restlessness. Vomiting so frequent and forceful that it can perforate the esophagus. Blood pressure and heart rate so high that they damage the heart. Sweating that drenches clothing and sheets. Nerve sensitivity that makes even the softest touch agonizing. A prolonged panic attack that is provoked and worsened by even mundane activities and conversations.

The withdrawal symptoms from “tranq dope” – the combination of the synthetic opioid fentanyl and the animal tranquilizer xylazine that dominates Philadelphia’s street opioids supply – tend to be far worse than those experienced by even the most severe heroin users of the past.

So it’s no surprise that people will do whatever they can to forestall them. That includes walking out of the hospital before their care is complete.

I’m an associate professor of emergency medicine who has spent a decade as an emergency physician working in Center City and South Philadelphia. I’ve spent most of that time directing projects to improve care for people who use drugs.

Beginning in 2022, our team – a group of emergency and addiction physicians – began experimenting with new approaches to treating tranq dope withdrawal.

We were able to reduce the likelihood of these patients leaving the hospital before treatment was complete by more than half – from 10% to just under 4%.

We also reduced the severity of their suffering, lowering their withdrawal scores – or how they rate their pain and other symptoms – by more than half.

Traditional treatments don’t work

Before tranq dope, treating opioid withdrawal in the emergency department was relatively straightforward, with well-studied, conventional protocols.

For patients without chronic pain, health care providers started buprenorphine, known by its brand name Suboxone, when patients showed signs of withdrawal.

Buprenorphine works by partially, rather than fully, stimulating opioid receptors in the body. This subtle difference relieves symptoms of withdrawal but reduces the risk of overdose if patients continue to use other opioids. It quite literally saves lives.

Tranq dope, however, created a much larger set of challenges.

Fentanyl and other synthetic opioids are dozens to hundreds of times more powerful than heroin. Xylazine, meanwhile, adds symptoms of sedative withdrawal to the mix: restlessness, adrenaline activation and agitation.

As synthetic opioids became pervasive in Philadelphia’s drug supply over the past decade, overdose deaths in the city tripled. Those numbers are beginning to decline, for reasons that remain unclear.

Fear of withdrawal can even prevent people with serious medical conditions from going to the hospital.
Jeff Fusco/The Conversation US, CC BY-ND

Meanwhile, tranq users started to share buprenorphine horror stories. They refused the medication due to a phenomenon called “precipitated withdrawal.” Precipitated withdrawal is a condition in which taking buprenorphine paradoxically makes withdrawal symptoms worse, rather than improving them. Due to the severity of their symptoms, some patients who precipitate severely even require treatment in the intensive care unit.

Furthermore, when patients did accept buprenorphine, their withdrawal symptoms were no longer being effectively controlled, even with very high doses. We were adrift.

Patients demand discharge

When people with severe substance use disorders are hospitalized, even compassionate staff members sometimes lose patience.

Being confined to a stretcher in a loud, chaotic environment, in withdrawal, with prior traumatic health care experiences, can lead patients to act out. They might repeatedly hit call bells, use inappropriate language, make impulsive decisions or sneak drugs into the hospital.

This creates a lot of stress for nurses and staff, and distracts from the care of others.

So when patients demand to leave before treatments are complete, exhausted care teams often quickly acquiesce. Traditionally, this was termed leaving “against medical advice,” but is now called “patient-directed discharge.”

Patient-directed discharge is associated with higher rates of mortality, permanent disability and rehospitalization.

Rates of patient-directed discharge can be 10 to 50 times higher in people with an opioid use disorder compared with the general public.

A cycle of mistrust can also form, where the expectation that a patient may leave again leads to a less engaged care team, which in turn can make patients more likely to leave.

At staff meetings, some compared the challenges of caring for these individuals to those experienced in the hardest parts of the COVID-19 pandemic.

New approach needed

Many physicians have been reticent to consider other options for treating opioid withdrawal. I believe there are two key reasons for this. One is the lack of Food and Drug Administration approval for alternative treatments. The other is that federal regulations consider addiction a behavioral rather than medical condition, effectively separating most doctors from the addiction care of these individuals.

As fentanyl and xylazine became ubiquitous in Philadelphia’s street dope, local hospitals reported astronomical rates of patient-directed discharge among these patients. This was happening despite the best efforts of hospital staffs that are deeply experienced in conventional opioid withdrawal treatment.

In 2021, an editorial in the Annals of Internal Medicine journal advocated for the use of short-acting opioids for some patients’ opioid withdrawal – which is already common practice in Canada. Short-acting opioids are medications doctors traditionally use to treat acute pain.

Philadelphia hospitals started experimenting with using these previously verboten medications. That included our team at Jefferson Health.

Overdose deaths in Philadelphia spiked as fentanyl and xylazine became more prevalent.
Jeff Fusco/The Conversation US, CC BY-ND

Oxycodone, hydromorphone and ketamine

By using short-acting opioids such as oxycodone or hydromorphone, combined with a low-dose version of buprenorphine, we prevented precipitated withdrawal and treated opioid withdrawal and pain in our patients.

The low-dose bupenorphine can be increased over time to steady doses. This shows patients that the medication is safe and provides them a bridge to long-term treatment.

The short-acting opioids replace the opioids that their bodies are frantically searching for. They reduce their pain and misery, and are decreased when their symptoms are controlled.

Patients with opioid use disorder will often do whatever they can to stay out of the hospital due to fear of withdrawal. Asking how withdrawal symptoms are managed, therefore, is often their first priority when hospitalized. We see this even when they have conditions that require complicated and time-sensitive treatments.

Owing to the vast amounts of opioids many of our patients use, we also give them additional strong medications, or “adjunctive therapies,” to supplement the effects of the short-acting opioids and low-dose buprenorphine. One is ketamine, an anesthetic that affects nerve impulses and is increasingly being used to treat depression, post-traumatic stress discorder and substance use disorders.

Ketamine is also an effective pain medication that can extend the effects of opioids and reduce the number of doses needed.

We additionally add muscle relaxants – which work similarly to xylazine – along with nausea medications and IV fluids, to help give patients a chance at healing.

