We primary care clinicians, scholars, and leaders ascribe value to Barbara Starfield’s core tenets of primary care—the 4 Cs: first contact, comprehensiveness, coordination, and continuity. In today’s era of rapid technological advancements and dwindling resources, what are the implications for face-to-face interactions of patient-clinician relationships? We propose adding a 5th C: "Contiguity." Contiguity—or physical proximity and presence—is a key dimension that not only enables the necessary technical aspects of a physical exam but also authenticates the most human aspects of a relationship and occurs specifically when we are physically vulnerable and responsible for the other before us. This, in turn, may best enable us to bridge difference and nurture trust with our patients. We measure what we value and, thus, naming Contiguity as a core tenet assures that we will not lose sight of this keystone in a patient’s relationship with their personal physician.

The usual challenges of conducting primary care research, including randomized trials, have been exacerbated, and new ones identified, during the COVID-19 pandemic. HOMER (Home versus Office for Medication Enhanced Recovery; subsequently, Comparing Home, Office, and Telehealth Induction for Medication Enhanced Recovery) is a pragmatic, comparative-effectiveness research trial that aims to answer a key question from patients and clinicians: What is the best setting in which to start treatment with buprenorphine for opioid use disorder for this patient at this time? In this article, we describe the difficult journey to find the answer. The HOMER study began as a randomized trial comparing treatment outcomes in patients starting treatment with buprenorphine via induction at home (unobserved) vs in the office (observed, synchronous). The study aimed to enroll 1,000 participants from 100 diverse primary care practices associated with the State Networks of Colorado Ambulatory Practices and Partners and the American Academy of Family Physicians National Research Network. The research team faced unexpected challenges related to the COVID-19 pandemic and dramatic changes in the opioid epidemic. These challenges required changes to the study design, protocol, recruitment intensity, and funding conversations, as well as patience. As this is a participatory research study, we sought, documented, and responded to practice and patient requests for adaptations. Changes included adding a third study arm using telehealth induction (observed via telephone or video, synchronous) and switching to a comprehensive cohort design to answer meaningful patient-centered research questions. Using a narrative approach based on the Greek myth of Homer, we describe here the challenges and adaptations that have provided the opportunity for HOMER to thrive and find the way home. These clinical trial strategies may apply to other studies faced with similar cultural and extreme circumstances.

PURPOSE

HIV pre-exposure prophylaxis (PrEP) may increase rates of bacterial sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (GBM) through risk compensation (eg, an increase in condomless sex or number of partners); however, longitudinal studies exploring the time-dependent nature of PrEP uptake and bacterial STIs are limited. We used marginal structural models to estimate the effect of PrEP uptake on STI incidence.

PURPOSE

Chest pain frequently poses a diagnostic challenge for general practitioners (GPs). Utilizing risk stratification tools might help GPs to rule out acute coronary syndrome (ACS) and make appropriate referral decisions. We conducted a systematic review of studies evaluating risk stratification tools for chest pain in primary care settings, both with and without troponin assays. Our aims were to assess the performance of tools for ruling out ACS and to provide a comprehensive review of the current evidence.

Patient expectations of receiving antibiotics for common symptoms can trigger unnecessary use. We conducted a survey (n = 564) between January 2020 to June 2021 in public and private primary care clinics in Texas to study the prevalence and predictors of patients’ antibiotic expectations for common symptoms/illnesses. We surveyed Black patients (33%) and Hispanic/Latine patients (47%), and over 93% expected to receive an antibiotic for at least 1 of the 5 pre-defined symptoms/illnesses. Public clinic patients were nearly twice as likely to expect antibiotics for sore throat, diarrhea, and cold/flu than private clinic patients. Lack of knowledge of potential risks of antibiotic use was associated with increased antibiotic expectations for diarrhea (odds ratio [OR] = 1.6; 95% CI, 1.1-2.4) and cold/flu symptoms (OR = 2.9; 95% CI, 2.0-4.4). Lower education and inadequate health literacy were predictors of antibiotic expectations for diarrhea. Future antibiotic stewardship interventions should tailor patient education materials to include information on antibiotic risks and guidance on appropriate antibiotic indications.

The aim of this work is to test whether the use of a transparent capsule affects the residual capsule weight after inhalation as a surrogate of the inhaled delivered dose for patients with non-reversible chronic airway disease. Researchers conducted an observational cross-sectional study with patients using a single-dose dry powder inhaler. The weight of the capsule was measured with a precision microbalance before and after inhalation. Ninety-one patients were included, of whom 63 (69.2%) used a transparent capsule. Inhalation with a transparent capsule achieved a weight decrease of 30.1% vs 8.6% for devices with an opaque capsule (P <0.001). These data reinforce the need to provide patients with mechanisms that verify the correct inhalation technique.

