Editor Notes:

February 24, 2024 marked two years since the outbreak of the Russia-Ukraine conflict, which now still shows no signs of abetting. How do ordinary Ukrainians live in the midst of the conflict? The Global Times recently interviewed several Ukrainians who said that while the supply of goods in Kiev is relatively adequate, many people have lost their jobs or seen a significant decline in income. Many have had to change their way of life to adapt to frequent air raids and explosions. The healthcare and education sectors have also been impacted.

Those interviewed in Ukraine said that the conflict has completely changed their lives and their outlook on the future. "Almost everyone around me has lost someone they love," said one interviewee. Another young Ukrainian woman said that she no longer thinks about the future because "tomorrow may never come."

This story is a part of the Global Times' "Witness to history" series, which features first-hand accounts from witnesses who were at the forefront of historic moments. From scholars, politicians and diplomats to ordinary citizens, their authentic reflections on the impact of historical moments help reveal a sound future for humanity through the solid forward steps taken in the past and the present.
After the outbreak of the conflict, Anna Smirnova and her husband moved from the countryside to the capital, Kiev, as they thought it would be relatively safer there. However, they still had to frequently seek shelter due to air raids, which have become a common occurrence over the last two years.

What's more dangerous, for her, is that "sometimes we are asleep and fail to hear the air raid alert in time, but the subsequent explosion wakes us up. Since we don't have time to get to the shelter, we can only lie on the floor, putting some pillows over and around us (as protection)," Smirnova told the Global Times.

She has lived in anxiety and fear every day for the last 700 days. Her experience is representative of many in Ukraine. After the outbreak of the conflict, almost all underground spaces in Kiev were converted into shelters, from larger city metro stations to smaller basement levels of office buildings and restaurants, according to media reports.

On January 2, humanitarians in Kiev counted over 30 explosions in the city alone, according to a UN report. According to a recent survey of the United Nations International Children's Emergency Fund, children in cities in the frontline areas of Ukraine have spent between 3,000 and 5,000 hours equivalent to between four and almost 7 months - hiding in basements and underground metro stations over the last two years.

The conflict has also completely changed Smirnova's daily schedule. She is now more accustomed to sleeping during the day while remaining awake at night. She works from home in the early morning and at night, as during the daytime, she may have to stay in shelters.

"I started working from home after the beginning of the conflict, because I feel safer. My office is full of glass; this is quite dangerous when there is an attack or air alert, and people might get injured easily because of this office design," she said, adding that her current life and working style have greatly affected her health.

Despite facing constant danger, several interviewees in Kiev told the Global Times that the city's order is relatively stable, and there are no signs of shortages in the market, especially of food, vegetables, and other basic necessities. However, over the last two years, prices have increased significantly, while many people's incomes have decreased due to the impact of the conflict.

While Smirnova's salary remains constant, she has found that her purchasing ability has decreased as commodities become more expensive and the prices for many daily essentials and foods in supermarkets have roughly doubled compared to two years ago and continue to rise.

According to her, a dozen eggs that cost 30 Ukrainian hryvnias ($0.79) previously now cost 60 hryvnias. The same goes for bread. People dare not spend money as they did in peacetime. "Everyone wants to save some money because we are afraid of the future."

Anastasiia Kupryk, 22, is not as lucky as Smirnova. Kupryk now works at a skincare product store in a shopping mall in Kiev, but business has suffered, leading to a significant reduction in her income.

She told the Global Times that she now looks for extra work every day to earn more money, especially more stable work, but it is difficult to land such a job.

A Reuters report in February pointed out that a profound challenge for Kiev is that trying to recruit more people into the military could further damage the already war-ravaged economy.

Live in the moment

Before the outbreak, Kupryk lived in Borodyanka, a peaceful and beautiful small town in central northern Ukraine. In her eyes, it was once a peaceful and beautiful town, but now large areas of land have been reduced to ruins.

Her own home was destroyed in the bombings, and now she can only temporarily live in Kiev. Some of Kupryk's relatives still live in Borodyanka but their lives are much harder than before. People are also trying to do some reconstruction work, but progress is very slow, according to her.

In Borodyanka, she lost her mother and her ex-boyfriend, painful memories she still avoids touching upon to this day. "At that time, I couldn't do anything. I was powerless. Later, I realized that war is not just happening on the battlefield, among soldiers - it is a huge threat and pain to civilians," the young Ukrainian woman told the Global Times. "All of my friends and relatives have lost someone they love."

According to a study conducted by the World Bank, the United Nations, and the European Commission, some 3.7 million Ukrainians have been internally displaced by the fighting and another 5.9 million are still displaced outside of Ukraine. Many children have lost their opportunity for education due to the conflict. According to data from the UNICEF in August 2023, only about one-third of school-age children in Ukraine were able to attend school regularly, read a Reuters report.

The conflict has even profoundly changed the way people talk to each other.

Smirnova said that the topics among people on the streets are mainly about the conflict. In Kupryk's view, even the "atmosphere" in the city seems to have changed as tense emotions consume everyone and every conversation.

For Kupryk, aside from losing loved ones, the biggest change the war has brought is that she no longer plans for the future. "Now I only plan what to do 2 to 3 hours ahead every day. I don't even think about the whole day, let alone talk about a week, a month, or a year," she told the Global Times.

Before the conflict erupted, Smirnova and her husband had planned to have a child and renovate their apartment. However, both of these plans have been put on hold. In her view, investing in a house during wartime is very risky, and having a child is even more challenging because bringing a new life into this world means taking on enormous responsibility.

She is even afraid to take antidepressants again. "Shortly after the outbreak, I needed to take antidepressants, but the closure of many pharmacies made it difficult to buy these medications. The situation has improved a lot now, and in Kiev, it is not very difficult to buy basic medications other than antibiotics. But when the doctor suggested me continuing taking these medications, I dared not start the treatment again because I was afraid that one day, pharmacies would close again."

"It has completely changed my life," Smirnova said. "I now look at life from different angles. I live in the present because tomorrow may never come."
Grim peace prospect

"Ukraine, two years on: Exhaustion at home, fatigue abroad, but the fight continues," read a recent commentary piece in The Guardian.

"A year ago, there was still cautious optimism about the counteroffensive. But hopes of a breakthrough were dashed and Russia's capture of the eastern city of Avdiivka last week was its biggest gain since the capture of Bakhmut last May," the Guardian article went on to say.

