Donald Trump and a world of disorder – BBC News
Image copyright Getty Images Image caption Trump has often cut an isolated figure on the world stage At a moment when America has been focussed myopically on the highest court in the land, the Trump administration stands accused of being a bystander to lawlessness around the world.
The forced disappearance of the Interpol chief, Meng Hongwei, who it turns out is being held by the Chinese authorities.
Mounting evidence underscoring the Kremlin’s involvement in the chemical poisonings in Salisbury.
The seemingly gruesome case of Jamal Khashoggi, the missing journalist who Turkish authorities suspect was killed and dismembered by a Saudi hit squad inside the kingdom’s Istanbul consulate.
All point to a world of disorder: of a slide towards unruliness; of a new era of strongman authoritarianism and a waning of international law.
Traditionally the United States has viewed itself as the upholder of norms, an exemplar of moral leadership, the policeman of global bad behaviour – an idealised notion it has not always lived up to.
But this week has driven home not just how much Donald Trump has been reluctant to perform that role. It also speaks of how his doctrine of patriotism is at risk of being interpreted by other nations as a doctrine of anything goes.
In the red, white and blue of America First do other countries see a green light to act with impunity?
On Wednesday, the president described Jamal Khashoggi’s disappearance as “very serious” and said his administration had raised the case at the “highest levels” with Riyadh. Image copyright Getty Images Image caption A young protester clutches a photo of the Saudi journalist
The national security adviser, John Bolton, and the president’s son-in-law, Jared Kushner, have spoken to Crown Prince Mohammed bin Salman, the de facto ruler of Saudi Arabia. Plans are also afoot for a White House meeting with the journalist’s fiancée, Hatice Cengiz.
But the president has stopped short of condemning or criticising the Saudi Arabians, even though the Washington Post reports US intelligence intercepted communications of Saudi officials plotting to capture Khashoggi, one of the newspaper’s columnists and a prominent critic of the Saudi Arabian government. The journalist who vanished into a consulate
The Khashoggi disappearance has been absent from Donald Trump’s Twitter feed, his preferred outlet for presidential outrage.
He has not mentioned it at his campaign rallies, another forum where he regular gives vent to his most visceral feelings. Though he smiled on Tuesday night when a rally crowd in Iowa aimed a “Lock Her Up” chant at Senator Diane Feinstein, the ranking Democrat on the Senate Judiciary Committee, he said nothing about the journalist’s disappearance.
Clearly, the White House is keen to avoid a rush to judgment and says it is “demanding” answers from Riyadh. But is Donald Trump’s circumspection merely a cover to avoid reproaching his Saudi allies?
For a president who does not normally hesitate, it could easily be construed as moral foot-dragging and an abdication of traditional American leadership.
Republicans on Capitol Hill have been more damning. Senator Bob Corker, the chairman of the Foreign Relations Committee, said “there will definitely be consequences” if it turns out the Saudis were involved. Lindsey Graham, the president’s golf buddy, said it would be “devastating” to US-Saudi relations. No such public warnings have come from the White House.
President Trump has befriended the Crown Prince, and been staunch in his support of the Saudi leadership.
His first international visit was to Saudi Arabia, where he took part in that that mystical-looking ceremony during which he placed his hands on a glowing orb. Image copyright Getty Images Image caption One of the more bizarre photos of 2017
The Trump administration has backed the Saudi-led bombing campaign of Yemen, part of Riyadh’s proxy war with Tehran.
Last November, the president endorsed the royal purge of Saudi princes, businessman and government ministers under the auspices of an anti-corruption drive. He has approved a $1bn (£757m) arms package to the royal kingdom.
On Wednesday, President Trump also reiterated his admiration for the 33-year old crown prince, calling him a “fine man”. He continues to speak of the Crown Prince with almost fatherly pride.
One of the most marked features of President Trump’s foreign policy has been his denigration of close allies and acclamation of leaders who flatter him, whatever their human rights records.
Presently, US Secretary of State Mike Pompeo is organising a second summit with Kim Jong-un. And even though the dictator has been accused among other brutalities of carrying out executions with anti-aircraft guns and of detaining up to 130,000 North Koreans in gulags, the president told a rally in West Virginia last week he “fell in love” with the North Korean at the Singapore summit.
Donald Trump has praised Egypt’s autocratic president Abdel Fattah al-Sisi, describing him as “a fantastic guy.” Media playback is unsupported on your device Media caption Why does Trump admire strongmen leaders?