PURPOSE

The impact of digital health on medically underserved patients is unclear. This study aimed to determine the early impact of a digital innovation to grow quality care through an interprofessional care team (DIG IT) on the blood pressure (BP) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of medically underserved patients.

PURPOSE

Meeting scholarly activity requirements continues to be a challenge in many family medicine (FM) residency programs. Studies comprehensively describing FM resident scholarship have been limited. We sought to identify institutional factors associated with increased scholarly output and meeting requirements of the Accreditation Council for Graduate Medical Education (ACGME).

PURPOSE

We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care.

PURPOSE

Despite being key to better health outcomes for patients from racial and ethnic minority groups, the proportion of underrepresented in medicine (URiM) physicians remains low in the US health care system. This study linked a nationally representative sample of family physicians (FPs) with Medicaid claims data to explore the relative contributions to care of Medicaid populations by FP race and ethnicity.

PURPOSE

Currently, 40% of counties in the United States do not have an obstetrician or midwife, and in rural areas the likelihood of childbirth being attended to by a family medicine (FM) physician is increasing. We sought to characterize the effect of the FM presence on unit culture and a key perinatal quality metric in Iowa hospital intrapartum units.

BACKGROUND

For many patients with post–COVID-19 condition (long COVID), primary care is the first point of interaction with the health care system. In principle, primary care is well situated to manage long COVID. Beyond expressions of disempowerment, however, the patient’s perspective regarding the quality of long COVID care is lacking. Therefore, this study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long COVID.

The strength of reproductive isolation (RI) between two or more lineages during the process of speciation can vary by the ecological conditions. However, most speciation research has been limited to studying how ecologically dependent RI varies among a handful of broadly categorized environments. Very few studies consider the variability of RI and its effects on speciation at finer scales—that is, within each environment due to spatial or temporal environmental heterogeneity. Such variation in RI across time and/or space may inhibit speciation through leaky reproductive barriers or promote speciation by facilitating reinforcement. To investigate this overlooked aspect of speciation research, we conducted a literature review of existing studies of variation in RI in the field and then conducted individual-based simulations to examine how variation in hybrid fitness across time and space affects the degree of gene flow. Our simulations indicate that the presence of variation in hybrid fitness across space and time often leads to an increase in gene flow compared to scenarios where hybrid fitness remains static. This observation can be attributed to the convex relationship between the degree of gene flow and the strength of selection on hybrids. Our simulations also show that the effect of variation in RI on facilitating gene flow is most pronounced when RI, on average, is relatively low. This finding suggests that it could serve as an important mechanism to explain why the completion of speciation is often challenging. While direct empirical evidence documenting variation in extrinsic RI is limited, we contend that it is a prevalent yet underexplored phenomenon. We support this argument by proposing common scenarios in which RI is likely to exhibit variability and thus influence the process of speciation.

Vision is initiated by capturing photons in highly specialized sensory cilia known as the photoreceptor outer segment. Because of its lipid and protein composition, the outer segments are prone to photo-oxidation, requiring photoreceptors to have robust antioxidant defenses and high metabolic synthesis rates to regenerate the outer segments every 10 days. Both processes required high levels of glucose uptake and utilization. Retinitis pigmentosa is a prevalent form of inherited retinal degeneration characterized by initial loss of low-light vision caused by the death of rod photoreceptors. In this disease, rods die as a direct effect of an inherited mutation. Following the loss of rods, cones eventually degenerate, resulting in complete blindness. The progression of vision loss in retinitis pigmentosa suggested that rod photoreceptors were necessary to maintain healthy cones. We identified a protein secreted by rods that functions to promote cone survival, and we named it rod-derived cone viability factor (RdCVF). RdCVF is encoded by an alternative splice product of the nucleoredoxin-like 1 (NXNL1) gene, and RdCVF was found to accelerate the uptake of glucose by cones. Without RdCVF, cones eventually die because of compromised glucose uptake and utilization. The NXNL1 gene also encodes for the thioredoxin RdCVFL, which reduces cysteines in photoreceptor proteins that are oxidized, providing a defense against radical oxygen species. We will review here the main steps of discovering this novel intercellular signaling currently under translation as a broad-spectrum treatment for retinitis pigmentosa.

Missing or inaccessible lung function measurements, gathered over time, have the potential to stagnate or impair clinical care decisions being made. This jeopardises patient safety and often contributes to excessive resource utilisation. Data integration is fundamental to clinical decision-making and entails amalgamating lung function data from multiple sources in a user-friendly format. Despite this, current systems for recording lung function data are suboptimal, with copious gaps in the clinical picture arising from missing or inaccessible lung function measurements. This article discusses the importance of data integration for lung function, with a call to action for key stakeholders involved in the performance, management and interpretation of such tests.