The former commander-in-chief of the Ukrainian Armed Forces, Valerii Zaluzhnyi, said recently that the Russia-Ukraine conflict has now entered a phase characterized by stalemate and attrition.

Analysts pointed out that the prolonged conflict in Ukraine has begun to wear on many Western nations, resulting in a divided stance on extending additional support to the country. The recent Palestinian-Israeli conflict has further diverted the attention of the West, especially the US, limiting their ability to prioritize the situation in Ukraine.

They pointed out that the upcoming US presidential elections in November are also seen as the biggest variable in the trajectory of the conflict.

A January survey conducted across 12 EU countries found that pessimism about the conflict's outcome was being fueled by Ukraine's failed counteroffensive. A recent Gallup poll found out that nearly half of the US public believes their country is spending too much on Ukraine.

A Pew Research Center survey released in December 2023 showed that the share of Americans who believe the US is giving "too much support to Ukraine" has grown steadily over the last two years, especially among Republicans.

The percentage of Republicans and Republican-leaning independents who believe the US is providing too much aid to Ukraine has increased to 48 percent. This marks a slight uptick from June, when it was at 44 percent, and a significant increase from earlier stages in the war, according to the Pew report.

A 60-billion-US-dollar package of aid to Ukraine is currently stalled in US Congress by right-wing Republicans. EU countries reached an agreement in early February to offer Ukraine 50 billion euros in assistance. This deal was secured after Hungary withdrew its veto threats. However, transforming this dedication into readily accessible ammunition for soldiers on the front lines remains a challenge.

In February 2024, compared to October 2023, the percentage of Ukrainians who believe that the West is growing tired of Ukraine has increased from 30 percent to 44 percent, according to a survey from the Kyiv International Institute of Sociology conducted from February 17 to 23, Ukrainian media outlet Ukrainska Pravda reported.

However, the Ukrainians interviewed maintain a strong will to resist, even though they also understand the helplessness of the situation. They hope for assistance from the West, but many struggle to grasp the complex geopolitics behind the Russia-Ukraine conflict.

As the conflict in Ukraine drags on, it is not just Ukraine that is suffering. The longer the fighting continues, the more likely it will become a problem for the US as well. Rising energy, industrial, and commodity prices will impact people around the world. While the US may see temporary gains from arms and energy sales, in the long term, the US dollar could lose its strength and the country's global dominance could diminish, analysts noted to the Global Times.

"If one day, peace can come again, I hope to regain my previous aspirations. My husband and I will renovate our little home and have a child. We will strive to resume a complete life," Smirnova told the Global Times.

Chinese President Xi Jinping on Tuesday arrived in Belgrade to pay a state visit to Serbia.

Major Chinese airports saw record transport resulting from rising demand in 2023, with airports in Xinjiang and Xizang in particular welcoming record volumes of passenger throughput.

Xinjiang Airport Group Co reported record high of passenger throughput of 40.61 million as of December 31, 2023, facilitating 490,000 takeoffs and landings. Annual passenger throughput and takeoffs and landings have returned to 108.2 percent and 113.2 percent of 2019 levels, respectively, the group said. 

Among the airports in Xinjiang, passenger throughput across nine airports in Northwest China's Xinjiang Uygur Autonomous Region including Urumqi, Kashi, Korla and Aksu all exceeded that of 2019. Annual passenger throughput at Urumqi Diwopu International Airport exceeds the 25 million mark for the first time, reaching 25.08 million passengers.

In 2023, Xinjiang Airport Group launched a total of 451 domestic routes and 20 international routes.

Xizang Autonomous Region Administration of the Civil Aviation Administration of China (CAAC) also reported a record high of 6.897 million passenger trips in 2023, representing growth of 106.1 percent over 2022, also marking a record high. Among the airports in Xizang, annual passenger throughput at Lhasa Gonggar International Airport reached 5.47 million, a year-on-year increase of 111.8 percent. Annual passenger throughput of Qamdo Bangda Airport reached 424,000, a year-on-year increase of 60 percent, the bureau said. 

Currently, there are 12 airlines operating in Xizang, with the flying footprint covering 169 routes across 74 cities.

The rapid recovery of aviation industry has provided a solid foundation greater airport activity, market watchers said. 

CAAC data showed that the scale of domestic route passenger traffic in 2023  exceeded  pre-epidemic levels, with an increase of 1.5 percent compared to 2019, and the fastest recovery among all types of transportation modes in China. 

Guangzhou Baiyun International Airport reported a passenger turnover of 65 million in 2023, ranking first for domestic airports. In July alone, the airport handled 6.05 million passenger trips, becoming the first domestic airport to handle more than six million passengers in a single month since 2020.

In 2024, China's domestic passenger transport will continue to grow steadily, passenger volume on domestic routes is expected to reach 630 million throughout the year, exceeding 2019 levels by 7.7 percentage points, the CAAC said.

The CAAC predicted that China's international passenger traffic will continue to rebound, with the number of flights expected to reach 6,000 flights per week at the end of 2024, recovering to the 80 percent of levels seen before the epidemic. 

China's civil aviation will enter a new cycle of sustained, rapid and healthy development, as the country's transport sector returns to a period of natural growth, the CAAC said.

What special apps does a young Tibetan living on the snowy plateau have on their phone? Recently, a new app called "Linka" has appeared on the phones of young people. Using it, you can easily browse and learn information about the Tibetan culture. Additionally, you can find both the oldest and the latest Tibetan songs, and learn about their origins and historical background. Most importantly, you can share your joy and sorrow in life and build your own neighborhood online.

Of course, we are not here to advertise any social app. However, the name of this app is indeed well chosen. It encompasses all the meanings and uses of the Tibetan word "linka." 

For thousands of years before the advent of online social platforms, linka was the primary social bond between Tibetan people, their communities, and nature. Through these activities, ­Tibetans stay cheerful, optimistic, and lively even in the challenging high-altitude and oxygen-deficient natural environment.

In Tibetan, linka means gardens and groves. However, in a daily context, "linka running" is similar to outings or picnics. Linka running exists as a long-standing Tibetan tradition of ­being close to nature, a habit developed by Tibetan compatriots living in a high-altitude climate and unique environment. 