He has commended Rodrigo Dutertes, the president of the Philippines, for an “unbelievable job on the drug problem,” even though the crackdown has led to the killing of 12,000 suspected drug dealers and users, according to Human Rights Watch.
He has given Recep Erdogan of Turkey “very high marks”, despite widespread criticism of the president’s increasingly authoritarian rule. Then there is his well-documented averseness to criticising Vladimir Putin.
The die was arguably cast in the first weeks of the Trump presidency during an interview with the former Fox News host Bill Reilly. “Putin is a killer,” said O’Reilly, when Trump expressed respect for the former KGB spymaster.
“There are a lot of killers. We have a lot of killers,” replied the US president, with almost a shrug of the shoulders. “Well, you think our country is so innocent?”
As well as suggesting moral parity between the thuggishness of the Kremlin and the actions of successive US administrations, his remarks signalled a temporary end to American exceptionalism, the idea the US should hold other countries to a higher standard and exemplify them itself.
The departure of Nikki Haley is another inflection point. When she steps down as the UN ambassador at the end of the year, the administration will lose its most outspoken defender of international norms. Image copyright Getty Images Image caption Trump took decisive action in Syria which prompted protests in New York
Haley has been a strident critic of Moscow and Damascus especially. But she, too, has been criticised by human rights groups, for advocating US withdrawal from the UN Human Rights Council and defending Israel’s use of lethal force in Gaza that left 150 demonstrators dead.
Not every international crime has gone unpunished. Twice Donald Trump has authorised limited airstrikes against the Assad regime in retaliation for its use of chemical weapons, enforcing the kind of red lines that Barack Obama paid lip service to but failed to uphold.
Yet President Trump has often been reluctant to take punitive action.
As Bob Woodward’s new book Fear chronicled, the president fumed at aides for pushing him to expel 60 Russian diplomats and suspected spies in retaliation for the Salisbury nerve agent attack. He wanted a more limited response.
China Uighurs: Xinjiang ‘legalises’ Muslim internment camps – BBC News
Image copyright Reuters Image caption Some reports say a million Uighurs have been detained China’s western Xinjiang region has written “vocational training centres” for Muslim Uighurs into law amid growing international concern over large-scale disappearances there.
Xinjiang says the centres will tackle extremism through “thought transformation”.
Rights groups say detainees are made to swear loyalty to President Xi Jinping and criticise or renounce their faith.
In August, China denied allegations that it had locked up a million people.
But officials attending a UN human rights meeting admitted that Uighurs “deceived by religious extremism” were undergoing re-education and resettlement.
China’s Muslim ‘crackdown’ explained Xinjiang has seen cycles of violence and crackdowns for years. China accuses Islamist militants and separatists of orchestrating the trouble.
What does the Chinese legislation say? Xinjiang’s new legislation is the first detailed indication of what China is doing in the region.
It says examples of behaviour that could lead to detention include expanding the concept of halal – which means permissible in Islam – to areas of life outside diet, refusing to watch state TV and listen to state radio and preventing children from receiving state education.
Media playback is unsupported on your device Media caption John Sudworth reports from Xinjiang, where all filming and reporting by foreign media is tightly controlled China says its network of detention centres will also teach Mandarin Chinese, legal concepts and provide vocational training.
Rights groups have criticised the move. Sophie Richardson from Human Rights Watch said the “words on paper outlining grotesque, vast human rights abuses don’t deserve the term ‘law'”.
ICU Dementia: How Hospitals Can Prevent It : Shots – Health News
Enlarge this image Randy O’Burke at his son’s home in Hendersonville, Tenn. After an overwhelming infection sent O’Burke into five-organ failure, he also developed ICU delirium, perhaps related to heavy sedation. An ICU protocol developed at Vanderbilt University Medical Center found that getting him on his feet sooner was key to speeding his recovery. Morgan Hornsby for NPR hide caption
toggle caption Morgan Hornsby for NPR Randy O’Burke at his son’s home in Hendersonville, Tenn. After an overwhelming infection sent O’Burke into five-organ failure, he also developed ICU delirium, perhaps related to heavy sedation. An ICU protocol developed at Vanderbilt University Medical Center found that getting him on his feet sooner was key to speeding his recovery.
Morgan Hornsby for NPR If you are one of the 5.7 million Americans who ends up in the intensive care unit each year, you are at high risk of developing long-term mental effects like dementia and confusion. These mental problems can be as pronounced as those experienced by people with Alzheimer’s disease or a traumatic brain injury and many patients never fully recover .