Advancements in immunotherapy in the perioperative setting have revolutionised the treatment of resectable nonsmall cell lung cancer (NSCLC). Here we present the methodology and results of the clinical trial CheckMate 816 demonstrating the benefit of neoadjuvant therapy with nivolumab plus chemotherapy compared with chemotherapy alone. Furthermore, this article discusses the implications for future practice in resectable NSCLC and the need for future research.

Lung cancer is one of the leading causes of death worldwide. It can broadly be divided into small cell lung cancer (SCLC) and nonsmall cell lung cancer. There have been many advances over the recent years in both fields. The purpose of this review is to provide a concise summary of SCLC for the general respiratory readership.

New research shows that levels of overall and heavy drinking among Americans are still higher than they were in 2018.

Pitched as a mix of ‘Blade Runner’ and ‘Jurassic Park,’ Neom is the world’s biggest construction project. Twenty-one thousand people have died so far to make it happen.

The head of one of the world's largest oil companies has had it with government flip-flopping.

HBO's Casey Bloys was asked about the Game of Thrones author's spicy take on House of the Dragon season two.

This is not a joke, the subscription to ExpressVPN is at an unprecedented price. We'll tell you everything you need to know so you don't miss out on its Black Friday offer.

Five years on from its incredible debut, The Mandalorian has come to embody a lot of the issues facing Star Wars in its uncertain current moment.

There has been fallout. Speaker Nathan Cooper is said to have decreed guests will never again be seated inside the legislative chamber.

The post Edmonton activist protests climate crisis with demonstration in AB legislature appeared first on rabble.ca.

With 420,000 Quebec public sector workers on strike on Monday, and with little progress in negotiations, the Front Commun promises further strike action.

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In August, fellow reporter Jason Patinkin and I crossed on foot from northern Uganda into rebel-held South Sudan. Over the course of four days, we walked more than 40 miles through the bush, escorted by rebel soldiers, to shed light on one of the world’s most underreported conflicts.

Reporting on South Sudan’s war, which began in 2013, has always been a challenge due to the risk and logistical hurdles associated with accessing remote areas where fighting takes place. But over the past year, covering the war and its humanitarian fallout has become particularly difficult. Since the beginning of this year, South Sudan’s government has banned at least 20 foreign journalists in an apparent effort to silence reporters who had a track record of critically reporting on the government.

This systematic crackdown on the foreign press (South Sudanese journalists have long risked imprisonment and death for doing their work) coincided with two important developments. In November 2016, the United Nations warned that the violence being committed against civilians in the southern region of Equatoria risked spiraling into genocide. Then, in February, the UN declared a man-made famine, warning that 100,000 people were at risk of starving to death as a result of civil war.

Journalists seeking to cover these events were left with two equally unsavory options: self-censorship or a risky trip to rebel-held parts of the country. Only a handful of journalists have attempted the latter since fighting escalated in July last year. For us, this was our second embed with the rebels this year.

We set off from a town in northern Uganda at five in the morning, bouncing along a bumpy dirt track towards the South Sudan border. Crammed into our four-wheel drive were rebel commander Martin Abucha, a dual American and South Sudanese citizen who we planned to profile for our PBS NewsHour Weekend segment, a couple of guides, and several duffle bags stuffed with our tents, sleeping bags, emergency medical kits and provisions to last us four days.

Just as the sun began to rise above a distant range of hills that we aimed to cross later that day, our car came to a halt in front of a stream. Because of the rainy reason, it carried more water than usual. It was time to disembark and start walking, or “footing,” as South Sudanese tend to call it.

We took off our shoes and waded through the stream’s chilly waters. This was the first of a many rivers we’d have to cross along the way, either on foot or in small flimsy canoes dug out from tree trunks. Each time, we dreaded the idea of falling in with our camera gear.

The first part of our journey in northern Uganda felt very much like a hike through a national park. Passing beautiful landscapes and idyllic farming villages, one could almost forget we were headed into a war zone — but we were about to get a reality check.

We had just crossed into South Sudan when out of nowhere, two dozen armed men popped out of the tall grass and surrounded us at gunpoint.

“Stop! Who are you and where are you going?” a soldier called out in Juba Arabic from his hideout no more than 20 yards away, pointing his AK47 at us. Another one next to him had a rocket-propelled grenade propped on his shoulder, also unequivocally aiming it in our direction.

Instinctively, we threw our hands in the air and exchanged a baffled glance. Had we accidentally bumped into government soldiers? Or perhaps we had come onto the “wrong” rebels? Abucha’s group, called the Sudan People’s Liberation Army In Opposition, is the biggest but not the only armed group in Equatoria, an area rife with rival militia and bandits who exploit the security vacuum left by war.

To our relief, and only after Abucha answered a series of questions, this routine security check quickly gave way to a warm welcome. The platoon would be our escort for the next four days as we trekked to their base and to Loa, Abucha’s hometown.

