Maryna Lialko had raised the girls alone after their father left the family, their grandmother, Nina Lialko, said.

“She was devoted to these two girls,” she said.

Kateryna was discharged this fall from Ohmadyt hospital, where she received psychiatric and physical therapy, and the girls are now in Kyiv living with their grandmother and aunt.

The aunt, Olha Lialko, said she has seen a shift in their personalities. Kateryna is increasingly turning inward; she speaks very little and struggles to maintain eye contact. Yuliia still can’t fully comprehend the loss.

“Katya is very closed; she keeps it all to herself,” Olha Lialko said. “Yuliia is missing mom a lot. She needs attention, she likes to cuddle.”

The family is trying to help the girls process their loss. And occasionally they see glimpses of the girls they knew before the war.

They dye their hair wild colors and play with makeup. They fight as only sisters can, and cling closely to each other for company.

But no one knows what will come next for them. Their life is on hold. They attend school online and have few friends in the new city. The family is unable to return home to Donetsk but unwilling to commit to staying in Kyiv.

“It will be very difficult for them to live without her,” their grandmother said. “This life has no sense at all.”

Oleksandra Mykolyshyn contributed reporting

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US Economy Grew at 2.6% Annual Rate in Q3, GDP Report Shows

The U.S. economy grew slowly over the summer, adding to fears of a looming recession — but also keeping alive the hope that one might be avoided.

Gross domestic product, adjusted for inflation, returned to growth in the third quarter after two consecutive quarterly contractions, according to government data released Thursday. But consumer spending slowed as inflation ate away at households’ buying power, and the sharp rise in interest rates led to the steepest contraction in the housing sector since the first months of the pandemic.

The report underscored the delicate balance facing the Federal Reserve as it tries to rein in the fastest inflation in four decades. Policymakers have aggressively raised interest rates in recent months — and are expected to do so again at their meeting next week — in an effort to cool off red-hot demand, which they believe has contributed to the rapid increase in prices. But they are trying to do so without snuffing out the recovery entirely.

The third-quarter data — G.D.P. rose 0.6 percent, the Commerce Department said, a 2.6 percent annual rate of growth — suggested that the path to such a “soft landing” remained open, but narrow.

loss of purchasing power over time, meaning your dollar will not go as far tomorrow as it did today. It is typically expressed as the annual change in prices for everyday goods and services such as food, furniture, apparel, transportation and toys.

President Biden cheered the report in a statement Thursday morning. “For months, doomsayers have been arguing that the U.S. economy is in a recession, and congressional Republicans have been rooting for a downturn,” he said. “But today we got further evidence that our economic recovery is continuing to power forward.”

By one common definition, the U.S. economy entered a recession when it experienced two straight quarters of shrinking G.D.P. at the start of the year. Officially, however, recessions are determined by a group of researchers at the National Bureau of Economic Research, who look at a broader array of indicators, including employment, income and spending.

Most analysts don’t believe the economy meets that more formal definition, and the third-quarter numbers — which slightly exceeded forecasters’ expectations — provided further evidence that a recession had not yet begun.

But the overall G.D.P. figures were skewed by the international trade component, which often exhibits big swings from one period to the next. Economists tend to focus on less volatile components, which have showed the recovery steadily losing momentum as the year has progressed. One closely watched measure suggested that private-sector demand stalled out almost completely in the third quarter.

Mortgage rates passed 7 percent on Thursday, their highest level since 2002.

“Housing is just the single largest trigger to additional spending, and it’s not there anymore; it’s going in reverse,” said Diane Swonk, chief economist at the accounting firm KPMG. “This has been a stunning turnaround in housing, and when things start to go really quickly, you start to wonder, what are the knock-on effects, what are the spillover effects?”

The third quarter was in some sense a mirror image of the first quarter, when G.D.P. shrank but consumer spending was strong. In both cases, the swings were driven by international trade. Imports, which don’t count toward domestic production figures, soared early this year as the strong economic recovery led Americans to buy more goods from overseas. Exports slumped as the rest of the world recovered more slowly from the pandemic.

Both trends have begun to reverse as American consumers have shifted more of their spending toward services and away from imported goods, and as foreign demand for American-made goods has recovered. Supply-chain disruptions have added to the volatility, leading to big swings in the data from quarter to quarter.