Side effects and future problems

In patients who received our medications, the risks of serious side effects were minimal. The few patients who suffered serious adverse effects had other acute medical problems that could have contributed to the side effects. Almost all the side effects we saw were mild and resolved on their own.

As powerful synthetic opioids and other contaminants become pervasive in more U.S. cities, more emergency departments will need to figure out how to care for patients in withdrawal so that they don’t leave treatment.

It is our hope that this work will inspire others to do a better job of providing relief to patients suffering from this complicated and severe condition. Läs mer…

One group of American voters is being largely ignored in the closely watched polling leading up to the Nov. 5 elections: U.S. citizens living abroad, whether as civilians or as members of the military. We know from governmental data that the number of ballots cast by overseas Americans has been greater than the margin of victory in races in the past – and may be again in 2024.

But that one potentially crucial group of American voters – U.S. citizens living abroad – does not get much attention, from pollsters or campaigns.

We are scholars of political science whose research shows that overseas voters can make a difference in elections – and that there is potential for campaigns to mobilize these voters, despite a more complex process of voting than for domestic voters.

Who are overseas Americans?

Though there is not an exact count of American citizens living abroad, we do know they number in the millions. Estimates from the Federal Voter Assistance Program and the Association of Americans Resident Overseas placed this number between 4.4 million and 5.3 million in 2023.

But those are likely undercounts. It’s almost impossible to account fully for dual citizens, naturalized U.S. citizens who have returned to the country of their birth or people who split their time between the U.S. and other countries.

Research that we and others have conducted indicates that Mexico and Canada are home to the largest numbers of Americans outside the U.S., followed by the U.K., France, Israel and Germany. The three most common reasons Americans move abroad are family connections, employment and quality of life, although there are others.

Overseas Americans tend to be highly educated: More than three-quarters have a college degree, double the percentage within the U.S. Most overseas Americans do not move from country to country but rather stay in one country, often for a decade or more. But our surveys have found they remain interested in U.S. politics – not least because they pay U.S. income taxes, whether they work for a U.S. or foreign employer. IRS data shows that the vast majority are not ultra-wealthy.

Voting from abroad

Military members and U.S. citizens living abroad have had the right to vote in federal elections since 1976. This right was further consolidated in the 1986 Uniformed and Overseas Citizens Absentee Voting Act, while the right for Americans living abroad to vote in local and state elections depends on state law.

Some people have recently expressed concern that overseas voting could be used to cast fraudulent ballots, but there is no evidence of illegal voting by noncitizens abroad.

Overseas voters’ absentee ballot requests and their returned ballots are carefully scrutinized by local officials in the state where they last lived in the U.S., making abuse very unlikely. But it is complex for overseas voters to vote: The paperwork is complicated, and there is comparatively little outreach from political parties and candidates.

Barriers to voting from overseas

In 2020, the Federal Voting Assistance Program, which is supposed to help overseas voters exercise their voting rights, estimated that just shy of 8% of eligible American voters overseas cast ballots in that year’s presidential election. Using program numbers to calculate a percentage another way finds that no more than 20% of overseas Americans cast ballots in the 2020 election.

That’s far lower than the 67% national turnout rate that year.

Federal law requires local election officials in the U.S. to mail absentee ballots 45 days before an election to overseas Americans who request them. Poor mail service in the U.S. and elsewhere can mean that voters don’t always get the ballots in time, and the ballots mailed back to election officials face similar delays.

Some states allow voters to receive or return their ballots electronically, which is faster; an overseas voter casting a ballot in Massachusetts can request a ballot, receive a blank ballot and return it all by email, while an overseas voter from Pennsylvania must return it by mail or courier, following exact procedures for enclosing their ballot in multiple envelopes.

In 2023, the Federal Voting Assistance Program estimated that as many as 150,000 U.S. citizens overseas did not cast ballots in the 2022 elections because of administrative hurdles, such as slow or irregular mail service and difficulties in communicating procedural changes to prospective voters abroad.

Interest in US politics

Another possible reason Americans abroad don’t vote is that they have lost interest in U.S. politics. But our own research, and the work of others, finds that not to be true.

Even given the logistical challenges, U.S. citizens living in Canada, as one example, have very similar levels of interest in American politics compared with citizens back home.

During the 2020 and 2022 campaign seasons, two of us surveyed American citizens who had moved north of the border. In 2020, 55% indicated they were very interested in American politics, as did 44% in the midterm year of 2022. This is comparable with levels of attention to politics within the U.S. during those campaigns, as gauged by the Cooperative Election Study.

So although Americans in Canada indicated interest levels as high as those in the U.S. during the past two national election cycles, the vast majority of them did not cast a vote. Administrative barriers play a role, but they’re not enough to explain such low turnout among citizens overseas.

Ignored by campaigns

Another key factor driving low turnout from abroad is a lack of communication from campaigns and parties. Research demonstrates that contacts by campaigns and parties significantly increase a person’s likelihood of voting.

In the U.S., parties and campaign organizations can help streamline the voter registration process, reinforce the stakes of an election and bolster a sense of camaraderie among citizens.

U.S. citizens living abroad are unlikely to hear from campaigns, even in nearby Canada. When asked in 2020 or 2022 whether they had been contacted by American political campaigns, most potential voters in the U.S. had. But our surveys of Americans living in Canada show less than one-third reported contact from parties or candidates.

Because overseas citizens vote in their last state of residence in the U.S. but are not physically resident there, campaigns find it harder to identify them as swing-state residents or members of favorable demographic groups.

Overall, Americans living overseas are as eligible to vote as citizens in the U.S. They are as attentive to politics as Americans living in the U.S. On the other hand, they face major administrative hurdles and are generally not contacted by American parties or campaigns. Läs mer…

The American public is on alert about artificial intelligence and the 2024 election.

A September 2024 poll by the Pew Research Center found that well over half of Americans worry that artificial intelligence – or AI, computer technology mimicking the processes and products of human intelligence – will be used to generate and spread false and misleading information in the campaign.

My academic research on AI may help quell some concerns. While this innovative technology certainly has the potential to manipulate voters or spread lies at scale, most uses of AI in the current election cycle are, so far, not novel at all.

I’ve identified four roles AI is playing or could play in the 2024 campaign – all arguably updated versions of familiar election activities.