In the Xizang Autonomous Region in Southwest China, severe cold and snow are the norm. So, any day with good weather is never wasted. They are seen as gifts from Heaven. 

Tibetan people deeply adhere to the belief that "Every day in which you do not dance is a day wasted in life." Therefore, during such days, Tibetans often gather with family and friends, bringing along some food, and head to lush linka areas. There, they set up tents, lay out carpets, set out barley wine and various snacks, and indulge in merrymaking, celebrating the joys of nature with singing and feasting.

Over time, linka running has become a unique daily way of life for ­Tibetans. In Lhasa, whether in urban areas or the outskirts of the city, there are incredibly beautiful linka sites everywhere. Under the intense plateau sunshine, they appear as green as emeralds, turning Lhasa into a mythological world. 

Follow along and step into the world of Lhasa's linka to experience the unique ethnic customs and folk culture of the Tibetan people.

Having lived in Xizang for many years, I have heard the most beautiful songs, the most captivating stories, and the most entertaining jokes at linka running events. We believe that any cultural identity is a product of negotiation and interaction between people and nature.

It can be said that linka running reconciles the innate human desire to be close to nature with the challenges of the harsh natural environment. 

Tibetan people have a natural inclination toward outdoor life, camping, and picnics, and they love the forests, rivers, flowers, and meadows. 

At linka sites they set up tents of various colors and lavish or simple curtains, build stoves, prepare food and tea, and sometimes, they stay for a day, several days, or even up to half a month.

During these days, they sing, dance, play cards, roll dice, tell stories, perform Tibetan opera, entertain guests, feast, drink, and celebrate. There are also various games, sports, and archery activities.

The most touching crystallization of their culture naturally emerges during these carefree moments. The most popular sport during these times is archery, known as bishao in Tibetan. The target is made of cowhide, with a movable center. The arrowheads are carved from wood with many holes, producing a sharp sound when released from the bowstring. Hitting the bull's-eye causes the center to drop, indicating victory for the archer. 

During every archery competition, men and women standing on both sides of the competitors sing and dance enthusiastically to cheer and support them. This type of song is called dhashei, meaning arrow song.

In today's urban life in Xizang, this atmosphere has also spread extensively. Colleagues in the workplace, business partners, teachers and students in schools, guests and hosts, tourists and locals - more and more social relationships are influenced by Tibetan culture. 

People have learned to place the trivial matters of daily life under the vast starry sky and the scene of bonfire dances, giving everything a pastoral and idyllic filter.

We cannot deny that it is in one of the harshest natural environments on the plateau that the Tibetan people have created this most optimistic and relaxed way of life. This is rarely seen in cultures around the world. 

No matter how grand and lavish gatherings are organized in other places, they ultimately remain mere embellishments in the daily routine. But in the linka culture of Xizang, it seems that the Tibetan people have turned this around. 

It is said that in some families, the linka can last for up to a month. Family members with work or other obligations can leave at any time and naturally return to the festivities after finishing their tasks. This is indeed a very appealing way of life: Bothersome jobs and tasks are merely interludes in a grand feast.

No one knows whether chronic marijuana smoking causes emotional troubles or is a symptom of them…. This dearth of evidence has a number of explanations: serious lingering reactions, if they exist, occur after prolonged use, rarely after a single dose; marijuana has no known medical use, unlike LSD, so scientists have had little reason to study the drug…. Also, marijuana has been under strict legal sanctions … for more than 30 years. – Science News, October 7, 1967

In 29 states and in Washington, D.C., marijuana is now commonly prescribed for post-traumatic stress disorder and chronic pain. But the drug’s pros and cons remain hazy. Regular pot use has been linked to psychotic disorders and to alcohol and drug addiction (SN Online: 1/12/17). And two recent research reviews conclude that very little high-quality data exist on whether marijuana effectively treats PTSD or pain. Several large-scale trials are under way to assess how well cannabis treats these conditions.

The iconic Arecibo Observatory has survived a hurricane and dodged deep budget cuts. On November 16, the National Science Foundation, which funds the bulk of the observatory’s operating costs, announced that they would continue funding the radio telescope at a reduced level.

It’s not clear yet who will manage the observatory in the long run, or where the rest of the funding will come from. But scientists are celebrating. For example:
Arecibo, a 305-meter-wide radio telescope located about 95 kilometers west of San Juan, is the second largest radio telescope in the world. It has been instrumental in tasks as diverse as monitoring near-Earth asteroids, watching for bright blasts of energy called fast radio bursts and searching for extraterrestrial intelligence.

But the NSF, which covers $8.3 million of the observatory’s nearly $12 million annual budget, has been trying to back away from that responsibility for several years. After Hurricane Maria hit Puerto Rico on September 20, damaging the telescope’s main antenna, the observatory’s future seemed unclear (SN: 9/29/17).

On November 16, the NSF released a statement announcing it would continue science operations at Arecibo “with reduced agency funding,” and would search for new collaborators to cover the rest.、
“This plan will allow important research to continue while accommodating the agency’s budgetary constraints and its core mission to support cutting-edge science and education,” the statement says.

Internist Gail Povar has many female patients making their way through menopause, some having a tougher time than others. Several women with similar stories stand out in her mind. Each came to Povar’s Silver Spring, Md., office within a year or two of stopping her period, complaining of frequent hot flashes and poor sleep at night. “They just felt exhausted all the time,” Povar says. “The joy had kind of gone out.”

And all of them “were just absolutely certain that they were not going to take hormone replacement,” she says. But the women had no risk factors that would rule out treating their symptoms with hormones. So Povar suggested the women try hormone therapy for a few months. “If you feel really better and it makes a big difference in your life, then you and I can decide how long we continue it,” Povar told them. “And if it doesn’t make any difference to you, stop it.”
At the follow-up appointments, all of these women reacted the same way, Povar recalls. “They walked in beaming, absolutely beaming, saying, ‘I can’t believe I didn’t do this a year ago. My life! I’ve got my life back.’ ”

That doesn’t mean, Povar says, that she’s pushing hormone replacement on patients. “But it should be on the table,” she says. “It should be part of the discussion.”

