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Getting ready to welcome millions of visitors – as Russia is now doing in Moscow, Sochi and other cities in advance of the 2018 World Cup soccer tournament – takes years of planning and lots of construction. It’s also expensive: Building 12 stadiums in 11 cities cost Russia an estimated US$11 billion.

When these big events are underway, they always seem worth the money and the trouble. Having worked at three World Expos, attended the Olympics twice and gone to a Tour de France and an Australian Open, I have personally experienced the palpable excitement they offer. But I have also done enough research to see that international extravaganzas don’t always benefit the locals in the long run.

I’m on a team at Michigan State University’s mega-event planning research group that identifies what works and what may prove disastrous.

Here’s what we’ve learned.

President Donald Trump nominated Adm. Ronny Jackson, the White House physician who has no experience administering a large organization, to be secretary of Veterans Affairs, a department with a 360,000 employees and a US$186 billion annual budget.

Jackson is best known for his fulsome report on Trump’s health following an annual physical in January 2018.

Now, Jackson’s nomination is in trouble after allegations that he abused subordinates, created a hostile work environment, was drunk on the job, and freely passed out prescription pills including Ambien, Provigil and Percocet. The allegations come from various sources, including a summary prepared by Democratic Senate staff.

It is too early to determine if the allegations are true, and whether or not Jackson will be confirmed as Secretary of Veterans Affairs.

But whoever gets that position will have the task of trying to manage an agency that has long been in crisis. Nevertheless, the VA has pioneered evidence-based medicine and, overall, gets better outcomes at lower costs than many private health care providers.

As someone who has studied government budgets and the organization of government agencies, I believe Admiral Jackson, like his predecessor, will have to address three major problems if the VA is to be effective in meeting the needs of the millions of veterans who depend on it for their care.

1. Funding

First, the VA is funded much less generously than private medical providers. That means VA doctors earn substantially less than other physicians,...

President Donald Trump’s nominees to head the State Department, Veterans Affairs and the CIA are facing confirmation battles in the Senate.

Behind those battles lies the power of the president to nominate and the Senate to confirm candidates for more than 2,000 positions – including ambassadors, federal judges and Cabinet secretaries.

The Senate’s confirmation role is a fundamental governmental function, embedded into the U.S. Constitution Article II, Section 2, that preserves the balance of power between the executive and legislative branches. Its job of “advice and consent” on presidential nominees aims to limit to the power of any one person or branch of government.

Some nominees face significant scrutiny from U.S. senators who customarily grill prospective government officials in open committee hearings. The committee then votes whether or not to advance the nomination to a full Senate vote, though it may also not vote at all on a controversial nominee.

Almost all nominees survive the confirmation process. Just a handful are forced to withdraw from consideration or come up short when put to a vote. According to the Congressional Research Service, 99 percent of nominees are approved.

Rejected by the Senate

But there have been exceptions. In 1987, Ronald Reagan famously nominated Robert Bork to the U.S. Supreme Court.

Bork’s controversial conservative views on...

Armenia, Azerbaijan and Georgia, three countries in the South Caucasus once ruled by the former Soviet Union, still operate in the shadow of what is now called Russia.

The three states are located between Iran and Turkey on the western side and Russia to the north. What happens in them affects Russian interests in the region.

Russian President Vladimir Putin, over the last 18 years, has maintained strong political, military and economic relations – sometimes welcome, sometimes not – with these countries and their leaders in an attempt to keep them on Russia’s side. Russia’s intervention in Syria’s civil war and its growing alliances with Iran and Turkey makes maintaining influence over the South Caucasus states even more enticing for Putin. He wants to be the guy in charge.

So when a head of state from this region resigns after a weeklong protest that draws a million people, as happened this week in Armenia, commentators are quick to proclaim that the sky is falling on Putin’s sphere of influence.

One said, “Consumed by cynicism, the Russian ruler and his clique are incapable of accepting that spontaneous political uprisings by outraged publics are possible.”

I lived in the Caucasus for several years, as a U.S. Peace Corps volunteer and later as an academic. What I think most analysts get wrong about Armenia is just how fiercely...

President Donald Trump is vowing to crack down on deceptive transshipment. That is the practice of moving cargo from one country to another by way of a third nation to evade trade restrictions.