1. Voter information

The 2022 launch of ChatGPT brought the promise and peril of generative AI into public consciousness. This technology is called “generative” because it produces text responses to user prompts: It can write poetry, answer history questions – and provide information about the 2024 election.

Rather than search Google for voting information, people may instead ask generative AI a question. “How much has inflation changed since 2020?” for example. Or, “Who’s running for U.S. Senate in Texas?”

Some generative AI platforms such as Google’s AI chatbot Gemini, decline to answer questions about candidates and voting. Some, such as Facebook’s AI tool Llama, respond – and respond accurately.

AI’s response to an election query on Facebook.
Screenshot from Facebook, CC BY-SA

But generative AI can also produce misinformation. In the most extreme cases, AI can have “hallucinations,” offering up wildly inaccurate results.

A CBS news account from June 2024 reported that ChatGPT had given incorrect or incomplete responses to some prompts asking how to vote in battleground states. And ChatGPT didn’t consistently follow the policy of its owner, OpenAI, and refer users to CanIVote.org, a respected site for voting information.

As with the web, people should verify the results of AI searches. And beware: Google’s Gemini now automatically returns answers to Google search queries at the top of every results page. You might inadvertently stumble into AI tools when you think you’re searching the internet.

2. Deepfakes

Deepfakes are fabricated images, audio and video produced by generative AI and designed to replicate reality. Essentially, these are highly convincing versions of what are now called “cheapfakes” – altered images made using basic tools such as Photoshop and video-editing software.

The potential of deepfakes to deceive voters became clear when an AI-generated robocall impersonating Joe Biden before the January 2024 New Hampshire primary advised Democrats to save their votes for November.

After that, the Federal Communication Commission ruled that AI-generated robocalls are subject to the same regulations as all robocalls. They cannot be auto-dialed or delivered to cellphones or landlines without prior consent.

The agency also slapped a US$6 million fine on the consultant who created the fake Biden call – but not for tricking voters. He was fined for transmitting inaccurate caller-ID information.

While synthetic media can be used to spread disinformation, deepfakes are now part of the creative toolbox of political advertisers.

One early deepfake aimed more at persuasion than overt deception was an AI-generated ad from a 2022 mayoral race contest portraying the then-incumbent mayor of Shreveport, Louisiana, as a failing student summoned to the principal’s office.

Blink and you’ll miss the disclaimer that this campaign ad is a deepfake.

The ad included a quick disclaimer that it was a deepfake, a warning not required by the federal government, but it was easy to miss.

Wired magazine’s AI Elections Project, which is tracking uses of AI in the 2024 cycle, shows that deepfakes haven’t overwhelmed the ads voters see. But they have been used by candidates across the political spectrum, up and down the ballot, for many purposes – including deception.

Former President Donald Trump hints at a Democratic deepfake when he questions the crowd size at Vice President Kamala Harris’ campaign events. In lobbing such allegations, Trump is attempting to reap the “liar’s dividend” – the opportunity to plant the idea that truthful content is fake.

Discrediting a political opponent this way is nothing new. Trump has been claiming that the truth is really just “fake news” since at least the “birther” conspiracy of 2008, when he helped to spread rumors that presidential candidate Barack Obama’s birth certificate was fake.

3. Strategic distraction

Some are concerned that AI might be used by election deniers in this cycle to distract election administrators by burying them in frivolous public records requests.

For example, the group True the Vote has lodged hundreds of thousands of voter challenges over the past decade working with just volunteers and a web-based app. Imagine its reach if armed with AI to automate their work.

Such widespread, rapid-fire challenges to the voter rolls could divert election administrators from other critical tasks, disenfranchise legitimate voters and disrupt the election.

As of now, there’s no evidence that this is happening.

4. Foreign election interference

Confirmed Russian interference in the 2016 election underscored that the threat of foreign meddling in U.S. politics, whether by Russia or another country invested in discrediting Western democracy, remains a pressing concern.

Special counsel Robert Mueller’s investigation into the 2016 U.S. election concluded that Russia had worked to get President Donald Trump elected.
Jonathan Ernst/Pool via AP

In July, the Department of Justice seized two domain names and searched close to 1,000 accounts that Russian actors had used for what it called a “social media bot farm,” similar to those Russia used to influence the opinions of hundreds of millions of Facebook users in the 2020 campaign. Artificial intelligence could give these efforts a real boost.

There’s also evidence that China is using AI this cycle to spread malicious information about the U.S. One such social media post transcribed a Biden speech inaccurately to suggest he made sexual references.

AI may help election interferers do their dirty work, but new technology is hardly necessary for foreign meddling in U.S. politics.

In 1940, the United Kingdom – an American ally – was so focused on getting the U.S. to enter World War II that British intelligence officers worked to help congressional candidates committed to intervention and to discredit isolationists.

One target was the prominent Republican isolationist U.S. Rep. Hamilton Fish. Circulating a photo of Fish and the leader of an American pro-Nazi group taken out of context, the British sought to falsely paint Fish as a supporter of Nazi elements abroad and in the U.S.

Can AI be controlled?

Acknowledging that it doesn’t take new technology to do harm, bad actors can leverage the efficiencies embedded in AI to create a formidable challenge to election operations and integrity.

Federal efforts to regulate AI’s use in electoral politics face the same uphill battle as most proposals to regulate political campaigns. States have been more active: 19 now ban or restrict deepfakes in political campaigns.

Some platforms engage in light self-moderation. Google’s Gemini responds to prompts asking for basic election information by saying, “I can’t help with responses on elections and political figures right now.”

Campaign professionals may employ a little self-regulation, too. Several speakers at a May 2024 conference on campaign tech expressed concern about pushback from voters if they learn that a campaign is using AI technology. In this sense, the public concern over AI might be productive, creating a guardrail of sorts.

But the flip side of that public concern – what Stanford University’s Nate Persily calls “AI panic” – is that it can further erode trust in elections. Läs mer…

Former President Donald Trump and his running mate, U.S. Sen. JD Vance, have criticized the Biden administration’s decision to allow Haitian nationals who are in the U.S. to apply for permission to stay under a legal classification called Temporary Protected Status. Here is what this designation means and how it’s made:

TPS permits foreign nationals who are already in the United States – even if they did not enter the country through an official or legal means – to remain for six, 12 or 18 months at a time if the situation in their home country is deemed too dangerous for them to return. Threats that prompt TPS designations include ongoing armed conflict, natural disasters, epidemics and other extraordinary and temporary conditions.