Hormone replacement therapy toppled off the table for many menopausal women and their doctors in 2002. That’s when a women’s health study, stopped early after a data review, published results linking a common hormone therapy to an increased risk of breast cancer, heart disease, stroke and blood clots. The trial, part of a multifaceted project called the Women’s Health Initiative, or WHI, was meant to examine hormone therapy’s effectiveness in lowering the risk of heart disease and other conditions in women ages 50 to 79. It wasn’t a study of hormone therapy for treating menopausal symptoms.

But that nuance got lost in the coverage of the study’s results, described at the time as a “bombshell,” a call to get off of hormone therapy right away. Women and doctors in the United States heeded the call. A 2012 study in Obstetrics & Gynecology showed that use plummeted: Oral hormone therapy, taken by an estimated 22 percent of U.S. women 40 and older in 1999–2000, was taken by fewer than 12 percent of women in 2003–2004. Six years later, the number of women using oral hormone therapy had sunk below 5 percent.
Specialists in women’s health say it’s time for the public and the medical profession to reconsider their views on hormone therapy. Research in the last five years, including a long-term follow-up of women in the WHI, has clarified the risks, benefits and ideal ages for hormone therapy. Medical organizations, including the Endocrine Society in 2015 and the North American Menopause Society in 2017, have released updated recommendations. The overall message is that hormone therapy offers more benefits than risks for the relief of menopausal symptoms in mostly healthy women of a specific age range: those who are under age 60 or within 10 years of stopping menstruation.

“A generation of women has missed out on effective treatment because of misinformation,” says JoAnn Pinkerton, executive director of the North American Menopause Society and a gynecologist who specializes in menopause at the University of Virginia Health System in Charlottesville. It’s time to move beyond 2002, she says, and have a conversation based on “what we know now.”

End of an era
Menopause, the final menstrual period, signals the end of fertility and is confirmed after a woman has gone 12 months without having a period. From then on she is postmenopausal. Women reach menopause around age 51, on average. In the four to eight years before, called perimenopause, the amount of estrogen in the body declines as ovarian function winds down. Women may have symptoms related to the lack of estrogen beginning in perimenopause and continuing after the final period.

Probably the best-known symptom is the hot flash, a sudden blast of heat, sweating and flushing in the face and upper chest. These temperature tantrums can occur at all hours. At night, hot flashes can produce drenching sweats and disrupt sleep.

Hot flashes arise because the temperature range in which the body normally feels comfortable narrows during the menopause transition, partly in response to the drop in estrogen. Normally, the body takes small changes in core body temperature in stride. But for menopausal women, the slightest uptick in degree can be a trigger for the vessels to dilate, which increases blood flow and sweating.

About 75 to 80 percent of menopausal women experience hot flashes and night sweats, on and off, for anywhere from a couple of years to more than a decade. In a study in JAMA Internal Medicine in 2015, more than half of almost 1,500 women enrolled at ages 42 to 52 reported frequent hot flashes — occurring at least six days in the previous two weeks — with symptoms lasting more than seven years.

A sizable number of women have moderate or severe hot flashes, which spread throughout the body and can include profuse sweating, heart palpitations or anxiety. In a study of 255 menopausal women, moderate to severe hot flashes were most common, occurring in 46 percent of women, during the two years after participants’ last menstrual period. A third of all the women still experienced heightened hot flashes 10 years after menopause, researchers reported in 2014 in Menopause.

Besides hot flashes and night sweats, roughly 40 percent of menopausal women experience irritation and dryness of the vulva and vagina, which can make sexual intercourse painful. These symptoms tend to arise after the final period.

Alarm bells
In the 1980s and ’90s, researchers observed that women using hormone therapy for menopausal symptoms had a lower risk of heart disease, bone fractures and overall death. Some doctors began recommending the medication not just for symptom relief, but also for disease prevention.

Observational studies of the apparent health benefits of hormone therapy spurred a more stringent study, a randomized controlled trial, which tested the treatment’s impact by randomly assigning hormones to some volunteers and not others. The WHI hormone therapy trials assessed heart disease, breast cancer, stroke, blood clots, colorectal cancer, hip fractures and deaths from other causes in women who used the hormones versus those who took a placebo. Two commonly prescribed formulations were tested: a combined hormone therapy — estrogen sourced from horses plus synthetic progesterone — and estrogen alone. (Today, additional U.S. Food and Drug Administration–approved formulations are available.)
The 2002 WHI report in JAMA, which described early results of the combined hormone therapy, shocked the medical community. The study was halted prematurely because after about five years, women taking the hormones had a slightly higher risk of breast cancer and an overall poor risk-to-benefit ratio compared with women taking the placebo. While the women taking hormones had fewer hip fractures and colorectal cancers, they had more breast cancers, heart disease, blood clots and strokes. The findings were reported in terms of the relative risk, the ratio of how often a disease happened in one group versus another. News of a 26 percent increase in breast cancers and a 41 percent increase in strokes caused confusion and alarm.

Women dropped the hormones in droves. From 2001 to 2009, the use of all hormone therapy among menopausal women, as reported by physicians based on U.S. office visits, fell 52 percent, according to a 2011 study in Menopause.

But, researchers say, the message that hormone therapy was bad for all was unwarranted. “The goal of the WHI was to evaluate the balance of benefits and risks of menopausal hormone therapy when used for prevention of chronic disease,” says JoAnn Manson, a physician epidemiologist at Harvard-affiliated Brigham and Women’s Hospital in Boston and one of the lead investigators of the WHI. “It was not intended to evaluate its role in managing menopausal symptoms.”

Along with the focus on prevention, the WHI hormone therapy trials were largely studies of older women — in their 60s and 70s. Only around one-third of participants started the trial between ages 50 and 59, the age group more likely to be in need of symptom relief. Hormone therapy “was always primarily a product to use in women entering menopause,” says Howard Hodis, a physician scientist who focuses on preventive medicine at the University of Southern California’s Keck School of Medicine in Los Angeles. “The observational studies were based on these women.”

Also lost in the coverage of the 2002 study results was the absolute risk, the actual difference in the number of cases of disease between two groups. The group on combined hormone therapy had eight more cases of breast cancer per 10,000 women per year than the group taking a placebo. Hodis notes that that absolute risk translates to less than one extra case for every 1,000 women, which is classified as a rare risk by the Council for International Organizations of Medical Sciences, a World Health Organization group. There was also less than one additional case for every 1,000 women per year for heart disease and for stroke in the hormone-treated women compared with those on placebo.