As an international economist, I have researched the impact of imported textiles and apparel on those industries in North Carolina over the last 20 years. Based on this recent history, I believe it will be hard for Trump to succeed.

Indirect routes

Not all transshipments are intentionally misleading. For example, a car shipped from Stockholm, Sweden, to Montreal, Canada, may first travel to New York City’s port, before being transferred to another boat, a train or a tractor-trailer for the NYC-Montreal leg of the trip.

These indirect routes can reduce costs when they let shipping companies move more freight on their busiest routes.

But the Trump administration claims something else is going on with Chinese steel. Washington is accusing Chinese steelmakers of routing their U.S.-bound product through Vietnam and other Asian countries to avoid existing tariffs on Chinese steel. That could become even more of a problem if the administration goes ahead with plans to impose new 25 percent tariffs on Chinese steel.

Federal rules of origin allow importers to say goods hail from a given country as long as they were “substantially transformed” there. Slapping a “made in” label onto a steel slab doesn’t satisfy this criterion, while rolling that steel into finished pipes in that country definitely does. In practice,...

The devastating opioid epidemic is one of the largest public health problems facing the U.S. Over 2.5 million people in the U.S. suffer from opioid use disorder.

Four in five new heroin users started out misusing prescription painkillers. A 2015 analysis by the Centers for Disease Control and Prevention found people who are addicted to painkillers are 40 times more likely to be addicted to heroin.

The epidemic actually began more than three decades ago. In 1980, crack and cocaine addiction contributed to the thousands of overdose deaths, whereas now people die from pain relievers and synthetic opioids such as fentanyl.

In 1990, I began studying its relationship to HIV and the experiences of people with multiple addictions. My research team and I have recruited research participants from emergency rooms, methadone programs, jails, prisons, alternative to incarceration projects, and HIV and primary care clinics. We have examined barriers to accessing care for drug addiction and HIV, and some of the lessons we have learned apply to the broader population.

Two faces of the opioid addiction

Years ago, I interviewed Jennifer, a former nurse, who was prescribed antidepressants to cope with childhood sexual abuse trauma. When this didn’t help, she stole narcotics from her clinic and was fired. With no access to pain pills, Jennifer began using heroin and cocaine. She...

As college tuition continues to rise at a staggering rate, people tend to worry about how much harder it becomes for students and families to pay for college.

As researchers who focus on higher education, we found a different reason to worry.

We examined tuition hikes at public four-year colleges and universities over a 14-year period. We wanted to see if tuition increases at public colleges and universities changed the racial and ethnic makeup of students on campus.

What we found is that for every $1,000 increase in tuition at four-year nonselective public universities, diversity among full-time students decreased by 4.5 percent.

In other words, as tuition goes up, diversity goes down. The end result is the nation’s colleges and universities become less reflective of the ethnic diversity of the United States as a whole.

How long does it take for tuition to rise by $1,000 at a given university? A $1,000 hike could happen over the course of only one or two years in some cases. Over the past decade tuition and fees rose by $2,690 at public four-year institutions.

Why diversity on campus matters

The fact that diversity drops when tuition rises at certain colleges and universities is a big deal. For starters, it means that more minorities might choose not to enroll in college and, therefore, forego the economic and social benefits of higher education.

But less diversity doesn’t...

As biologists explore the variation across the genomes of living people, they’ve found evidence of evolution at work. Particular variants of genes increase or decrease in populations through time. Sometimes this happens by chance. Other times these changes in frequency result from the gene’s helping or hindering individuals’ survival, a phenomenon known as selection. If a gene conferred a survival advantage, people with the mutation would have more offspring and the mutation would become more common in subsequent generations.

Most of those past episodes of selection make sense, as they worked on genes involved with things like resisting disease, blood oxygen levels at high altitudes, and having paler skin at northern latitudes.

However, researchers have also identified an episode of strong selection that doesn’t have such an obvious logic. It’s a mutation on a gene involved with the development of a suite of traits that don’t seem very similar at first glance: hair, teeth, sweat glands and breasts. This one was a mystery — what could have been the adaptive value of this mutation that led to it being common in northeastern Asia but nowhere else?

My research usually focuses on teeth, specifically genetic influences on their development. I came to this particular evolution puzzle when my colleagues and I gathered in Boston at the...