The Secretary of the U.S. Department of Homeland Security designates a foreign country for TPS when conditions there meet requirements spelled out in federal law. Once the secretary determines that the foreign country is safe for its nationals to return, their protected status expires and people who have been granted it are expected to return to their home country.

Congress created TPS as part of the Immigration Act of 1990. Since then, administrations have used it to protect thousands of people from dozens of countries. The first nations to be designated, in March 1991, were Kuwait, Lebanon and Liberia.

As of March 2024, there were 863,880 people from 16 countries under Temporary Protected Status in the U.S. Another 486,418 people had initial or renewal applications pending. An estimated 316,000 people may also be eligible under two new extensions since that date.

TPS beneficiaries may not be detained by federal officials over their immigration status or deported from the United States. They can obtain work permits and apply for authorization to travel outside the U.S. and return to it.

People who receive TPS don’t automatically become legal permanent residents. But they can petition for an adjustment of their immigration status, such as applying for permanent residency, a student visa or asylum. Applying for a change of immigration status does not necessarily mean their application will be approved.

Humanitarian measures

TPS is not the only tool administrations can use to protect people from countries facing disaster or conflict.

For example, a Haitian person currently living in the U.S. is eligible for TPS under a designation that lasts through Feb. 3, 2026. In contrast, a Haitian who travels through Mexico and applies for entry to the U.S. at the border is not likely to be admitted.

However, there is a third possibility for Haitians, known as parole. The federal government can give certain groups permission to enter or remain in the U.S. if it finds “urgent humanitarian or significant public benefit reasons” for doing so.

People who enter through parole programs must have an approved financial supporter in the U.S., undergo a robust security vetting and meet other eligibility criteria. They typically can stay for one to two years, and may apply for authorization to work.

One current parole program is for people from Latin American countries that are TPS designates. The U.S. government can grant advance permission to enter the U.S. to up to 30,000 Cubans, Haitians, Nicaraguans and Venezuelans each month. People fleeing these countries – all of which have been designated for Temporary Protected Status – can seek authorization to travel from their homes to the U.S. for urgent humanitarian reasons, and then stay for a temporary period of parole for up to two years.

Immigrant rights groups rally at the U.S. Capitol following a federal court ruling that threatened the legal standing of thousands with Temporary Protected Status, Sept. 15, 2020.
Chip Somodevilla/Getty Images

I’ve studied global migration and asylum policy for 25 years. I see both TPS and parole as legal and carefully considered ways to support people from countries experiencing wrenching conflict, disorder and disaster who are seeking safety in the U.S. Doing away with these programs, as Trump sought to do during his term in office, would make it extremely difficult for people in great danger to escape.

Neither TPS nor parole programs are automatic roads to citizenship or permanent residence. They are ways to provide humanitarian assistance to people in appalling circumstances, such as rampant gang violence in Haiti and economic hardship and political repression in Venezuela and Nicaragua.

Certainly, cities need more resources to support large numbers of immigrants. But offering temporary protection to people whose home countries are not safe places to live is a long-standing – and, in my view, crucial – element of U.S. immigration policy. Läs mer…

Former President Donald Trump and his running mate, U.S. Sen. JD Vance, have criticized the Biden administration’s decision to allow Haitian nationals who are in the U.S. to apply for permission to stay under a legal classification called Temporary Protected Status. Here is what this designation means and how it’s made:

TPS permits foreign nationals who are already in the United States – even if they did not enter the country through an official or legal means – to remain for six, 12 or 18 months at a time if the situation in their home country is deemed too dangerous for them to return. Threats that prompt TPS designations include ongoing armed conflict, natural disasters, epidemics and other extraordinary and temporary conditions.

The Secretary of the U.S. Department of Homeland Security designates a foreign country for TPS when conditions there meet requirements spelled out in federal law. Once the secretary determines that the foreign country is safe for its nationals to return, their protected status expires and people who have been granted it are expected to return to their home country.

Congress created TPS as part of the Immigration Act of 1990. Since then, administrations have used it to protect thousands of people from dozens of countries. The first nations to be designated, in March 1991, were Kuwait, Lebanon and Liberia.

As of March 2024, there were 863,880 people from 16 countries under Temporary Protected Status in the U.S. Another 486,418 people had initial or renewal applications pending. An estimated 316,000 people may also be eligible under two new extensions since that date.

TPS beneficiaries may not be detained by federal officials over their immigration status or deported from the United States. They can obtain work permits and apply for authorization to travel outside the U.S. and return to it.

People who receive TPS don’t automatically become legal permanent residents. But they can petition for an adjustment of their immigration status, such as applying for permanent residency, a student visa or asylum. Applying for a change of immigration status does not necessarily mean their application will be approved.

Humanitarian measures

TPS is not the only tool administrations can use to protect people from countries facing disaster or conflict.

For example, a Haitian person currently living in the U.S. is eligible for TPS under a designation that lasts through Feb. 3, 2026. In contrast, a Haitian who travels through Mexico and applies for entry to the U.S. at the border is not likely to be admitted.

However, there is a third possibility for Haitians, known as parole. The federal government can give certain groups permission to enter or remain in the U.S. if it finds “urgent humanitarian or significant public benefit reasons” for doing so.

People who enter through parole programs must have an approved financial supporter in the U.S., undergo a robust security vetting and meet other eligibility criteria. They typically can stay for one to two years, and may apply for authorization to work.

One current parole program is for people from Latin American countries that are TPS designates. The U.S. government can grant advance permission to enter the U.S. to up to 30,000 Cubans, Haitians, Nicaraguans and Venezuelans each month. People fleeing these countries – all of which have been designated for Temporary Protected Status – can seek authorization to travel from their homes to the U.S. for urgent humanitarian reasons, and then stay for a temporary period of parole for up to two years.