In 2004, researchers published results of the WHI study of estrogen-only therapy, taken for about seven years by women who had had their uteruses surgically removed. (Progesterone is added to hormone therapy to protect the uterus lining from a risk of cancer seen with estrogen alone.) The trial, also stopped early, reported a decreased risk of hip fractures and breast cancer, but an increased risk of stroke. The study didn’t change the narrative that hormone therapy wasn’t safe.

Timing is everything
Since the turn away from hormone therapy, follow-up studies have brought nuance not initially captured by the first two reports. Researchers were finally able to tease out the results that applied to “the young women — and I love saying this — young women 50 to 59 who are most apt to present with symptoms of menopause,” says Cynthia Stuenkel, an internist and endocrinologist at the University of California, San Diego School of Medicine in La Jolla.

In 2013, Manson and colleagues reported data from the WHI grouped by age. It turned out that absolute risks were smaller for 50- to 59-year-olds than they were for older women, especially those 70 to 79 years old, for both combined therapy and estrogen alone. For example, in the combined hormone therapy trial, treated 50- to 59-year-olds had five additional cases of heart disease and five more strokes per 10,000 women annually compared with the same-aged group on placebo. But the treated 70- to 79-year-olds had 19 more heart disease cases and 13 more strokes per 10,000 women annually than women of the same age taking a placebo. “So a lot more of these events that were of concern were in the older women,” Stuenkel says.

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A Danish study reported in 2012 of about 1,000 recently postmenopausal women, ages 45 to 58, also supported the idea that timing of hormone treatment matters. The randomized controlled trial examined the use of different formulations of estrogen (17β-estradiol) and progesterone than the WHI. The researchers reported in BMJ that after 10 years, women taking hormone therapy — combined or estrogen alone — had a reduced risk of mortality, heart failure or heart attacks, and no added risk of cancer, stroke or blood clots compared with those not treated.

These findings provide evidence for the timing hypothesis, also supported by animal studies, as an explanation for the results seen in younger women, especially in terms of heart disease and stroke. In healthy blood vessels, more common in younger women, estrogen can slow the development of artery-clogging plaques. But in vessels that already have plaque buildup, more likely in older women, estrogen may cause the plaques to rupture and block an artery, Manson explains.

Recently, Manson and colleagues published a long-term study of the risk of death in women in the two WHI hormone therapy trials — combined therapy and estrogen alone — from the time of trial enrollment in the mid-1990s until the end of 2014. Use of either hormone therapy was not associated with an added risk of death during the study or follow-up periods due to any cause or, specifically, death from heart disease or cancer, the researchers reported in JAMA in September 2017. The study provides reassurance that taking hormone therapy, at least for five to seven years, “does not show any mortality concern,” Stuenkel says.

Both the Endocrine Society and the North American Menopause Society state that, for symptom relief, the benefits of FDA-approved hormone therapy outweigh the risks in women younger than 60 or within 10 years of their last period, absent health issues such as a high risk of breast cancer or heart disease. The menopause society position statement adds that there are also benefits for women at high risk of bone loss or fracture.

Today, the message about hormone therapy is “not everybody needs it, but if you’re a candidate, let’s talk about the pros and cons, and let’s do it in a science-based way,” Pinkerton says.

Hormone therapy is the most effective treatment for hot flashes, night sweats and genital symptoms, she says. A review of randomized controlled trials, published in 2004, reported that hormone therapy decreased the frequency of hot flashes by 75 percent and reduced their severity as well.

More than 50 million U.S. women will be older than 51 by 2020, Manson says. Yet today, many women have a hard time finding a physician who is comfortable prescribing hormone therapy or even just managing a patient’s menopausal symptoms, she says.

Stuenkel, who says many younger doctors stopped learning about hormone therapy after 2002, is trying to play catch up. When she teaches medical students and doctors about treating menopausal symptoms, she brings up three questions to ask patients. First, how bothersome are the symptoms? Some women say “fix it, get me through the day and the night, put me back in order,” Stuenkel says. Other women’s symptoms are not as disruptive. Second, what does the patient want? Third, what is safe for this particular woman, based on her health? If a woman’s health history doesn’t support the use of hormone therapy, or she just isn’t interested, there are nonhormonal options, such as certain antidepressants, and also nondrug lifestyle approaches.

Menopause looms large for many women, Povar says, and discussing a patient’s expectations as well as whether hormone therapy is the right approach becomes a unique discussion with each patient, she says. “This is one of the most individual decisions a woman makes.”

Young children travel to fantasy worlds every day, packing just imaginations and a toy or two.

Some preschoolers scurry across ocean floors carrying toy versions of cartoon character SpongeBob SquarePants. Other kids trek to distant universes with miniature replicas of Star Wars robots R2-D2 and C-3PO. Throngs of youngsters fly on broomsticks and cast magic spells with Harry Potter and his Hogwarts buddies. The list of improbable adventures goes on and on.

Parents today take for granted that kids need toys to fuel what comes naturally — outlandish bursts of make-believe. Kids’ flights of fantasy are presumed to soar before school and life’s other demands yank the youngsters down to Earth.
Yet some researchers call childhood fantasy play — which revolves around invented characters and settings with no or little relationship to kids’ daily lives — highly overrated. From at least the age when they start talking, little ones crave opportunities to assist parents at practical tasks and otherwise learn how to be productive members of their cultures, these investigators argue.

New findings support the view that children are geared more toward helping than fantasizing. Preschoolers would rather perform real activities, such as cutting vegetables or feeding a baby, than pretend to do those same things, scientists say. Even in the fantastical realm of children’s fiction books, reality may have an important place. Young U.S. readers show signs of learning better from human characters than from those ever-present talking pigs and bears.
Studies of children in traditional societies illustrate the dominance of reality-based play outside modern Western cultures. Kids raised in hunter-gatherer communities, farming villages and herding groups rarely play fantasy games. Children typically play with real tools, or small replicas of tools, in what amounts to practice for adult work. Playgroups supervised by older children enact make-believe versions of what adults do, such as sharing hunting spoils.
These activities come much closer to the nature of play in ancient human groups than do childhood fantasies fueled by mass-produced toys, videos and movies, researchers think.
Handing over household implements to toddlers and preschoolers and letting them play at working, or allowing them to lend a hand on daily tasks, generates little traction among Western parents, says psychologist Angeline Lillard of the University of Virginia in Charlottesville. Many adults, leaning heavily on adult-supervised playdates, assume preschoolers and younger kids need to be protected from themselves. Lillard suspects that preschoolers, whose early helping impulses get rebuffed by anxious parents, often rebel when told to start doing household chores a few years later.