Keeping up with the rebels was no easy task. Given the country’s pervasive lack of basic infrastructure, South Sudanese grow up walking for dozens of miles just to go about their daily lives. For sedentary Westerners, keeping the target pace of “two meters per second” (around five miles an hour) proved challenging amid 90-degree temperatures, all while filming and plowing our way through dense, itchy elephant grass.

The upside of the cumbersome terrain was that it kept us safe. During our four-day trip, we didn’t cross a single road, instead walking along a dizzying network of narrow bush paths the rebels seemed to know like the backs of their hands. An unwanted encounter with government troops, who tended to stick to roads and move around in vehicles as opposed to on foot, was highly unlikely.

The closest we got to government-controlled area was a visit to Loa, located just two kilometers away from a main road frequently patrolled by government soldiers. We couldn’t stay long, but the hour we spent on the ground offered us a glimpse into what villages must look like in many parts of Equatoria: burned mud huts, looted schools and clinics, fallow fields and – most strikingly – no civilians.

The war has had a devastating impact on South Sudanese communities like the one in Loa, but much of it has remained out of the limelight of international media. Our four-day venture into rebel-held South Sudan offered us a rare opportunity to report ground truths, and we are thankful for that.

The post Column: Why reporting from South Sudan is so difficult — and critically needed appeared first on PBS NewsHour.

At least 231 people were killed and hundreds more wounded after a massive truck bomb on Saturday struck Somalia’s capital city of Mogadishu.

The Somali government has blamed the al-Qaida-linked militant group al-Shabab for the attack, and called it the deadliest ever to hit the nation.

The blast took place outside the Safari Hotel, where rescue workers dug through the rubble of collapsed buildings overnight in search of survivors. Witnesses described a devastating scene with large-scale carnage, as doctors worked feverishly to attend to the dead and injured, many badly burned.

“The hospital is overwhelmed by both dead and wounded,” Dr. Mohamed Yusuf, the director of Medina hospital located near the blast, told the Associated Press. “We also received people whose limbs were cut away by the bomb. This is really horrendous, unlike any other time in the past.”

Photos and videos of the bombing, which took place on a busy street near a section of the city housing foreign embassies, showed collapsed walls, twisted metal, and sporadic fires spewing smoke. The Qatari government said its embassy was “severely damaged” in the strike.

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Family members searched through the wreckage and waited at local hospitals with the hopes of finding relatives who survived the bombing.

Somali President Mohamed Abdullahi Mohamed announced three days of mourning. The attacks received international condemnation, including from the United States.

The post Hundreds dead after massive truck bomb strikes Mogadishu appeared first on PBS NewsHour.

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The United Nations says South Sudan’s four-year-old civil war has left half of the nation’s population — 6 million people — in need of humanitarian aid. The conflict began when South Sudan’s army split between factions loyal to President Salva Kiir and former Vice President Riek Machar. The two men mobilized their respective tribes, the Dinka and the Nuer. The war has caused what is now one of the world’s worst refugee crises.

SIMONA FOLTYN: Civil war is emptying huge swaths of South Sudan. The violence has uprooted four million people, including two million who’ve fled to neighboring countries. In the last year, more than a million South Sudanese have poured into northern Uganda alone, crossing makeshift bridges like this one to flee fighting, hunger, and brutal attacks on civilians.

SEME LUPAI, REFUGEE: They started fighting very, very severely. So that made us to escape with our properties to this side.

SIMONA FOLTYN: When Seme Lupai’s family went to one of the refugee camps, initially, he stayed behind to look after the family’s most precious commodity — their cattle. He hid for a year to escape the violence. The refugees carry whatever they can salvage — mattresses, pots, clothes, notebooks — remnants of once peaceful lives turned upside down. At checkpoints, Ugandan soldiers search their belongings for weapons, before the refugees proceed to reception centers. After entering Uganda, the refugees sign in at small waystations. For many, it’s the first night spent in safety after walking for days to escape fighting. Levi Arike fled with his wife and four children.

LEVI ARIKE, REFUGEE: When the gunshots started, we laid under a tree with the whole family, because there was nowhere else to hide. We waited for the fighting to stop, and then we got up and started walking to Uganda.

SIMONA FOLTYN: Uganda now shoulders most of the burden of Africa’s biggest refugee crisis, managing a constellation of camps which require food, water, healthcare, and policing. At Imvepi Camp, now home to more than 120,000 South Sudanese, new arrivals receive vaccinations, hot meals, and basic items such as soap and plastic tarps to build a house. The government also gives each refugee family a small plot of land, about a twentieth of an acre, where they can build a tent shelter and grow crops to eat or sell. But the land often proves too rocky for farming.

SIMONA FOLTYN, IMVEPI REFUGEE CAMP, NORTHERN UGANDA: After completing the registration process, the new arrivals will receive their plot, to start a new life as refugees in Uganda. While they are safe here, there are many challenges ahead, not least processing the trauma of what they experienced back home.