Immigrant rights groups rally at the U.S. Capitol following a federal court ruling that threatened the legal standing of thousands with Temporary Protected Status, Sept. 15, 2020.
Chip Somodevilla/Getty Images

I’ve studied global migration and asylum policy for 25 years. I see both TPS and parole as legal and carefully considered ways to support people from countries experiencing wrenching conflict, disorder and disaster who are seeking safety in the U.S. Doing away with these programs, as Trump sought to do during his term in office, would make it extremely difficult for people in great danger to escape.

Neither TPS nor parole programs are automatic roads to citizenship or permanent residence. They are ways to provide humanitarian assistance to people in appalling circumstances, such as rampant gang violence in Haiti and economic hardship and political repression in Venezuela and Nicaragua.

Certainly, cities need more resources to support large numbers of immigrants. But offering temporary protection to people whose home countries are not safe places to live is a long-standing – and, in my view, crucial – element of U.S. immigration policy. Läs mer…

Centuries ago, estuaries around the world were teeming with birds and turbulent with schools of fish, their marshlands and endless tracts of channels melting into the gray-blue horizon.

Fast-forward to today, and in estuaries such as New York Harbor, San Francisco Bay and Miami’s Biscayne Bay – areas where rivers meet the sea – 80% to 90% of this habitat has been built over.

The result has been the environmental collapse of estuary habitats and the loss of buffer zones that helped protect cities from storm surge and sea-level rise. But the damage isn’t just what’s visible on land.

Below the surface of many of the remaining waterways, another form of urbanization has been slowly increasing the vulnerability of coastlines to extreme storms and sea-level rise: Vast dredging and engineering projects have more than doubled the depths of shipping channels since the 19th century.

Side-by-side illustrations show how dredging and ‘estuary urbanization’ alter the water flow in estuaries.
Talke, S.A., and Jay, D.A, Annual Reviews of Marine Science, 2020

Some of these oceanic highways enable huge container ships, with drafts of 50 feet below the waterline and lengths of nearly a quarter mile, to glide into formerly shallow areas. An example is New Jersey’s Newark Bay, which was as little as 10 feet (3 meters) deep in the 1840s but is 50 feet (15 meters) deep today.

A consequence of dredging deep channels is that water also enters and exits the estuaries more easily with each tide or storm. In these dredged channels, the natural resistance to flow created by a rough and shallow channel bottom is reduced. With less friction, that can lead to larger high tides and storm surge.

As coastal engineers and oceanographers, we study coastal ocean physics and storm surge. There are solutions to the problems “estuary urbanization” is causing, if people are willing to accept some trade-offs.

An unintended side effect of dredging

The effects of dredging are most visible in the daily tides, which have grown larger over the past century in many estuaries and aggravated nuisance flooding in many cities, as our research shows.

Tide range – the average variation between high and low tide – has doubled in multiple estuaries and changed significantly in others. As a result, high-tide levels are often rising faster than sea-level rise, worsening its consequences.

The most common culprit for these larger tides is estuary urbanization.

For example, in Miami, where the tide range has almost doubled, a major contributor is the construction and dredging of a nearly 50-foot-deep (15 meter), 500-foot-wide (150 meter) harbor entrance channel beginning in the early 20th century.

In New York City, some neighborhoods in southern Queens see 15 minor tidal floods per year today. Computer modeling shows that these floods are caused in about equal measure by sea-level rise and landscape alterations, including dredging and wetland reclamation projects that fill in wetlands to build industrial sites, airports and neighborhoods.

Evidence and computer modeling show that any hurricane storm surge affecting parts of New York City, Jacksonville, Wilmington, Philadelphia, Southeast Florida and Southwest Louisiana, among other locations, will likely produce higher water levels due to estuary urbanization, potentially causing more damage in unprotected regions.

These costs have gone largely unnoticed, since changes have occurred gradually over the past 150 years. But as sea-level rise and turbo-charged storms increase flooding frequency and severity, the problem is becoming more visible.

Building solutions to the flooding problem

In response to rising sea levels, a different form of estuary urbanization is attracting new attention as a possible solution.

Gated storm-surge barriers or tide gates are being built across estuaries or their inlets so they can be closed off during storm-surge events. Some examples include barriers for New Orleans; London; Venice, Italy; and the Netherlands. Such barriers are increasingly being proposed alongside levee systems for coastal protection of urbanized estuary shorelines.

The U.S. Army Corps of Engineers recently recommended surge barriers for 11 additional estuaries, including near Miami, Jamaica Bay in Queens and Galveston, Texas.

Surge barriers are not long-term solutions to flooding driven by sea-level rise, and their negative impacts remain poorly understood.

Venice’s rising flood wall includes 58 gates, each about the size of two tennis courts, that rise to block the inlet from storm surge.

Natural solutions

Wetlands and mangroves have also emerged as a popular nature-based solution.

Communities and government funding have focused on attempts to restore or create new wetlands as buffers in shoreline areas. But this solution is ineffective for flood protection in most harbor cities, such as New York, due to the lack of available space.

A storm surge crossing over a mile of marsh can be reduced by several inches, depending on the site’s characteristics. But typical urban estuary waterfronts have only tens of feet of open space to work with, if that much. In a narrow space, the best that vegetation can do is reduce wave action, which often isn’t the the most pressing problem for cities on estuaries that are typically sheltered from wind-driven storm waves.

As a result, engineered wetlands, while attractive, may be ineffective, especially if trends in ship sizes and estuarine urbanization continues.

Better ways to put nature back to work

Our research reveals an opportunity for scientists, engineers and broader society to think bigger – to consider a more comprehensive reshaping and restoration of the natural features of estuaries that once mitigated or absorbed flooding.

Possible solutions include halting the maintenance dredging of underutilized shipping channels, gradually retreating from vulnerable – and now often waterlogged – landfill industrial sites and neighborhoods, and restoring these larger expanses to wetlands.

These approaches can sharply reduce flooding and provide years of protection against sea-level rise. Restoration to historical channel and wetland configurations, however, is rarely given serious consideration in coastal storm risk management studies because of the perceived economic cost, but also because the cumulative effect of deeper channel depths is often unrecognized.