But research shows you are less likely to suffer those effects if the doctors and nurses follow a procedure that’s gaining ground in ICUs nationwide.
The steps are part of a bundle of actions aimed at reducing delirium in ICU patients. Doctors define delirium as a usually temporary state of mental confusion characterized by a lack of focus, difficulty in understanding what’s going on around you and, sometimes, hallucinations.
Shots – Health News When ICU Delirium Leads To Symptoms Of Dementia After Discharge Following this checklist of actions can reduce the risk of mental impairment following an ICU stay by 25 to 30 percent, says Dr. E. Wesley “Wes” Ely at the Vanderbilt University Medical Center. (This post-ICU condition is separate from memory problems that can arise after heart surgery and general anesthesia in the elderly).
It isn’t simply detailed medical care — it’s a philosophy .
“I think the most modifiable piece of this is what we do to the patient,” Ely says. “And what we do to the patient [that] is dangerous is immobilize them chemically [with drugs] and physically, and then not allow the family there, and allow them to subsist in delirium.”
When Ely started in the ICU years ago, he realized every doctor made different decisions about basic matters such as how quickly to get a patient off the breathing machine. He figured those small decisions might be having a big impact on the patient’s recovery. So he gradually built an evidence-based checklist of the best way to handle the basic tasks that most quickly get patients back on their feet.
First, medical researchers developed a system to determine when it was safe to take a patient off a ventilator. Next, Ely says, “we started standardizing how to remove people off of sedation. Then we came up with a way to measure whether your brain was delirious or not.”
Enlarge this image Dr. E. Wesley Ely at Vanderbilt University Medical Center in Nashville, has developed a checklist of procedures in the ICU that reduces long-term mental deficits by easing sedation, getting patients up and around earlier and helping them stay oriented to their surroundings. Morgan Hornsby for NPR hide caption
toggle caption Morgan Hornsby for NPR Dr. E. Wesley Ely at Vanderbilt University Medical Center in Nashville, has developed a checklist of procedures in the ICU that reduces long-term mental deficits by easing sedation, getting patients up and around earlier and helping them stay oriented to their surroundings.
Morgan Hornsby for NPR Ely has dubbed this checklist the ABCDEF bundle . Other elements include assessing pain, managing medications, testing patients’ ability to awaken spontaneously, and getting them up and about quickly.
Randy O’Burke, 49, recently experienced the treatment regime after he was rushed to Vanderbilt with five failing organs — his brain, heart, liver, lung and kidneys.
His saga started out in Los Angeles, where he lives. He’d eaten a tuna sandwich that he suspects had gone bad. The next morning, he hopped a flight with his wife Karen to visit their son in Nashville.
“We got on the plane and I just didn’t feel right,” Randy says. He told his wife his stomach was bothering him.
The symptoms kept getting worse once they were in Tennessee. Even so, his wife says, she couldn’t convince him to go to a doctor until his symptoms were out of control. He was rushed to the emergency room closest to his son’s house, a half-hour from Nashville.
“They started putting in tons of [IV] lines and going to work and doing different things,” Karen recalls. It was all a blur to her. “Imagine the shock when you go in there and [doctors say] ‘Oh, every organ is shutting down.’ “
O’Burke was diagnosed with sepsis , which is a leading cause of death in hospitals. It’s the body’s overwhelming reaction to an infection. O’Burke’s case was so bad, he ended up on a respirator and kidney dialysis. Drugs sunk him into a state of quiet delirium.
Why Do ICU Patients Get Delirium? Though the causes of delirium still aren’t completely worked out, and may be multiple in a particular case, a website put together by the team at Vanderbilt for patients and families says you can think of delirium as being “caused by a change in the way the brain is working.” The website cites a number of factors that might be contributing to that change:
•The brain’s inability to use oxygen
•Chemical changes in the brain
•Alcohol, sedatives, or pain killers
•Withdrawal from alcohol, nicotine
“He was supposed to be lightly sedated and he was heavily sedated,” Karen says, “and that was not a good thing.”
She says when the doctors told her to start calling next of kin, she knew it was time to get him transferred to a hospital better equipped to treat him. That’s how he ended up at Vanderbilt.
Within 24 hours of his arrival, Randy’s condition had turned around completely, Karen says. He was off dialysis, the ventilator, and off the drugs that put him into a delirious haze.