Few economists expect the strong trade figures from the third quarter to continue, especially because the strong dollar will make American goods less attractive overseas.

Jim Tankersley contributed reporting.

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U.K. Live Updates: Liz Truss Resigns as Prime Minister

LONDON — For Liz Truss, the end came on Thursday in a midday meeting with grandees of the Conservative Party. But Ms. Truss’s fate as prime minister was all but sealed three weeks earlier when currency and bond traders reacted to her new fiscal program by torpedoing the pound and other British financial assets.

The market’s swift, withering verdict on Ms. Truss’s tax-cutting agenda shattered her credibility, degraded Britain’s reputation with investors, drove up home mortgage rates, pushed the pound down to near parity with the American dollar, and forced the Bank of England to intervene to prop up British bonds.

That repudiation, measured in the second-by-second fluctuations of bond yields and exchange rates, mattered more than the noisy departures of Ms. Truss’s cabinet ministers or the hothouse anxieties of Conservative lawmakers that ultimately made her position untenable.

For that reason, world leaders, buffeted by economic challenges, are watching the turmoil in Britain with anything but relish, concerned about the stability of Britain itself. Interest rates, energy costs and inflation are rising around the world. Labor unrest is proliferating across borders. Non-British pension funds potentially face the same financial stresses that afflicted those in Britain. The last thing leaders want is for Ms. Truss’s woes to be a harbinger for other countries.

President Emmanuel Macron of France, who recently mended fences with Ms. Truss after she refused last summer to characterize him as a friend or foe, said: “I wish in any case that Great Britain will find stability again and moves on, as soon as possible. It’s good for us, and it’s good for our Europe.”

Credit…Henry Nicholls/Reuters

Ms. Truss, economists said, is correct to argue that markets are driven by global trends broader than her tax cuts. Central banks worldwide are raising rates to battle inflation, which has been fueled by a surge in demand as the coronavirus pandemic ebbed and a spike in gas prices driven by Russia’s war in Ukraine.

“The problems are by no means all Truss’s doing but she should have known that getting blamed for everything comes with the territory,” said Kenneth Rogoff, a professor of economics at Harvard and a scholar of financial upheavals.

“What is really worrisome now,” he said, is that the situation in Britain “might be the canary in the coal mine as global interest rates keep soaring, especially as they do not seem likely to come down anytime soon.”

Ms. Truss long cultivated a reputation as a disrupter and a free-market evangelist in the tradition of Margaret Thatcher and Ronald Reagan. Her tax cut proposals made her an outlier among leaders of big economies fighting inflation. But she made no apologies for offending either economic orthodoxy or the expectations of financial markets in pursuit of her vision of a “low-tax, high growth” Britain.

“Not everyone will be in favor of change,” a defiant Ms. Truss said a week ago at the annual meeting of the Conservative Party, even though one of her planned tax cuts, for high-earning people, had already been reversed. “But everyone will benefit from the result: a growing economy and a better future.”

The prime minister’s fatal miscalculation, experts said, was to believe that Britain could defy the gravity of the markets by passing sweeping tax cuts, without corresponding spending cuts, at a time when inflation is running in double digits and interest rates were rising.

“It was the combination of the wrong fiscal policy at the wrong time — borrowing when rates were rising rather than, as in 2010s, when they were low,” said Jonathan Portes, a professor of economics and public policy at Kings College London.

He cited what he called Ms. Truss’s “institutional vandalism,’’ in particular the way she and her ousted chancellor of the Exchequer, Kwasi Kwarteng, broke with custom by announcing sweeping tax cuts without subjecting them to the scrutiny of the government’s fiscal watchdog, the Office of Budget Responsibility.

In that sense, he said, Ms. Truss was following in the footsteps of her predecessor, Boris Johnson, who resigned as prime minister barely three months earlier after a series of scandals prompted a wholesale walkout of his ministers.

Credit…Oli Scarff/Agence France-Presse — Getty Images

Mr. Kwarteng’s budget maneuvering led many in the markets to suspect the government was engaged in a kind of fiscal sleight of hand, which would inevitably require massive borrowing to cover a hole in the budget estimated at 72 billion pounds ($81.5 billion).