Renaturing urbanized estuaries in these ways could be paired with buyout programs to also reclaim the floodplain, reducing risk in more sustainable ways. Or it could be paired with seawalls to protect existing neighborhoods in a more ecologically beneficial way. These approaches should be considered as alternatives to further urbanizing our cities’ few remaining natural areas – their estuaries. Läs mer…

To American voters, the process of electing a president and other officials may be difficult to explain and understand. For America’s math teachers, the system represents a gold mine for real-life lessons on ratios, statistics and data.

And by basing the lessons on elections, teachers can help put students on the path to becoming informed and engaged voters later in life, according to a 2020 survey of 2,232 young adults ages 18-21.

Americans don’t vote directly for the president. Instead, a group of electors vote for the candidate who wins the popular vote in that state. In most states, whoever wins the most votes wins all the state’s electors, or “electoral votes.”

Not all states have the same number of electors. Each state starts with two electoral votes, based on the two U.S. senators in each state. States receive additional electors based on the number of representatives they have in the House of Representatives, which depends on a state’s population. The number of representatives in the House, however, has been set at 435 since 1929, despite a huge and varied increase in the population. This means the number of people represented by each member of the U.S. House – the ratio of people to representative – varies considerably, as shown in a table from the U.S. Census Bureau.

Armed with this background, math teachers can use the census data on population and ratios to teach students the following math – and voting – topics.

Topic 1: Ratio

To calculate a state’s representative ratio, the number of people for every one representative, divide the population by the number of the state’s representatives in the U.S. House. In 2020, for example, Montana had two congressional representatives and a population of 1,085,407. The representative ratio was 542,704:1 – 1,085,407 divided by 2 – or 542,704 residents for each representative.

Topic 2: Minimum and maximum

In any set of numbers, the minimum is the smallest number in the set and the maximum is the largest number. For example, using the representative ratios from the 2020 census data, Montana’s ratio of 542,704:1 is the smallest – the minimum – and Delaware’s ratio of 990,837:1 is the largest, or the maximum.

Topic 3: The shape, center and spread of data

Shape means how data, such as the ratios of residents to representatives, looks on a chart or graph. Teachers can use a histogram, a kind of graph used to illustrate how data is distributed: evenly, skewed to one side, or with some numbers as outliers, at a distance from the other numbers.

The ratios can also be used to explain how to find the “center” of data, its mean or median. The mean is the average, found by adding all the numbers in the set and dividing by how many there are. For example, adding the ratios for all the states and dividing by 50. The median is the middle number when all numbers are placed in order from minimum to maximum. Simple spreadsheet formulas are available online to help students find both.

Students can examine ratios of residents to representatives for all 50 states.
iofoto via Getty Images

The “spread” of a set of numbers tells how much the numbers are different from the center. One measure of spread is called the range, which is the difference between the maximum and the minimum. For example, the range in representative ratios among the states is 448,133: the maximum, Delaware’s 990,837, minus the minimum, Montana’s 542,704.

When students understand how ratios – and elections – work, teachers can ask questions such as, “Montana has fewer people per representative than Delaware. Where would your vote count more?” Answer: Montana, because fewer people per representative means each vote counts more.

Topic 4: Gerrymandering

Each state is divided into districts; residents of each district vote for their state and federal representatives. Gerrymandering occurs when the borders of voting districts are drawn to favor one party at the expense of another. The political party in power often draws these district lines to make it easier for that party to win in the future.

Imagine a state has 10 representatives, and Party X gets 60% of the votes. With 60% of the votes, it seems fair that Party X should get 6 of the state’s 10 seats for representatives.

There is no rule that says the percentage of votes cast for a party in a state has to line up with the number of seats the party wins. And Party X wants more. To keep control of as many seats as possible, the politicians in Party X would like to manipulate – or gerrymander – each of 10 districts to make sure it would win 60% of the vote in each. With a majority in each district, Party X would win all 10 seats. Gerrymandering to this extreme is not always possible because districts must consist of adjoining areas, and voters who favor one party might not live in areas that can be easily connected.

Lessons on gerrymandering can vary by grade level. For example, elementary students can get hands-on experience manipulating borders with the Julia Robinson Mathematics Festival “puzzles” tool. The puzzle, which can be tied to lessons about shapes, percents and area, allows children to change boundaries on a graph to increase or decrease the number of yellow or green squares – representing voters – in each “district.” There are fewer green squares than yellow squares in each puzzle. Students win when they successfully gerrymander, changing the borders so the green voters are in the majority in most, or all, of the districts.

High school students, who already understand the basics of gerrymandering, can use a tool called Districtr to draw real voting districts. The site uses actual data about where voters live and which political party won in which area. Using this tool, students cannot only try to gerrymander districts, they can also try to create districts that are more fairly balanced. After trying to draw their own “fair” districts, students might be interested in some states’ use of independent groups to draw fairer district lines.

By using elections as a learning tool, students can gain a better understanding of ratios, means and range, and they might also start thinking about what they can do to improve the process. Läs mer…

Pedigree cat breeding has long had its controversies but a new trend for cats bred to look like American bully XL dogs could be one of the most worrying fads yet.

So-called “bully cats” originated in the US and are a result of mutant breeding. Unlike pedigree breeding, which focuses on keeping animals purebred, mutant breeding involves intentionally combining genetic mutations to create cats with a specific look. In this case, they mix the gene that causes hairlessness in sphynx cats with the gene responsible for the short legs of munchkin cats, making bully cats a munchkin-sphynx cross.

These cats share a close resemblance to bully dogs, a group of breeds characterised by a solid build, wide body and short coat. American XL bully dogs were banned in the UK in 2023. Recently, bully cats have made their way to the UK, where social media accounts promoting this new mutant breed have emerged.

YouTube users criticised this video for “making it normal” to breed animals with genetic health problems.

According to Marjan van Hagen and Jeffrey de Gier, animal welfare and reproduction experts at Utrecht University in The Netherlands, these mutations can have serious health consequences for the cats and limit their freedom of movement. Kittens already have a limited ability to regulate their body temperature and this is made even more difficult by hairlessness and makes them more suspectible to respiratory infections.

A lack of fur can also lead to sunburn and skin cancer in hairless cats. Like the sphynx, bully cats also lack whiskers, which cats depend on for communication, navigating their environment and gauging spatial dimensions.