“Apparently, I’m pretty much of a miracle,” he says. The doctors told him that the chance of survival for a patient with five-organ failure is about one in a thousand.
Recovery still lies ahead, as his mildly slurred speech suggests.
“I’m starting to get my faculties about me,” Randy says. “My brain’s starting to work really good again. But just the fact that I can carry on a conversation right now is pretty amazing in itself.”
As part of this more rapid recovery trajectory, ICU nurses got him out of bed as soon as possible.
“I’ve done laps around this place!” he says.
An enormous amount of medical care went into O’Burke’s recovery. Overlaid on that was the bundle of steps to reduce delirium. Those are now baked into the checklists that nurses, respiratory therapists and doctors use with every ICU patient they treat at Vanderbilt.
“Getting you out of bed early … cuts delirium in half,” Ely tells the O’Burkes, as he explains the reasoning behind the bundle. “E” stands for Early Mobility and Exercise. And “F” — having family members present in the room and talking to medical staff — also makes a notable difference in motivating patients to be alert and moving about.
Ely explains to the couple that this bundle of procedures is a big change from what many ICUs still do, which is to knock out a patient and treat their dysfunctional body, rather than focusing on them holistically.
“To me the linchpin of this whole thing is to respect the humanness of each patient,” Ely says.
Vanderbilt’s protocol, when systematically followed, can make a big difference to a lot of patients. One study involving 6,064 patients showed that the approach increased the odds of surviving and decreased the amount of time people spent delirious or in a coma.
Ely is lead author of another study, with the Society of Critical Care Medicine , which has enrolled 15,000 patients at 68 ICUs around the country. Findings from that soon-to-be published study add more support for the practice, Ely says. (The study is funded by the Gordon and Betty Moore Foundation, which has supported science coverage on NPR).
Gradually, the bundle of techniques for reducing delirium has been adopted at many ICUs in recent years, Ely says, but is still not the standard everywhere.
“About half [of hospitals] from our last survey have been doing some elements of the bundle,” he says.
Pulling it all together, A to F, can be a challenge.
Enlarge this image Randy and Karen O’Burke together at their son’s home in Hendersonville, Tenn., last week. “Apparently, I’m pretty much of a miracle,” Randy says. Morgan Hornsby for NPR hide caption
toggle caption Morgan Hornsby for NPR Randy and Karen O’Burke together at their son’s home in Hendersonville, Tenn., last week. “Apparently, I’m pretty much of a miracle,” Randy says.
Morgan Hornsby for NPR “It was not as easy as we expected it to be,” says Dr. Kirk Voelker, a critical care intensivist at the Sarasota Memorial Hospital in Florida. His hospital was part of the 15,000-patient study that Ely coordinated.
Voelker says he found that patients can require more time and attention if they’re alert in bed or walking up and down the hallways with their respirators in tow.
And for the staff, “we’re talking about a cultural change,” he tells NPR. “We had to get buy-in from the nursing staff. Once we were able to get that buy-in, then you have to have buy-in from the physicians also.”
That’s harder in a community hospital, he says, where physicians are more independent and may only do rounds three days a week.
The ideas slowly took hold, he says, though there’s still resistance to using the “A through F” checklist to make sure every element is attended to every day in every patient.
The concept behind the protocol has become the rule at his hospital, Voelker says, “but actually going through and saying ‘ABDCEF’ is the exception.”
It was even a challenge to make the protocol routine at the medical center where it was pioneered.
Joanna Stollings , a clinical pharmacist in Vanderbilt’s ICU, says when she arrived at the hospital, it was clear what needed to get done, but nobody was responsible for seeing it through.
“It needs somebody to coordinate this, who’s going to be here every single day,” she says. “And so Wes [Ely] helped me kind of champion this project, to really empower the nurses and respiratory therapists to make sure this happens every day.”
Ely’s mission now is to make what his hospital does standard around the world. For one thing, it can actually reduce the cost of care, he points out, by reducing the amount of time people spend in expensive ICU units.
“But the most important thing, of course, is not the money, it’s the human being,” he says. “So if they’re getting better care, surviving more — often with a more intact brain — and not bouncing back to the ICU … to me that’s a win-win.”
You can contact Richard Harris at firstname.lastname@example.org .
F-35 jets: US military grounds entire fleet – BBC News
These are external links and will open in a new window Close share panel Image copyright Getty Images Image caption An F-35B launching from the USS Essex The US military has temporarily grounded its entire fleet of F-35 fighter jets in the wake of a crash in South Carolina last month.