Mr. Kwarteng, who studied the history of financial crises as a doctoral student at Cambridge University, brushed off the blowback in financial markets as a temporary phenomenon. Like Ms. Truss, he is a believer in disruptive change. Together, they were among the authors of “Britannia Unchained,” a manifesto for a Thatcher-style, free-market revolution in post-Brexit Britain. Among other things, the authors described Britons as “among the worst idlers in the world.”

When, or even whether, Britain can fully recover from this period of political and economic turbulence is not yet clear. On Thursday, as news of Ms. Truss’s resignation broke, the pound rose against the dollar and yields on British government bonds fell.

Virtually all the government’s planned tax cuts have been reversed, and the next prime minister, regardless of his or her politics, will have little choice but to pursue a policy of spending cuts and strict fiscal discipline. Some fear a return to the bleak austerity of Prime Minister David Cameron in the years after the 2008 financial crisis.

“Rishi or another can steady the ship and calm the markets,” Professor Portes said, referring to Rishi Sunak, a former chancellor who ran unsuccessfully against Ms. Truss and may seek to succeed her. “But it’s hard to see how, given the state of the Conservatives, any Tory prime minister can repair the longer-term damage.”

Much of that damage is to Britain’s once-sterling reputation in the markets. Economists have begun mentioning Britain in the same breath as fiscally wayward countries like Italy and Greece. Lawrence H. Summers, the former U.S. Treasury secretary, told Bloomberg News, “It makes me very sorry to say, but I think the U.K. is behaving a bit like an emerging market turning itself into a submerging market.”

That is a humbling comedown for a country that in 2009 announced a $1.1 trillion emergency fund to bail out the global economy.

“If you’re an American fund manager, you’re not going to put Britain in the super-safe category you might have earlier,” said Jonathan Powell, who served as chief of staff to Prime Minister Tony Blair. “It’s not about Britain’s standing in the world, but what category we’ve put ourselves in.”

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Putin Declares Martial Law in Occupied Ukraine as Evacuation of Civilians Starts

Credit…Nicole Tung for The New York Times

KYIV, Ukraine — Russian occupation officials were moving civilians out of Kherson on Wednesday, another sign that Moscow’s hold on the strategic southern Ukrainian city was slipping, as President Vladimir V. Putin of Russia sought to reassert control over that and other occupied regions by declaring martial law.

The move by Mr. Putin was an effort to tighten the Kremlin’s authority over Kherson and three other Ukrainian regions he recently claimed to annex, even as his army loses ground in those areas to Ukrainian forces and as Western allies dismiss the annexations as illegal.

As Russian proxy officials in Kherson said they would move as many as 60,000 civilians to the eastern side of the Dnipro River and shift its civilian administration there, they appeared to be girding for a battle for control of the region. Amid a weekslong Ukrainian counteroffensive, the pro-Kremlin leader in Kherson, Vladimir Saldo, said the relocations would protect civilians and help Russian forces fortify defenses to “repel any attack.”

Ukrainian officials dismissed the plans as “a propaganda show.” Andriy Yermak, the head of President Volodymyr Zelensky’s office, accused the Russian proxies of scaring civilians with claims that Ukraine would shell the city. He called it “a rather primitive tactic, given that the armed forces do not fire at Ukrainian cities — this is done exclusively by Russian terrorists.”

Ukrainian forces have been advancing gradually for weeks along both sides of the river in Kherson, a region that Moscow seized early in the war and has declared part of Russia. Since late August, Ukrainian troops have damaged bridges near the city of Kherson, making it harder for Moscow to resupply the thousands of troops it has stationed there.

Western analysts have suggested that the Russian positions in and around the city are untenable without the bridges, and U.S. officials have said that Russian commanders have urged a retreat from Kherson, only to be overruled by Mr. Putin. But Ukraine’s counteroffensive in the Kherson region has moved more slowly than its recent advances in the east, and it was far from clear whether its forces could soon mount a push to retake the city of Kherson.

On Tuesday, the general Mr. Putin appointed earlier this month to command the war in Ukraine, Sergei Surovikin, said he was ready to make “difficult decisions” about the military deployments in the Kherson region, without specifying what those decisions would entail.

Ukrainian officials have greeted the hints of a Russian pullback of at least civil administrators with caution, saying the announcements could be intended for internal Russian audiences, signaling commitment to protecting civilians or preparation for a Russian military action in the area. Videos released on Russian media showed lines of civilians apparently boarding ferries at a river port to evacuate to the eastern bank of the Dnipro.