This woman, who we’ll call “Agnes,” agreed to tell us about her harrowing experience. She says four government soldiers from President Salva Kiir’s Dinka tribe stopped her as she was fleeing South Sudan and raped her right in front of her family.

AGNES (translated to English): When they started raping me, they told me not to raise alarm, otherwise they would shoot me. Still when I’m sleeping, I’m dreaming of the Dinka, that they are coming to rape me again.

SIMONA FOLTYN: How often do you have those dreams?

AGNES: Daily, every time I lie down, those dreams come.

SIMONA FOLTYN: A recent Human Rights Watch report on South Sudan found “…a clear pattern of government forces unlawfully targeting civilians for killings, rapes, torture…and destruction of property..” The victims are from ethnic groups suspected to support the rebels.

AGNES: They are doing it, because they know very well that those soldiers are our brothers. So they do it to punish them..

SIMONA FOLTYN: Although the rebels, known as the Sudan People’s Liberation Army In Opposition, purport to protect local communities, there are also reports of their fighters assaulting civilians near the Ugandan border. Josephine Yanya told us she didn’t feel safe in the presence of either side’s soldiers. Her family and neighbors fled their village after government soldiers killed her uncle.

They hid in the mountains only to find themselves under attack again, this time by opposition fighters from the Nuer tribe loyal to former vice president Riek Machar. Yanya says ethnic Nuer soldiers from the SPLA-IO rebel group raped a member of her group and stole her father’s’ cattle.

JOSEPHINE YANYA (translated to English): Before we were thinking that the rebels would protect us, but if they are lacking food, they just come and take things by force.

SIMONA FOLTYN: With nowhere left to hide, Yanya fled to Uganda with her son.
But instead of finding a place to rebuild their lives, they are in limbo. And aid groups don’t have enough food to distribute.

JOSEPHINE YANYA (translated to English):We are getting small food rations. I know it won’t be enough even for one month.

SIMONA FOLTYN: According to the United Nations, the international community has given less than a-third of the $1.4 billion dollars needed for the refugee response in South Sudan’s neighboring countries. These refugees foresee more hardship and have no idea when they might return home.

JOSEPHINE YANYA (translated to English): I’m always praying for peace in South Sudan, and until then, I’ll just stay here.

The post South Sudan civil war causes Africa’s worst refugee crisis appeared first on PBS NewsHour.

Watch President Donald Trump and the Greek prime minister’s joint news conference in the player above.

WASHINGTON — President Donald Trump says the U.S. stands with Greece as they recover from their economic crisis. He is speaking with Prime Minister Alexis Tsipras at the White House in a joint news conference.

The U.S. president says the two leaders have discussed defense, energy, commerce and trade.

Trump is praising Greece for its defense spending under NATO and is noting a potential sale to Greece to upgrade its F-16 aircraft, which he says would be worth up to $2.4 billion and generate thousands of U.S. jobs.

Tsipras says his country has made economic strides and is “leaving behind the economic model that led to the crisis.” He says Greece’s relationship with the U.S. is “more important than ever.”

The post WATCH: Trump and Greek prime minister hold joint news conference appeared first on PBS NewsHour.

U.S.-backed Syrian Democratic Forces announced Tuesday that they had captured the city of Raqqa from Islamic State militants.

“Everything is finished in Raqqa, our forces have taken full control of Raqqa,” SDF spokesman Talal Sello told AFP. A formal declaration would be announced after operations to clear any remaining sleeper cells and to remove landmines in the city were completed, Sello added.

The move is a major setback for the Islamic State which considered Raqqa the de-facto capital of its self-declared caliphate. It comes on the third anniversary of the global effort to defeat ISIS.

Raqqa was the first provincial capital to fall from government control in March 2013 after it was captured by a rebel army. The army included both Syrian opposition groups and more hard line  parties including al-Nusra and the Islamic State.

A civilian government  that was established in the city divided two months later, and less than a year later ISIS recaptured Raqqa and named the the capital of their caliphate.

About 900 civilians have been killed since the the start of the five-month operation, including 570 people in coalition air raids, according to the Syrian Network for Human Rights. The Britain-based Syrian Observatory for Human Rights put the civilian death toll at 1,130 people. American journalist James Foley was beheaded in the mountains south of the city.

SDF fighters pulled down the Islamic State’s black flag from the city’s National Hospital near the city’s stadium, according to a Reuters report.

Special presidential envoy for the Global Coalition to Defeat ISIS Brett McGurk said in August that the U.S. would attempt to perform a “stabilization” in Raqqa — including demining, removing rubble from major pathways to allow trucks and equipment through, and “basic electricity, sewage, water, the basic essentials to allow populations to come back to their home.”

It is not clear when the 300,000 civilians who have fled Raqqa since April during the operation will be able to return.

The post U.S.-backed Syrian forces recapture Raqqa from Islamic State group appeared first on PBS NewsHour.