Inspections are to be carried out on faulty fuel tubes.
An official report questioned earlier this year whether the F-35 was ready for combat after dozens of faults were found.
The F-35 is the largest and most expensive weapons programme of its type in the world.
The programme is expected to last several decades and global sales are projected to be 3,000. The US government’s accountability office estimates all costs associated with the project will amount to one trillion dollars.
In a statement, the F-35 Joint Program Office said the US and its international partners had suspended flight operations while a fleet-wide inspection of fuel tubes was conducted.
“If suspect fuel tubes are installed, the part will be removed and replaced. If known good fuel tubes are already installed, then those aircraft will be returned to flight status.
“Inspections are expected to be completed within the next 24 to 48 hours.”
The aircraft, which uses stealth technology to reduce its visibility to radar, comes in three variants.
The crash in South Carolina involved an F-35B , which is able to land vertically and costs around $100m (£75m).
The pilot in that incident ejected safely but the aircraft was destroyed. Media playback is unsupported on your device Media caption F-35 fighter jets prepare to land for first time on a UK carrier
The plane, manufactured by Lockheed Martin but including parts made in several other countries, has been sold to a number of nations, including the UK, Japan, Italy, Turkey and South Korea. Why the RAF’s new F-35 jets matter
The Ministry of Defence in London said the UK had decided to “pause some F-35 flying as a precautionary measure while we consider the findings of an ongoing enquiry”.
But the MOD said F-35 flight trials from the aircraft carrier, HMS Queen Elizabeth, were continuing and the programme remained on schedule to provide UK armed forces with “a game-changing capability”. No going back
By Jonathan Marcus, Defence and Diplomatic Correspondent
The temporary suspension of all F-35 flights is an embarrassment given the extraordinary cost of this frequently troubled programme. But the problem has already been identified as faulty fuel tubes. Once these are checked or replaced the aircraft will be back in the air.
The F-35 is only just entering service but it is already the most expensive weapons programme of all time.
It will equip the US Air Force and Marine Corps as well as several of Washington’s allies. It represents a step-change in capability but the F-35’s complexity has inevitably thrown up problems.
However there is no going back now. It promises to be the centrepiece of US air power for decades to come.
While its costs per aircraft are coming down there are still questions about how many planes the US can afford and whether it should also buy a cheaper, less capable aircraft alongside the F-35.
The F-35, first used in combat by Israel earlier this year to carry out two strikes, is designed for use by the US Air Force, Marine Corps and Navy.
It boasts avionics, sensors and communications that allow data to be shared quickly with operational commanders. Related Topics
Sears, once the world’s biggest retailer, now faces bankruptcy
Sears, once the world’s biggest retailer, now faces bankruptcy Unable to keep up with e-commerce, the 125-year-old company hasn’t turned a profit since 2010. by Lucy Bayly / / Updated Oct.10.2018 / 11:50 AM GMT The outdoor sign stands in the parking lot of a Sears department store in Saint Paul, Minn. David Zalubowski / AP file Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. SUBSCRIBE
Sears, once the largest retailer in the world, is now reportedly facing bankruptcy.
The company, which hasn’t turned a profit since 2010 and is $134 million in debt, recently approached several banks to prepare for bankruptcy filing, CNBC reported Wednesday.
Shares plunged almost 20 percent on the news, and are set to open at a record low. Sears is teaming up with Amazon to save its struggling business Jul.21.2017 02:28
Sears CEO Eddie Lampert has been pumping funds from his own hedge fund, ESL Investments, into the company for years in an attempt to keep it afloat. Lampert owns a controlling share in Sears, with 31 percent of its stock; his hedge fund owns another 19 percent.
In August, ESL made an offer to buy out Sears’ well-known appliance brand Kenmore and the company’s home improvement business. Cash from those sales would infuse the company with around half a billion dollars, which could stave off bankruptcy for a few more months. Sears sold off another legacy brand, Craftsman, in 2017.
Once a staple of Main Street and malls nationwide, the 125-year-old company has shut down over 100 stores in the last year, with 46 stores set to shutter next month alone. Sears and Kmart, part of Sears Holdings, operated around 1,000 stores in 2017.
Shares have fallen by more than 85 percent in the last year as e-commerce has taken over the brick-and-mortar retail space. Despite pairing up with Amazon in 2017 to sell appliances online, analysts say Sears has not kept pace with change nor made investments in the digital space to the extent that Walmart and Target have done. Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. SUBSCRIBE