“Kids like to do real things because they want a role in the real world,” Lillard says. “Our society has gone overboard in stressing the importance of pretense and fantasy for young children.”

Keep it real
Lillard suspects most preschoolers agree with her.

More than 40 years of research fails to support the widespread view that playing pretend games generates special social or mental benefits for young children, Lillard and colleagues wrote in a 2013 review in Psychological Bulletin. Studies that track children into their teens and beyond are sorely needed to establish any beneficial effects of pretending to be other people or acting out imaginary situations, the researchers concluded.

Even the assumption that kids naturally gravitate toward make-believe worlds may be unrealistic. When given a choice, 3- to 6-year-olds growing up in the United States — one of many countries saturated with superhero movies, video games and otherworldly action figures — preferred performing real activities over pretending to do them, Lillard and colleagues reported online June 20 in Developmental Science.
One hundred youngsters, most of them white and middle class, were tested either in a children’s museum, a preschool or a university laboratory. An experimenter showed each child nine pairs of photographs. Each photo in a pair featured a boy or a girl, to match the sex of the youngster being tested. One photo showed a child in action. Depicted behaviors included cutting vegetables with a knife, talking on a telephone and bottle-feeding a baby. In the second photo, a different child pretended to do what the first child did for real.

When asked by the experimenter whether they would rather, say, cut real vegetables with a knife like the first child or pretend to do so like the second child, preschoolers chose the real activity almost two-thirds of the time. Among the preschoolers, hard-core realists outnumbered fans of make-believe, the researchers found. Whereas 16 kids always chose real activities, only three wanted to pretend on every trial. Just as strikingly, 48 children (including seven of 26 of the 3-year-olds) chose at least seven real activities of the nine depicted. Only 14 kids (mostly the younger ones) selected at least seven pretend activities.

Kids often said they liked real activities for practical reasons, such as wanting to learn how to feed babies to help mom. Hands-on activities also got endorsed for being especially fun or novel. “I’ve never talked on the real phone,” one child explained. Reasons for choosing pretend activities centered on being afraid of the real activity or liking to pretend.

In a preliminary follow-up study directed by Lillard, 16 girls and boys, ages 3 to 6, chose between playing with 10 real objects, such as a microscope, or toy versions of the same objects. During 10-minute play periods, kids spent an average of about twice as much time with real items. That preference for real things increased with age. Three-year-olds spent nearly equal time playing with genuine and pretend items, but the older children strongly preferred the real deal.

Lillard’s findings illustrate that kids want and need real experiences, says psychologist Thalia Goldstein of George Mason University in Fairfax, Va. “Modern definitions of childhood have swung too far toward thinking that young children should live in a world of fantasy and magic,” she maintains.

But pretend play, including fantasy games, still has value in fostering youngsters’ social and emotional growth, Goldstein and Matthew Lerner of Stony Brook University in New York reported online September 15 in Developmental Science. After participating in 24 play sessions, 4- and 5-year-olds from poor families were tested on empathy and other social skills. Those who played dramatic pretend games (being a superhero, animal or chef, for instance) were less likely than kids who played with blocks or read stories to become visibly upset upon seeing an experimenter who the kids believed had hurt a knee or finger, the researchers found. Playing pretend games enabled kids to rein in distress at seeing the experimenter in pain, the researchers proposed.

It’s not known whether fantasy- and reality-based games shape kids’ social skills in different ways over the long haul, Goldstein says.

True fiction
Even on the printed page, where youngsters gawk at Maurice Sendak’s goggle-eyed Wild Things and Dr. Seuss’ mustachioed Lorax, the real world exerts a special pull.

Consider 4- to 6-year-olds who were read either a storybook about a little raccoon that learns to share with other animals or the same storybook with illustrations of human characters learning to share. Both versions told of how characters felt better after giving some of what they had to others. A third set of kids heard an illustrated storybook about seeds that had nothing to do with sharing. Each group consisted of 32 children.

Only kids who heard the realistic story displayed a general willingness to act on its message, reported a team led by psychologist Patricia Ganea of the University of Toronto in a paper published online August 2 in Developmental Science. On a test of children’s willingness to share any of 10 stickers with a child described as unable to participate in the experiment, listeners to the tale with human characters forked over an average of nearly three stickers, about one more than the kids had donated before the experiment.

Children who heard stories with animal characters became less giving, sharing an average of 1.7 stickers after having originally donated an average of 2.3 stickers. Sticker sharing declined similarly among kids who heard the seed story. These results fit with several previous studies showing that preschoolers more easily apply knowledge learned from realistic stories to the real world, as opposed to information encountered in fantasy stories.

Even for fiction stories that are highly unrealistic, youngsters generally favor realistic endings, say Boston University psychologist Melissa Kibbe and colleagues. In a study from the team published online June 15 in Psychology of Aesthetics, Creativity and the Arts, an experimenter read 90 children, ages 4 to 6, one of three illustrated versions of a story. In the tale, a child gets lost on the way to a school bus. A realistic version was set in a present-day city. A futuristic science fiction version was set on the moon. A fantasy version occurred in medieval times and included magical characters. Stories ended with descriptions and illustrations of a child finally locating either a typical school bus, a futuristic school bus with rockets on its sides or a magical coach with dragon wings.
When given the chance, 40 percent of kids inserted a typical school bus into the ending for the science fiction story and nearly 70 percent did so for the fantasy tale. “Children have a bias toward reality when completing stories,” Kibbe says.
Hands on
Outside Western cultures, children’s bias toward reality takes an extreme turn, especially during play.

Nothing keeps it real like a child merrily swinging around a sharp knife as adults go about their business. That’s cause for alarm in Western households. But in many foraging communities, children play with knives and even machetes with their parents’ blessing, says anthropologist David Lancy of Utah State University in Logan.

Lancy describes reported instances of youngsters from hunter-gatherer groups playing with knives in his 2017 book Raising Children. Among Maniq foragers inhabiting southern Thailand’s forests, for instance, one researcher observed a father looking on approvingly as his baby crawled along holding a knife about as long as a dollar bill. The same investigator observed a 4-year-old Maniq girl sitting by herself cutting pieces of vegetation with a machete.