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JUDY WOODRUFF: But first: Sunday’s elections Austria were the latest ample of a shift to the right Europe’s politics, as 31-year-old Christian Kurz was elected chancellor on an anti-immigration platform.

He may now form a government with a far-right party founded in the 1950s by former Nazis.

That follows recent elections in Germany, where a far-right party roiled the race and dealt a blow to returning leader Angela Merkel.

In Sweden, too, there is a strong challenge from the right and a neo-Nazi group that looks stand in elections next year.

Special correspondent Malcolm Brabant ha been surveying the political landscape in Germany and Sweden, and he begins his report in Scandinavia.

MALCOLM BRABANT, Special Correspondent: In a Gothenburg parking lot, supporters of the Nordic Resistance Movement form up for what they hope will be their biggest-ever march, to propagate an ideology espoused by mother of eight Paulina Forslund.

PAULINA FORSLUND, Nordic Resistance Movement: When white becomes the minority, they will be destroyed. I want my children to have a secure future. I want them not only for them to have a secure Sweden. I want them to have a secure world. And I want other people to fight for the same thing.

MALCOLM BRABANT: When addressing her fellow neo-Nazis, Forslund’s rhetoric sharpens.

PAULINA FORSLUND (through interpreter): I’m the welder’s daughter, the forester’s grandchild. My line consists of hardworking men and women. It’s people like them we can thank for the welfare system that our lying politicians are now giving away to imported scum.

MALCOLM BRABANT: Clearly expecting trouble, the movement’s leaders have a muscular protection detail, marching past a silent protest. The sign reads “No Nazis on our streets.”

This protester would only give her name as Johanna.

JOHANNA, Anti-Nazi Protester: They are racist people. They are people who think that certain people are better than others, and I will not stand for that. It’s not something I think has a place in a modern society.

MALCOLM BRABANT: Experts say the resistance movement is recruiting aggressively, and believe this demonstration is emblematic of the rise of the far right.

It took place on Yom Kippur, the Jewish day of atonement.

Allan Stutzinky is leader of Gothenburg’s Jewish community.

ALLAN STUTZINKY, Jewish Community Leader (through interpreter): Nazism has returned. The descendants of the murderers are organizing the same marches today, waving the same flags, shouting the same slogans, and have the same racist agenda.

MALCOLM BRABANT: Anna Johansson is a member of the governing Social Democrat Party. It’s considering outlawing the Nordic Resistance Movement.

ANNA JOHANSSON, Swedish Social Democratic Party: In Sweden and in Denmark, and in other countries, extreme parties are growing, and the hatred is spreading around.

MALCOLM BRABANT: “Go home to mama,” he shouts. “Nazi pigs,” chant the anti- fascist protesters, as a bottle flies through the air.

DAMON, Nordic Resistance Movement: If someone calls themselves a Nazi, most of us would dissociate with that person. That’s nothing we stand for ourselves. I never call myself a Nazi. I’m a national socialist.

MALCOLM BRABANT: Hitler’s party was also called National Socialist, but Damon, a 40-year-old welder, insists he’s a nonviolent family man.

DAMON: The demographic landscape of our — of the whole of Europe is changing, so, basically, it’s a concern on preserving my heritage for my family and our kin.

MALCOLM BRABANT: This demonstration has been stopped short of its destination. The Nordic Resistance Movement is currently trapped between a line of police and anti-fascist protesters. And it looks as though this demonstration isn’t going any further.

Violence briefly erupts as the resistance movement tries to break through police lines, and several marchers are arrested.

PAULINA FORSLUND: We are not your enemy. We are the government’s enemy.

They say we live in a democracy, but we have never had an election about if we want to take all these people in.

MALCOLM BRABANT: When Europe’s refugee crisis began in 2015, Sweden copied Germany’s open-door policy, and 160,000 migrants entered the country. Two years on, Sweden has tighter borders and has begun deporting some of the newcomers.

The new atmosphere alarms Floid Gumbo, entertaining an anti-Nazi rally.

FLOID GUMBO, Singer Originally from Zimbabwe: I came to Sweden over 20 years ago. The climate in Sweden, the people were so friendly, and things were completely different, more welcoming. And I feel like things have sort of gradually changed.

I’m very concerned, because I have children, because I’m thinking what I experienced here is not the same kind of climate, atmosphere that they are going to experience here.

ANNA JOHANSSON: It’s not so long ago that the Nazis ruined Europe. And that makes me very worried. The German elections were terrifying, I think.

MALCOLM BRABANT: Johansson is referring to last month’s success of the right-wing Alternative For Germany Party, or AFD, when it entered Parliament for the first time with 13 percent of the vote.

HUGH BRONSON, Alternative For Germany Party: The AFD only came into existence because Merkel deserted the traditional conservative Christian voters. They were looking for a home, and the AFD has offered them a safe place.