The Kherson region spans both banks of the river, with the city of Kherson, the regional capital, lying on the western side. The western bank is an expanse of pancake-flat farmland crisscrossed by rivers and irrigation canals, and one of the most pivotal battlefields of the war.

Ukrainian troops had through the summer whittled away at Russian supply lines by firing American-provided precision guided rockets at the four bridges over the Dnipro River in areas Russia controls. All are now mostly destroyed.

In late August, Ukraine opened an offensive with ground troops, advancing in bloody, slow-moving combat through several dozen villages while driving the Russian forces backward, toward the Dnipro. The Russian announcements of evacuating civilians and the civil administration could signal a faltering of military defenses, presaging a Russian pullback from the western bank of the Dnipro River in what would be a major setback for Moscow — but could also be a ruse.

Mr. Saldo, a Ukrainian politician who had switched sides at the start of the full-scale Russian invasion, told the Russian state news agency RIA on Wednesday that all ministries would evacuate to the eastern bank. The occupation government earlier on Wednesday said it would evacuate from 50,000 to 60,000 civilians across the river and onward to the occupied peninsula of Crimea or into Russia. Residents risked artillery fire from the Ukrainian Army or flooding from the destruction of the Kakhovka hydroelectric dam on the Dnipro River, Mr. Saldo said.

Correction: 

Oct. 19, 2022

An earlier version of this article misidentified the location that Russian proxy officials in Kherson, Ukraine, said they would move as many as 60,000 civilians to. It is the eastern side of the Dnipro River, not the western side.

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How Ukraine’s Surrogate Mothers Have Survived the War

KYIV, Ukraine — After months huddled in a basement to escape shelling, a surrogate mother named Viktoria was able to get her family, and the unborn child she carried for foreign clients, away from the fighting in northeastern Ukraine.

She could do so, she said, because her employer, a surrogacy agency, had offered financial aid and an apartment in the capital, Kyiv, to ensure her safety and the baby’s. And although she had initially been reluctant to leave her home, Kharkiv, even under artillery attacks, she is now glad to live in relative security.

“I would not have left if the clinic had not persuaded me,” she said.

Viktoria is one of hundreds of surrogate mothers who have brought pregnancies to term over seven harrowing months, running for safety as air-raid sirens sounded, surviving in bomb shelters, then fleeing from ruined towns to deliver children for parents abroad.

Before Russia invaded in February, Ukraine was a major provider of surrogacy, one of the few countries that allows it for foreign clients. After a pause in the spring, surrogacy agencies are resuming their work, reviving an industry that many childless people rely on but that critics have called exploitative and that, in peacetime, was already ethically and logistically complex.

the business would unravel — especially as Russia tried and failed to seize Kyiv in the war’s early weeks — have proved overblown. Life in western and central Ukraine has largely stabilized despite fighting in southern and eastern regions and the continued risks of long-range missile strikes.

“We did not lose a single one,” said Ihor Pechenoha, the medical director at BioTexCom, Ukraine’s largest surrogacy agency and clinic. “We managed to bring all our surrogate mothers out from under occupation and shelling.”

marooned in a basement nursery in Kyiv. For weeks and months, it was difficult or impossible for biological parents to reach their children in Ukraine, but by August, all of the babies had gone home.

The war has not diminished the appeal of surrogacy for couples desperate to have children, said Albert Tochylovsky, the director of BioTexCom. “They are in a hurry,” he said. “To explain, ‘We have a war going on,’ doesn’t work.”

Before Russia launched its full-scale invasion, BioTexCom was impregnating about 50 women per month. Since the beginning of June, the company has begun at least 15 new pregnancies.

With the money that the business brings in, Mr. Tochylovsky said, surrogate mothers have been moved from frontline towns and Russia-occupied regions to safer places, like Kyiv.

criticism that it leaves poor women vulnerable to exploitation by clients and agencies. Advocates of gestational surrogacy, in which surrogate mothers undergo in vitro fertilization to deliver the babies of clients who cannot have children on their own, say the practice is invaluable to such couples and offers a potentially life-changing sum for surrogates.

“I do it for money, but why not?” said Olha, 28, who started a new surrogate pregnancy this summer. “I have good health and can help people who have money” and want children, she added.

Before the war, the business thrived in Ukraine, where surrogate mothers typically earn about $20,000 per child they deliver. The war has made financial security even more urgent.