In East Africa, a Hadza infant can grab a knife and suck on it undisturbed, at least until an adult needs to use the tool. On Vanatinai Island in the South Pacific, children freely experiment with knives and pieces of burning wood from campfires.

Yes, accidents happen. That doesn’t mean hunter-gatherer parents are uncaring or indifferent toward their children, Lancy says. In these egalitarian societies, where sharing food and other resources is the norm, parents believe it’s wrong to impose one’s will on anyone, including children. Hunter-gatherer adults assume that a child learns best through hands-on, sometimes risky, exploration on his or her own and in groups with other kids. In that way, the adults’ thinking goes, youngsters develop resourcefulness, creativity and determination. Self-inflicted cuts and burns represent learning opportunities.

In many societies, adults make miniature tools for children to play with or give kids cast-off tools to use as toys. For instance, Inuit boys have been observed mimicking seal hunts with items supplied by parents, such as pieces of sealskin and miniature harpoons. Girls in Ecuador’s Conambo tribe mold clay balls provided by their mothers into various shapes as a first step toward becoming potters.
Childhood games and toys in foraging groups and farming villages, as in Western nations, reflect cultural values. Hunter-gatherer kids rarely engage in rough-and-tumble or competitive games. In fact, competition is discouraged. These kids concoct games with no winners, such as throwing a weighted feather in the air and flicking the feather back up as it descends. Children in many farming villages and herding societies play basic forms of marbles, in which each player shoots a hard object at similar objects to knock the targets out of a defined area. The rules change constantly as players decide among themselves what counts and what doesn’t.

Children in traditional societies don’t invent fantasy characters to play with, Lancy says. Consider imaginative play among children of Aka foragers in the Central African Republic. These kids may pretend to be forest animals, but the animals are creatures from the children’s surroundings, such as antelope. The children aim to take the animals’ perspective to determine what route to follow while exploring, says anthropologist Adam Boyette of Duke University. Aka youngsters sometimes pretend to be spirits that adults have told the kids about. In this way, kids become familiar with community beliefs and rituals.
Aka childhood activities are geared toward adult work, Boyette says. Girls start foraging for food within the first few years of life. Boys take many years to master dangerous tasks, such as climbing trees to raid honey from bees’ nests (SN: 8/20/16, p. 10). By around age 7, boys start to play hunting games and graduate to real hunts as teenagers.

In 33 hunter-gatherer societies around the world, parents typically take 1- to 2-year-olds on foraging expeditions and give the youngsters toy versions of tools to manipulate, reported psychologist Sheina Lew-Levy of the University of Cambridge and her colleagues in the December Human Nature. Groups of children at a range of ages play make-believe versions of what adults do and get in some actual practice at tasks such as toolmaking. Youngsters generally become proficient food collectors and novice toolmakers between ages 8 and 12, the researchers conclude. Adults, but not necessarily parents, begin teaching hunting and complex toolmaking skills to teens. For the report, Lew-Levy’s group reviewed 58 papers on childhood learning among hunter-gatherers, most published since 2000.

“There’s a blurred line between work and play in foraging societies because children are constantly rehearsing for adult roles by playing,” Boyette says.

Children in Western societies can profitably mix fantasy with playful rehearsals for adult tasks, observes George Mason’s Goldstein, who was a professional stage actor before opting for steadier academic work. “My 5-year-old son is never happier than when he’s helping to check us out at the grocery store,” she says. “But he also likes to pretend to be a robot, and sometimes a robot who checks us out at the grocery store.”

Not too far in the future, preschoolers pretending to be robots may encounter real robots running grocery-store checkouts. Playtime will never be the same.

The best shot we have at minimizing the future impacts of climate change is to limit global warming to 1.5 degrees Celsius. Since the Industrial Revolution began, humankind has already raised the average global temperature by about 1.1 degrees. If we continue to emit greenhouse gases at the current rate, the world will probably surpass the 1.5-degree threshold by the end of the decade.

That sobering fact makes clear that climate change isn’t just a problem to solve someday soon; it’s an emergency to respond to now. And yet, most people don’t act like we’re in the midst of the greatest crisis humans have ever faced — not politicians, not the media, not your neighbor, not myself, if I’m honest. That’s what I realized after finishing The Climate Book by Greta Thunberg.

The urgency to act now, to kick the addiction to fossil fuels, practically jumps off the page to punch you in the gut. So while not a pleasant read — it’s quite stressful — it’s a book I can’t recommend enough. The book’s aim is not to convince skeptics that climate change is real. We’re well past that. Instead, it’s a wake-up call for anyone concerned about the future.

A collection of bite-size essays, The Climate Book provides an encyclopedic overview of all aspects of the climate crisis, including the basic science, the history of denialism and inaction, and what to do next. Thunberg, who became the face of climate activism after starting the Fridays For Future protests as a teenager (SN: 12/16/19), assembles an all-star roster of experts to write the essays.

The first two sections of the book lay out how a small amount of warming can have major, far-reaching effects. For some readers, this will be familiar territory. But as each essay builds on the next, it becomes clear just how delicate Earth’s climate system is. What also becomes clear is the significance of 1.5 degrees (SN: 12/17/18). Beyond this point, scientists fear, various aspects of the natural world might reach tipping points that usher in irreversible changes, even if greenhouse gas emissions are later brought under control. Ice sheets could melt, raise sea levels and drown coastal areas. The Amazon rainforest could become a dry grassland.

The cumulative effect would be a complete transformation of the climate. Our health and the livelihood of other species and entire ecosystems would be in danger, the book shows. Not surprisingly, essay after essay ends with the same message: We must cut greenhouse gas emissions, now and quickly.

Repetition is found elsewhere in the book. Numerous essays offer overlapping scientific explanations, stats about emissions, historical notes and thoughts about the future. Rather than being tedious, the repetition reinforces the message that we know what the climate change threat is, we know how to tackle it and we’ve known for a long time.
Thunberg’s anger and frustration over the decades of inaction, false starts and broken pledges are palpable in her own essays that run throughout the book. The world has known about human-caused climate change for decades, yet about half of all human-related carbon dioxide emissions ever released have occurred since 1990. That’s the year the Intergovernmental Panel on Climate Change released its first report and just two years before world leaders met in Rio de Janeiro in 1992 to sign the first international treaty to curb emissions (SN: 6/23/90).