Scientists have known for a long time that as climate change started to heat up the Earth, its effects would be most pronounced in the Arctic. This has many reasons, but climate feedbacks are key. As the Arctic warms, snow and ice melt, and the surface absorbs more of the sun’s energy instead of reflecting it back into space. This makes it even warmer, which causes more melting, and so on.

This expectation has become a reality that I describe in my new book “Brave New Arctic.” It’s a visually compelling story: The effects of warming are evident in shrinking ice caps and glaciers and in Alaskan roads buckling as permafrost beneath them thaws.

But for many people the Arctic seems like a faraway place, and stories of what is happening there seem irrelevant to their lives. It can also be hard to accept that the globe is warming up while you are shoveling out from the latest snowstorm.

Since I have spent more than 35 years studying snow, ice and cold places, people often are surprised when I tell them I once was skeptical that human activities were playing a role in climate change. My book traces my own career as a climate scientist and the evolving views of many scientists I have worked with. When I first started working in...

Five women graduated from New York City’s Fire Academy on April 18, bringing the number of women serving in the Fire Department of New York to 72 – the highest in its history.

The FDNY’s 2018 graduating class also includes the first son to follow his mother into the profession. She was one of the 41 women hired in 1982 after the department lost a gender discrimination lawsuit and was ordered to add qualified women to the force.

Despite these milestones, women still make up less than 1 percent of New York’s 11,000 firefighters. The city trails Minneapolis, San Francisco, Seattle and Miami, where in recent years fire squads have been more than 10 percent female. The national average hovers around 5 percent.

Approximately 10,300 women nationwide worked as full-time firefighters in 2016, according to the most recent data available from the Department of Labor. In 1983, there were just 1,700.

These women are on the front lines, fighting fires, helping victims of natural disasters and combating terrorism.

I interviewed over 100 female firefighters for an academic study of women in traditionally male industries. My research reveals...

President Donald Trump recently visited West Virginia for the fourth time since taking office. He’s more popular there than in any other state, partly because of his avowed passion for coal and coal miners.

As he put it at a campaign rally in Charleston, when he visited in May 2016, “I’ve just always been fascinated by the mines and the courage of the miners.” He also promised “to put the miners back to work.”

For decades, presidents, lobbyists and policymakers have invoked the image of coal miners. In researching the history of West Virginia’s coalfield economy, I have found many examples of coal miners being used as symbols of bravery, hard work and manliness to achieve political ends.

Presidential politics

And it’s been like that for at least 60 years. The 1960 West Virginia primary, for example, was a milestone in John F. Kennedy’s bid for the presidency. At the time, many Americans questioned whether a Catholic could win the overwhelmingly Protestant state. But he did.

There, JFK shook hands with miners covered in coal dust and...

When two black men were arrested at a Philadelphia Starbucks where they had been waiting for a business meeting on April 12, the incident called renewed attention to the bias that racial minorities face in American society.

A few days later, a similar incident unfolded at an LA Fitness in New Jersey.

While these two incidents involved adults at places of business, the reality is black children face similar treatment in America’s schools.

The latest evidence is in a recent federal report that shows boys, black students and students with disabilities get kicked out of school at higher rates than their peers.

Findings like this are disturbing, but they are hardly surprising. As a trainer of school psychologists, consultant and researcher, I have worked with schools on the matter of racial disparities in school discipline, along with other problems of justice.

I believe racial disparities in school discipline will persist until educators seriously examine the role their decisions play in the matter. They will also persist until schools begin to implement new strategies that have proven it’s not necessary to kick kids out of school to effectively deal with their behavior.

The source of disparities

Racial disparities in school discipline are nothing new. In 2014 – after years of “zero tolerance” policies proved problematic – the Obama administration issued a guidance to...

In a move that might surprise some, the conservative evangelical Liberty University has chosen the liberal evangelical icon Jimmy Carter to give its commencement speech this year. Based on my research into the history of evangelical higher education, however, the move makes perfect sense: The long-standing dream of conservative evangelical universities like Liberty is to be more than a niche school.

The GOP love affair with Liberty

Liberty’s roots go back to the fundamentalist movement, a conservative interdenominational evangelical protest that began in the 1920s. In that era, fundamentalists hoped to cleanse their churches of liberalism and public schools of evolution. In recent years, many former fundamentalists prefer other labels, such as “conservative evangelical” or simply “Christian.” Liberty has often taken the lead as the movement’s public face.