MALCOLM BRABANT: Hugh Bronson is deputy leader of the AFD in Berlin.

Now his party, the third largest in Parliament, is demanding that Angela Merkel imposes tougher immigration rules.

Your opponents claim that you are a party of hate. What’s your response to that?

HUGH BRONSON: We embrace foreigners who respect our laws, pay their taxes, send their children to school, and go about their normal life. The problem is with people who abuse the system to have a better life, or let others pay for their better lives, or who are criminals.

MALCOLM BRABANT: Outside the opera house in Dresden, former East Germany, singer Luca Bergelt is dismayed by the political landscape shifting to the right.

LUCA BERGELT, Singer: My fear is that they will tear Europe apart. They are going to raise up the walls again. They’re going to build new walls between the countries, and that Europe will get more close into itself.

MALCOLM BRABANT: Anti-immigrant sentiment is strong in Dresden. The city was the birthplace of a pan-European anti-Islamic movement, and it delivered the largest number of votes for the right-wing party.

On a holiday to celebrate German unification after the fall of communism, retired engineer Wilfried Schmidt explained why he sent a message to Angela Merkel.

WILFRIED SCHMIDT, Retired Engineer (through interpretor): Let’s put it this way. We all need to recognize that Germany is undergoing social changes that are becoming harder to control. For one, there is mass immigration from difficult regions that is increasingly uncontrollable, of people with entirely different concepts of life, from fundamental differently structured societies that are problematic.

MALCOLM BRABANT: About one million migrants poured into Germany in 2015. Chancellor Merkel consistently defended her pro-refugee policies, but now she has been punished by voters who believe she ignored their concerns.

Chancellor Merkel has promised to listen to the people who voted for the AFD, and she says she’s going to try to win them over with what she calls good politics. But she will not countenance having the party in her coalition.

But the chancellor needs to find new partners who are prepared to be tough on immigration.

As she tries to forge a coalition, the chancellor has agreed to put an annual cap of 200,000 on the number of immigrants, something she previously refused to do. But will it be enough to woo back people who deserted her at the election?

A question for Werner Patzelt, a political scientist at Dresden University.

WERNER PATZELT, Dresden University: Since Chancellor Merkel has made so many U-turns in German domestic politics, it wouldn’t be a surprise if she would try to do a U-turn, also winning back AFD voters.

But this is a really hard political task, because so many of them are so much disappointed by the Christian Democratic Union in general, and by Chancellor Merkel in particular, that they will do anything to avoid going back.

MALCOLM BRABANT: Back in Sweden, the governing party is horrified at the concept of conceding ground to right-wingers, and is trying to isolate them.

ANNA JOHANSSON: Experience shows that, when you adopt the ideas from these right-wing parties, they spread. These parties have their agenda implemented by other parties. And I wouldn’t want to see that happen in Sweden.

FLOID GUMBO: We’re all human beings. We share this world. We’re all here. There’s enough space for us all.

MALCOLM BRABANT: But that’s an appeal that an increasing number of Swedes are rejecting, as the country and much of Europe go through a crisis of identity.

For the PBS NewsHour, I’m Malcolm Brabant in Gothenburg.

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Secretary of State Rex Tillerson speaks at the Center for Strategic and International Studies on Wednesday.

WASHINGTON — Secretary of State Rex Tillerson is condemning reported atrocities committed against Rohingya Muslims in Myanmar, and he says those responsible — perhaps the country’s military — will be held accountable.

Tillerson says accounts of the suffering of the Rohingya are “heartbreaking” — and that if those reports are true, then “someone is going to be held to account for that.”

Tillerson — who’s set to visit South Asia next week — is urging the Myanmar government to improve humanitarian access to the population in western Rakhine state.

Amnesty International has accused Myanmar’s security forces of killing hundreds of men, women and children during a systematic campaign to expel the Rohingya. More than 580,000 refugees have fled to neighboring Bangladesh since late August.

“We really hold the military leadership accountable for what’s happening,” Tillerson said at the Center for Strategic and International Studies, a Washington think tank. “What’s most important to us is that the world can’t just stand idly by and be witness to the atrocities that are being reported in that area.”

He also called Wednesday for the U.S. and India to expand strategic ties. He pointedly criticized China, which he accused of challenging international norms needed for global stability.

He said the world needed the U.S. and India to have a strong partnership. The two nations share goals of security, free navigation, free trade and fighting terrorism in the Indo-Pacific, and serve as “the eastern and western beacons” for an international rules-based order which is increasingly under strain, he said.

Both India and China had benefited from that order, but Tillerson said India had done so while respecting rules and norms, while China had “at times” undermined them. To make his point, he alluded to China’s island building and expansive territorial claims in seas where Beijing has long-running disputes with Southeast Asian neighbors.