Perversely, the people who will bear the brunt of the extreme storms, heat waves, rising seas and other impacts of climate change are those who are least culpable. The richest 10 percent of the world’s population accounts for half of all carbon dioxide emissions while the top 1 percent emits more than twice as much as the bottom half. But because of a lack of resources, poorer populations are the least equipped to deal with the fallout. “Humankind has not created this crisis,” Thunberg writes, “it was created by those in power.”

That injustice must be confronted and accounted for as the world addresses climate change, perhaps even through reparations, Olúfẹ́mi O. Táíwò, a philosopher at Georgetown University, argues in one essay.

So what is the path forward? Thunberg and many of her coauthors are generally skeptical that new tech alone will be our savior. Carbon capture and storage, or CCS, for example, has been heralded as one way to curb emissions. But less than a third of the roughly 150 planned CCS projects that were supposed to be operational by 2020 are up and running.

Progress has been impeded by expenses and technology fails, science writer Ketan Joshi explains. An alternative might be “rewilding,” restoring damaged mangrove forests, seagrass meadows and other ecosystems that naturally suck CO2 out of the air (SN: 9/14/22), suggest environmental activists George Monbiot and Rebecca Wrigley.

Fixing the climate problem will not only require transforming our energy and transportation systems, which often get the most attention, but also our economies (endless growth is not sustainable), political systems and connection to nature and with each other, the book’s authors argue.

The last fifth of the book lays out how we could meet this daunting challenge. What’s needed is a critical mass of individuals who are willing to make lifestyle changes and be heard. This could trigger a social movement strong enough to force politicians to listen and create systemic and structural change. In other words, it’s time to start acting like we’re in a crisis. Thunberg doesn’t end the book by offering hope. Instead, she argues we each have to make our own hope.

“To me, hope is not something that is given to you, it is something you have to earn, to create,” she writes. “It cannot be gained passively, through standing by and waiting for someone else to do something. Hope is taking action.”

Modern birds evolved from dinosaurs, but it’s not clear how well birds’ ancient dino ancestors could fly (SN: 10/28/16). Now, a look at the fossilized feet of one nonavian dinosaur suggests that it may have hunted on the wing, like some hawks today.

The crow-sized Microraptor had toe pads very similar to those of modern raptors that can hunt in the air, researchers report December 20 in Nature Communications. That means the feathered, four-winged dinosaur probably used its feet to catch flying prey too, paleobiologist Michael Pittman of the Chinese University of Hong Kong and colleagues say (SN: 7/16/20).
Other researchers caution that toe pads alone aren’t enough to declare Microraptor an aerial hunter. But if the claim holds up, such a hunting style would reinforce a debated hypothesis that powered flight evolved multiple times among dinosaurs, a feat once attributed solely to birds.

Toe pads are bundles of scale-covered flesh on the undersides of dinosaur feet, similar to “toe beans” on dogs and cats. Because the pads are points where the living animal interacted with surfaces, toe pads give paleontologists a “sense of where the rubber meets the road,” says Alexander Dececchi, a paleontologist at Mount Marty University in Yankton, S.D., who was not involved in the new study.

These contact points can paint a clearer picture of an animal’s behavior by providing “details that the skeleton itself wouldn’t show,” says Thomas Holtz Jr., a dinosaur paleobiologist at the University of Maryland in College Park, who was also not involved in the study.

To investigate dinosaur toe pads, Pittman and colleagues turned to the Shandong Tianyu Museum of Nature in Linyi, China. It “has arguably the largest collection of feathered dinosaurs in the world, and, importantly, they haven’t been prepared extensively,” Pittman says. Many of these dinosaur skeletons are still surrounded by rock, which is where soft tissues can be preserved. Such a specimen “gives us the best chance of finding this wonderful soft tissue information,” he says.
Using special lasers that cause the otherwise nearly invisible soft tissue in the fossils to fluoresce, the team found 12 specimens with exceptionally well-preserved toe pads among the thousands examined (SN: 3/20/17).

The team compared the fossil toe pads with those of 36 types of modern birds, whose toe pads vary with their lifestyle. Predatory birds, for example, have protruding toe pads with spiky scales for grasping prey, while ground birds that spend their time walking and running have flatter toe pads. The analysis showed that Microraptor’s toe pads and other aspects of the feet, like the shape of the toe joints and claws, are most like those of modern hawks. That similarity suggests that the dinosaur could hunt prey midair and on the ground like hawks do, the team says.

Other dinosaurs, like the feathered Anchiornis, had flatter toe pads and straighter claws, suggesting a terrestrial lifestyle. That’s in line with ideas about this dinosaur being a poor flier, Pittman says.
The idea that Microraptor hunted like a hawk is consistent with other fossil evidence. One Microraptor fossil has been found with a bird in its stomach, and Microraptor‘s skeletal and soft tissue anatomy suggest some powered flight capability.

There’s still more work to do to figure out how well the dinosaur may have flown. “Microraptor is not a bird, but a close relative. Just because it has feet like a predatory bird doesn’t necessarily mean it must be catching prey in the exact same way,” Pittman says. But Microraptor’s hawklike lifestyle “is a strong possibility,” he adds.
Flight could have been useful to Microraptor when hunting, even if it couldn’t stack up to today’s fliers. Dececchi speculates that Microraptor’s anatomy probably prevented it from outflying birds, but may have helped it surprise otherwise out-of-reach prey, including flying and gliding animals.

“You only have to be fast or aerobatic enough to catch other things in your environment,” Holtz says. “So, it’s not improbable that [Microraptor was] catching things in the air on occasion.”

Other paleontologists are more skeptical that Microraptor hunted on the wing. “It would be a bit of a stretch to me to suggest that Microraptor was pursuing prey in an aerial context,” says Albert Chen, a paleobiologist at the University of Cambridge. The new findings inform only “what the foot was used for.”

Alternative hypotheses, such as a completely or partially terrestrial hunting style, could fit the data too, Holtz says, but the “feet are definitely playing a major role in their prey capture,” whether on the ground or in the air.

For now, the picture of Microraptor’s ecology remains fuzzy, but as lasers continue to increase the picture’s resolution, our understanding of dinosaur flight may reach new heights.