Conservative politicians have rushed to flatter Liberty’s conservative vision. In 2017, for example, President Trump offered a rousing commencement speech to his evangelical fans at Liberty. As they ventured out of Lynchburg, Virginia, Trump told Liberty grads:

“I know that each of you will be a warrior for the truth, will be a warrior for our country and for your family. I know that each of you will do what is right, not what is the easy way, and that you will be true to yourself and your country and your beliefs.”

It wasn’t only President Trump who told the...

The success of liver transplantation represents one of the great miracles of modern medicine. Essentially an experimental procedure 35 years ago, it now represents the only definitive method to cure most patients with end-stage liver failure.

The major problem with liver transplantation now is not rejection or infections but rather that there are not enough livers for all the people who need them. Over 14,000 people are waiting for a liver transplant in the United States, but only about 8,000 transplants are done annually. The average waiting time for most patients measures in years – if they receive one at all. One in five patients dies on the waiting list, a number that could be significantly decreased with liver donations from living donors.

I am the clinical director of the Starzl Transplant Institute, named for University of Pittsburgh surgeon and professor Thomas Starzl, who pioneered liver transplantation. I have been involved in transplantation for over 20 years and have been witness to many advances in the field, including the development of live donor liver transplants, that have ultimately allowed thousands of lives to be saved. The medical community could perform a lot more liver transplants in the U.S. if we followed the lead of using livers from live donors, as do many countries.

A vital...

The pretzel, one of the fastest-growing snack foods in the world, recently crossed a billion dollars a year in sales.

It has its own emoji, comes in flavors like pumpkin spice, mocha and banana, and is now available as an aromatherapy scent. It even has its own special day: April 26 is National Pretzel Day.

But not that long ago, the future of the pretzel didn’t look as shiny as its surface. As I point out in my Food and Society class, foods that are ubiquitous in certain pockets of the world don’t often spread beyond that region. For decades in the U.S., the pretzel wasn’t known outside of the mid-Atlantic states. It took advances in manufacturing and tweaks to the recipe to make it the global snack it is today.

When German immigrants first started coming to America in the 1700s, they brought the pretzel with them. Bavarians and other southern Germans had been enjoying pretzels for hundreds of years. Sometimes they ate pretzels as a side to a main dinner course; other times, they munched on sweet pretzels for dessert. In Swabia, a region in southwestern Germany, signs for bakeries still include gilded pretzels hanging over the door.

Many of these immigrants settled in Pennsylvania’s Susquehanna Valley, where they became known as the Pennsylvania Dutch (Dutch being a corruption...

We’re all human beings, but we’re not all alike.

Each person experiences pain differently, from an emotional perspective as well as a physical one, and responds to pain differently. That means that physicians like myself need to evaluate patients on an individual basis and find the best way to treat their pain.

Today, however, doctors are under pressure to limit costs and prescribe treatments based on standardized guidelines. A major gap looms between the patient’s experience of pain and the limited “one size fits all” treatment that doctors may offer.

Concerns about the opioid epidemic make the problem worse. Opioids – including heroin and fentanyl – killed more than 42,000 people in the U.S. in 2016. Four in 10 of these deaths involved prescription painkillers such as hydrocodone and oxycodone. Physicians are increasingly reluctant to prescribe opioids for pain, fearing government scrutiny or malpractice lawsuits.

Where does this leave the patient whose experience of pain is outside the norm? How can physicians in all specialties identify these patients and do our best to manage their pain, even when their needs don’t match our expectations or experience?

Pain differences

Some pain is a natural part of healing. But that pain can vary depending on who is experiencing it.

Let’s start with a question that for years perplexed physicians who specialize in anesthesiology: Do redheads require more anesthesia than other patients? Anecdotally, many anesthesiologists thought they...

The health of children born to unauthorized immigrants – who are U.S. citizens – is affected by local and federal immigration policies. There are as many as 4 million children who have at least one parent who is undocumented.

Along with colleagues at Stanford’s Immigration Policy Lab and Oregon Health & Science University, we measure the impact of immigration policy on the health of individuals and communities. Our research reveals the public health benefits of laws that make it easier for unauthorized immigrants to integrate into society.