“China’s provocative actions in the South China Sea directly challenge the international law and norms that the United States and India both stand for,” Tillerson said in an address at the Center for Strategic and International Studies, a Washington think tank.

He added that the U.S. seeks constructive relations with China but “won’t shrink” from the challenges it poses when it “subverts the sovereignty of neighboring countries, and disadvantages the U.S. and our friends.”

U.S.-India relations have generally prospered in the past decade, in part because of their shared concerns about the rise of China. While President Donald Trump has looked to deepen cooperation with China on addressing the nuclear threat from North Korea, he’s also sought a closer relationship with India, which shares U.S. worries on Islamic extremism.

“In this period of uncertainty and angst, India needs a reliable partner on the world stage. I want to make clear: with our shared values and vision for global stability, peace and prosperity, the United States is that partner,” Tillerson said.

Tillerson said the U.S. wants to help improve India’s military capabilities, and also improve security cooperation among the region’s major democracies, which included Japan and Australia.

Tillerson said the U.S. and India were leading regional efforts on counterterrorism. He called for India’s archrival Pakistan “to take decisive action against terrorist groups based within their own borders that threaten its own people and the broader region.”

The post Tillerson: ‘Heartbreaking’ reports of suffering in Myanmar appeared first on PBS NewsHour.

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HARI SREENIVASAN: President Xi Jinping opened China’s twice-per-decade Communist Party Congress today with a lengthy list of his achievements during his first five-year term, and his vision of where he hopes to take his nation.

But beyond the words, Xi is asserting power like no Chinese leader in decades.

William Brangham reports.

WILLIAM BRANGHAM: The applause, the music, it was a reception befitting the commanding role that Xi Jinping has taken since being named party leader five years ago.

He opened today’s proceedings by hailing reforms he’s put in place, and proclaiming a — quote — “new era for China.”

PRESIDENT XI JINPING, China (through interpreter): The Chinese nation has realized a great leap, from declining in modern history to twisting its fate fundamentally and continuously moving to prosperity.

WILLIAM BRANGHAM: Over 3.5 hours, Xi laid out his vision to shape the nation of 1.4 billion people into what he called a — quote — “great modern socialist country” over the next three decades.

PRESIDENT XI JINPING (through interpreter): Achieving the great rejuvenation of the Chinese nation will be no walk in the park, and it will take more than drumbeating and gong-clanging to get there. The whole party must be prepared to make more arduous, strenuous efforts.

WILLIAM BRANGHAM: Susan Shirk is chair of the 21st Century China Center at the University of California, San Diego.

SUSAN SHIRK, University of California, San Diego: Xi Jinping has a vision of China’s role in the world that is much more ambitious than anything we have seen before, talking about China kind of moving toward the center of the world and having a lot more influence than it did before.

WILLIAM BRANGHAM: In his address, Xi largely ignored the question of political reforms in China, and he didn’t mention President Trump or North Korea’s nuclear weapons program.

But in a rare move, he did acknowledge that with global demand weakening, there were challenges facing China’s export-driven economy.

PRESIDENT XI JINPING (through interpreter):  While China’s overall productive forces have significantly improved and in many areas our production capacity leads the world, the more prominent problem is that our development is unbalanced and inadequate.

WILLIAM BRANGHAM: Xi was one of the first foreign leaders to meet with President Trump.

PRESIDENT DONALD TRUMP: The relationship developed by President Xi and myself, I think, is outstanding.

WILLIAM BRANGHAM: That was decidedly warmer than Mr. Trump’s past criticism of China and its economic and trade policies.

But other U.S. officials are more critical of Beijing’s actions.

REX TILLERSON, Secretary of State: China, while rising alongside India, has done so less responsibly.

WILLIAM BRANGHAM: Secretary of State Rex Tillerson today criticized China’s aggressive displays of economic and military power, particularly its expansion on man-made islands in the South China Sea.

REX TILLERSON: We will not shrink from China’s challenges to the rules-based order, and where China subverts the sovereignty of neighboring countries and disadvantages the U.S. and our friends.

SUSAN SHIRK: I think there are things to worry about in Chinese foreign policy that are mostly related to these maritime sovereignty issues and to a kind of bullying in Asia, but the global ambition could turn out to be positive.

WILLIAM BRANGHAM: Susan Shirk says China has filled a vacuum left by the United States’ withdrawal from global agreements like the Trans-Pacific Partnership and the Paris climate accords.

Perhaps the most important thing to watch for in the next few days is who Xi establishes as his likely successor.

SUSAN SHIRK: That is why there is a lot of speculation now that he may be trying, much like Putin, to stay on beyond his normal term or to rule behind the scenes even after he retires.

WILLIAM BRANGHAM: President Trump will be traveling to Beijing to meet Xi next month.

For the PBS NewsHour, I’m William Brangham.

The post Xi Jinping celebrates China’s rising power — and his own appeared first on PBS NewsHour.

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