Short-legged cats also face problems. Short legs limit their ability to jump, can put cats at a disadvantage in fights and can lead to painful health conditions. Although breeders claim that bully cats are healthy and long-lived, it’s still too early to determine their long-term health and welfare.

Some breeders also say they are screening the cats they breed from for conditions such as heart disease. This can help prevent health problems, but it can’t overcome all of the health and welfare issues with mutant breeding.

A May 2024 study by veterinary epidemiologist Kendy Tzu-Yun Teng and colleagues assessed annual life expectancy in UK cats and found that the average cat lives nearly 12 years, but sphynx cats have the shortest lifespan — just 6.7 years. Bully cats, being both hairless and short-legged, may face twice the number of challenges encountered by sphynx and munchkin breeds.

In the wild, unrelated species that face comparable environmental challenges often develop similar traits, a process known as “convergent evolution”. Despite coming from different evolutionary paths, these species evolve to look and behave in similar ways.

Take the sugar glider from Australia, for example. It looks and behaves much like the US flying squirrel, yet one is a marsupial and one is a mammal. Both animals faced the problem of how to move efficiently in a forest canopy, and evolved the same solution.

Sugar gliders are not related to flying squirrels.
I Wayan Sumatika/Shutterstock

In a similar way, many domesticated animals share common traits, collectively known as “domestication syndrome” including increased tameness, juvenile behaviour, floppy ears and smaller teeth. Traits that helped them adjust to life with humans. However, the resemblance between bully cats and dogs doesn’t come from this gradual, natural process. Instead, it’s the result of selective breeding based on aesthetics.

Veterinarian and animal welfare scientist Wenche Farstad summarises this as breeding for “curiosity or cuteness” in their 2018 paper on ethical breeding. While people normally find traits like round eyes and short nose length to be particularly cute, breeding for hairlessness and shorter legs is better aligned with the concept of breeding for curiosity.

In this case, the resemblance between bully cats and dogs is more about human-driven design, where appearance is prioritised. The bully cat seems to have been intentionally bred to resemble the bully dog, perhaps due to their perception among young men as a kind of status symbol.

Could bully cats survive without humans?

Mutations that hinder survival and reproduction typically become rare in nature. However, humans bypass natural selection by choosing which animals breed, allowing traits that would be disadvantageous in the wild to persist.

Examples of this can be seen across a number of domestic species. For example, due to the muscularity of their calves, Belgian Blue cattle require caesarean sections in more than 90% of births.

Another farm animal, the modern broiler chicken, has been bred to grow much faster than its wild counterparts. If allowed to live longer than their usual slaughter age, many would not survive. Bully cats would probably also struggle to survive in the wild, without humans to care for them.

Crossbreeding programs can help increase genetic diversity and reduce harmful traits in many breeds. However, for mutant breeds like the bully cat – where hairlessness and short legs are defining traits – this isn’t a realistic solution.

Prospective pet owners need to be aware of the risks associated with owning mutant and experimental breeds. Consumers hold purchasing power. We can discourage breeders from prioritising aesthetics over the health and welfare of the animals by refusing to buy breeds with extreme traits.

A fashion toward ethical breeding could ensure future cats are healthier, happier and free to enjoy natural feline behaviour like climbing, jumping and lounging in the sun. We should let cats be cats. Läs mer…

The quality of education in young offender institutions (YOIs) in England has seriously declined, according to a recent report from Ofsted and the prisons inspectorate.

The report into these institutions, whose offenders are aged 15 to 18, referred to “steadily declining educational opportunities”. Among the failings listed were a lack of time allocated to education, lack of proper staff training, staff shortages and poor behaviour of learners.

It claimed that the curriculum is narrow, fragmented, and poorly resourced due to lack of investment in technology. Prison leaders do not accurately pinpoint what students need to learn, while learners with special educational needs and disabilities do not always get the support that they need. According to data from 2022, only 8.6% of young people who received custodial sentences passed five GCSEs, compared to 58.3% of those without convictions.

Indeed, there are similar issues across the prison system. The quality of education in too many prisons is not good enough. Research suggests prisoners are often disengaged in classes and education lacks challenge and purpose.

This is especially disheartening when research also shows that participation in education within prisons can improve learners’ self-esteem and reduce prison violence, as well as increasing the chances of getting a job once offenders are released.

Teaching reading

Many adults in prison, as well as children in YOIs, struggle to read. English education inspectorate Ofsted and its prisons counterpart have published two reviews on the teaching of reading in prisons. The first report, published in 2022, highlighted that many teaching staff did not know how to teach reading.

Inspectors found that reading teachers did not have suitable resources. There was not enough time for learners to practise reading, and weak assessment resulted in teachers not fully understanding why some learners were struggling to learn to read. Some prisons were over-relying on reading skills being taught by peer mentors, who are only supposed to support learners individually or in small groups.

The second report, from 2023, highlighted that although some progress had been made a year later, it was too slow. Inspectors found that teachers still did not know how to improve reading skills. They also found that teachers did not monitor students’ progress, and interventions to support reading, particularly for non-English speakers, were not adequate.

Special educational needs

Too many pupils with special educational needs are excluded from schools and data shows that exclusion rates are higher for this group compared to those who do not have special educational needs. Many young people who are excluded from schools end up in prison, resulting in a high proportion of prisoners who have some form of learning difficulty or disability.

According to a House of Commons report from 2022, over 30% of prisoners have a learning difficulty or experience learning challenges.

In 2016 the Coates review of prison education made several recommendations to improve the quality of education in prisons. These included a focus on special educational needs – improving the assessment of educational needs on entry and more rigorous screening for prisoners with learning difficulties or disabilities.

The review recommended that all prisoners should have a personal learning plan. Also, better quality teachers were needed and prisons needed to find ways of improving attendance in education classes

Coates recommended that learners with special educational needs and disabilities needed better quality support and that prisoners needed to be able to continue their courses when they moved prisons. Unfortunately, evidence shows that in many prisons these recommendations have not been addressed.

Making changes

Another problem is that the growing prison population has led to overcrowding, resulting in poor conditions which make studying difficult.

Work with prisoners by charities such as the Prison Reform Trust and the Prisoners’ Education Trust highlights some important recommendations which will improve the quality of education in prisons. These include widening the curriculum in prisons so that prisoners can select options from a wider range of courses.