An Obama-era policy that temporarily shielded some Dreamers from deportation, Deferred Action for Childhood Arrivals, offers a a dramatic example of how this has worked at the federal level.

Power of policy

We looked at Oregon’s Emergency Medicaid program, which overwhelmingly covers the medical expenses of unauthorized immigrant mothers when they give birth.

We identified mothers who were born just before and just after the cutoff to be eligible for DACA. Their children, native-born U.S. citizens, were all covered by Medicaid. This allowed us to follow their children’s health over time and compare those whose mothers were either eligible or ineligible for DACA. We studied 8,610 children.

After the DACA policy was announced in 2012, the two groups of children suddenly diverged. Children whose mothers were eligible for DACA saw an immediate improvement in their mental health; they were diagnosed...

On beaches from North Carolina to Texas and throughout the wider Caribbean, one of nature’s great seasonal events is underway. Adult female sea turtles are crawling out of the ocean, digging deep holes in the sand and laying eggs. After about 60 days turtle hatchlings will emerge and head for the water’s edge, fending for themselves from their first moments.

I have spent 36 years studying sea turtle ecology and conservation. All seven species of sea turtle found around the world are classified as vulnerable or endangered. Nesting season is an important opportunity for us to collect data on turtle abundance and trends. For those of us who have spent decades studying turtles on nesting beaches, anticipation builds as we prepare for their arrival. And when that first turtle comes ashore to usher in the nesting season, it feels as though we are welcoming home old friends.

Today most coastal areas in the United States protect beaches during nesting season. Government agencies, researchers and volunteers monitor many beaches and help hatchlings make it to the water. These measures have helped turtle populations increase. For example, the critically endangered Kemp’s ridley sea turtle (Lepidochelys kempii), which was on the brink of extinction in the mid-1980s, has increased from a few hundred nests to over 20,000 nests laid in 2017.

But turtles face many hazards in...

Like any large company, a modern hospital has hundreds – even thousands – of workers using countless computers, smartphones and other electronic devices that are vulnerable to security breaches, data thefts and ransomware attacks. But hospitals are unlike other companies in two important ways. They keep medical records, which are among the most sensitive data about people. And many hospital electronics help keep patients alive, monitoring vital signs, administering medications, and even breathing and pumping blood for those in the most dire conditions.

A 2013 data breach at the University of Washington Medicine medical group compromised about 90,000 patients’ records and resulted in a US$750,000 fine from federal regulators. In 2015, the UCLA Health system, which includes a number of hospitals, revealed that attackers accessed a part of its network that handled information for 4.5 million patients. Cyberattacks can interrupt medical devices, close emergency rooms and cancel surgeries. The WannaCry attack, for instance, disrupted a third of the UK’s National Health Service organizations, resulting in canceled appointments and operations. These sorts of problems are a growing threat in the health care industry.

Protecting hospitals’ computer networks is crucial to preserving patient privacy – and even life itself. Yet recent research shows that the health care industry lags behind other industries in securing its data.

I’m a systems scientist at MIT Sloan School of Management,...

Malaria, a mosquito-borne parasitic infection that affects about 3.2 billion people in 95 countries, has become largely a disease of the young and poor.

Due to effective medications like chloroquine and artemisinins, malaria deaths dropped an estimated 60 percent worldwide between 2000 and 2015. The Americas and Africa saw the greatest improvements.

Still, 216 million new cases of malaria were reported in 2016, the latest data available. Most of them occurred in Nigeria, the Democratic Republic of the Congo, Uganda, Ivory Coast and Mozambique. And of the 445,000 people who died from the infection, about 70 percent were children under the age of 5.

If malaria is a curable disease with effective treatment, why does it still kill so many?

The rise of counterfeit drugs

Our research on the pharmaceutical industry has revealed that one reason for malaria’s continued virulence in the developing world is ineffective medicine. In fact, in some poor African countries, many malaria drugs are actually expired, substandard or fake.

Globally, some 200,000 preventable deaths occur each year due to anti-malarial drugs that do not work. Substandard and counterfeit medicines may be responsible for up to 116,000 malaria deaths annually in sub-Saharan Africa alone, according to recent World Health Organization estimates.

Fraudulent pharmaceuticals are on the rise. Reports of counterfeit or falsified anti-malarials rose...