One recommendation is to provide better incentives to prisoners to encourage them to study. This could be done by paying them the same weekly “wage” as prisoners who choose work-related activities. Increasing the number of learning mentors will help ensure that prisoners get the support they need.

Finally, introducing flexible education timetables would mean that education classes can also run in the evenings as well as during the day. This will mean that more prisoners can take part in education classes, because more classes can be timetabled across the day. Prisoners who work during the day will be able to take part in education in the evenings.

According to the Prison Education Trust digital technology “remains the essential ingredient that would revolutionise prison education”. And prisoners need to be supported and encouraged if they are going to achieve their full educational potential. Läs mer…

Iranian journalist Pouria Zeraati survived an assassination attempt outside his home in Wimbledon, south London, in late March 2024. Eighteen months earlier, the London-based independent television channel Iran International, for which Zeraati worked, had temporarily relocated to Washington DC over threats that they believe come from the Islamic Revolutionary Guards Corps.

Both incidents are examples of how it seems that a government can target an individual or organisation based outside their borders, with terrifying results.

According to the latest research from the V-Dem Institute at the University of Gothenberg, 71% of the world’s population lived in autocracies in 2023 – ten years ago it was 48%. But what’s also new is that autocracies – as well as some other nations – are increasingly reaching across their borders to target people living abroad, enforcing the idea that they can reach their critics wherever they live.

This kind of state action, taken outside national borders, is known as transnational repression, and is becoming more widespread. The Chinese government is seen as the biggest perpetrator, sometimes using violence to close down criticism or protests against its regime, held in other countries.

Countries reaching across borders

More than 20% of the world’s governments are believed to have taken this kind of action outside their borders in the past ten years. These included assassinations, abductions, assaults, detentions and unlawful deportations, according to the NGO Freedom House. These are aimed at forcibly silencing exiled political activists, journalists, former regime insiders and members of ethnic or religious minorities.
In 2023, 125 such incidents were committed by 25 countries.

While the majority of countries committing such practices tend to be autocracies, a number of democracies have also taken action across borders, including Israel, Hungary, India and Turkey, according to the report. In 2023, six countries engaged in these practices for the first time, including the Democratic Republic of Congo, El Salvador and Yemen.

Read more:
Why the growing number of foreign agent laws around the world is bad for democracy

Freedom House recorded 1,034 physical attacks between 2014 and 2023, committed by 44 governments in 100 target countries. China, Turkey, Tajikistan, Russia and Egypt are the most prolific perpetrators, with China accounting for a quarter of all incidents.

This type of terror tactic can take many forms. Freedom House has noted that governments increasingly cooperated to help target exiled dissidents. In 74% of the incidents of transnational repression that took place in 2021, both the origin and the host countries were rated “not free” by Freedom House.

Awareness of this type of cross-border action is growing. Both human rights groups and academics are now systematically tracking attacks. And several governments, including the US and Australia, have committed to taking action to combat these practices. A bill was introduced in the US Senate in 2023 to specifically tackle transnational repression by foreign governments in the US and abroad.

I studied the increasing levels of cooperation in transnational repression by different nations in a recent article published in International Studies Quarterly. We look at why states, which are normally reluctant to collaborate, do so when it comes to silencing dissidents abroad.

Read more:
Continuing crackdown on churches and NGOs moves Nicaragua further from democracy to authoritarianism

Historical lessons?

There are historical parallels between what happened during Operation Condor in South America and what’s happening today. Operation Condor was a system that Argentina, Bolivia, Chile, Paraguay and Uruguay started using in late 1975 with the backing of the US. It was aimed at persecuting exiles. Operation Condor was the most sophisticated, institutionalised and coordinated scheme ever established to persecute citizens who had been forced to flee their homeland.

Journalist Pouria Zeraati was attacked.

Three factors were found to explain why this form of repression was able to be used at the time and why countries agreed to cooperate.

First, politically active exiled dissidents constituted a threat to the reputation and survival of South America’s ruling juntas. They successfully named and shamed the region’s military regimes, discrediting their international public images given the human rights violations perpetrated and resulting in the US cutting funding to Uruguay in 1976 and Argentina in 1977.

Second, these autocracies, which came to power between 1964 and 1976, drew inspiration from the US National Security Doctrine and the French School of Counterinsurgency. In both, security was considered more important than human rights.

The history of Operation Condor.

Finally, two countries catalysed efforts to cooperate in this kind of action. Chile pushed for the formal creation of Operation Condor in 1975. Argentina then expanded it to include Brazil, Peru and Ecuador between 1976 and 1978. This significantly widened Operation Condor’s scope for action to most of South America.

Why Operation Condor is relevant?

Operation Condor was the only regional organisation to be created to hunt down political opponents across borders. Lessons from this historical experience are relevant today.

Cooperation in transnational repression in the last few years also occurs in regional clusters, as shown by research by academics and human rights groups. These groups of nations include, for instance, Belarus, Russia and Tajikistan, as well as Thailand, Cambodia, Laos and Vietnam.

In recent years these south-east Asian countries have closely collaborated to persecute, arbitrarily arrest and forcibly repatriate exiled activists and refugees, according to the media, the UN and international human rights NGOs.

Second, one or more countries, predominantly Russia and Turkey, have worked together on efforts to repress critics over a significant period.

Third, some regional organisations, of authoritarian nature, often enable cooperation in transnational repression, or at least create unsafe environments for migrating dissidents.

The Shanghai Cooperation Organisation (SCO) and the Gulf Cooperation Council are examples, since they “have expanded their collective efforts against exiles”, according to some sources. SCO member states, especially Russia, China and Uzbekistan, have repeatedly used the organisation to pursue political opponents abroad and persecute them as criminals. This shows the organisation’s role as a platform for the diffusion and consolidation of authoritarian principles.

Countries engaging in this kind of political repression today often wish to silence dissent wherever it occurs.

These countries are acting in complete disregard of established principles of international law and international relations, such as sovereignty and the protection of refugees, and seem to be expanding their operations. It remains to be seen if there’s anything that the rest of the international community can do to reverse this terrifying trend, but at least it has started trying. Läs mer…