One 30-year-old surrogate mother, who spoke on the condition of anonymity because she had evacuated from Melitopol in Russia-occupied southern Ukraine and feared she could be targeted for reprisal, said she credited the job with getting her family out. “With the help of surrogacy,” she said, “I saved my family.”

many new quandaries for the women, clients and medical personnel. Viktoria and her family face one such dilemma: Her payment will help them survive, but it is far from clear where they should go after her recovery from a C-section. The family has remained in the apartment rented by the clinic in Kyiv; her hometown, Kharkiv, is still hit by regular shelling.

For many surrogate mothers, the question was about where to deliver. Threats included not just fighting, but how the authorities established by the Russian occupation government would handle a surrogate birth.

A surrogate named Nadia lived in a village in Russia-occupied territory that was not at risk of artillery shelling. But she decided to evacuate to Ukrainian-controlled territory to deliver the baby, lest the biological parents be deprived of custody, and she lose the fee.

She spent two days with her husband and 11-year-old daughter sleeping in a car on a roadside that is sometimes shelled, waiting to cross the front line.

Ms. Burkovska, the small-agency owner, went into the war with two stranded surrogate babies in her care. In contrast to most surrogacy agencies, she cares for newborns in her own home before biological parents pick them up. For a time, she had to shelter in a basement with the newborns, her partner and her own children.

As more babies arrived in the first months of war, she wound up with seven newborns whose biological parents could not immediately retrieve them, as travel to wartime Ukraine became difficult and as some remaining coronavirus restrictions, like China’s, caused delays.

Ms. Burkovska’s own children helped care for the infants until their parents could get them. By August, most of the parents had arrived to pick up their children.

A Chinese client with BioTexCom, Zhang Zong, was one of those who struggled to reach Kyiv through travel delays. He said the wait had been excruciating. “I was very worried because of the war,” he said.

Meeting his 6-month-old son, he said, was both thrilling and a little strange. “I was extremely excited when they let me hug him,” Mr. Zhang said. “He has been here for a long time and everyone hugs him, everyone likes him, and I am not so special.”

But he added that was only for now. “When he grows up,” Mr. Zhang said, “I can tell him this story.”

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Germany’s Scholz calls for bigger European Union

BERLIN, Oct 15 (Reuters) – German Chancellor Olaf Scholz on Saturday called for an expanded European Union, telling a gathering of European social democrats that it would then be able to better pull its weight in global affairs.

Since assuming office, Scholz has made European Union expansion to include the Balkans and others nations a major plank of his foreign policy. It has taken on more urgency since Russia’s invasion of Ukraine, which became a candidate for EU membership early this summer.

“An EU with 27, 30, 36 states, with then more than 500 million free and equal citizens, can bring its weight to bear even more strongly in the world,” Scholz said at the congress.

The EU currently has 27 members.

“I am committed to the enlargement of the EU. That the EU continues to grow eastward is a win-win for all of us,” he said.

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Reporting by Andreas Rinke; writing by Tom Sims, editing by William Maclean

Our Standards: The Thomson Reuters Trust Principles.

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Advancing Ukrainian Troops Find Nearly Empty Towns Destroyed by Fighting

Credit…Nicole Tung for The New York Times

Ukraine, fresh from a string of victories in the northeast, is now poised at the gateway to the eastern Donbas region and may have its best opportunity yet to dislodge Russian forces that expanded their control over the area after brutal combat this summer. Lysychansk, which only three months ago fell to the Russians in a demoralizing setback for Kyiv, could be the next major city in Ukraine’s sights.

That a battle to retake Lysychansk is even conceivable shows just how much the tables have turned in the east in the few weeks since Ukraine launched a surprise counteroffensive in the northeastern Kharkiv region. The relative speed of its victories is a marked contrast to Russia’s grinding assault over the summer in Donbas.

“The offensive movement of our army and all our defenders continued,” President Volodymyr Zelensky said in a bullish speech overnight, in which he said that 450 settlements in Kharkiv had been recaptured. “There are new liberated settlements in several regions.”

“Fierce fighting continues in many areas of the front,” he said.

Over the weekend, Ukraine reclaimed the town of Lyman, a strategic rail hub in the north of Donetsk, one of two territories that make up Donbas, and has continued to press east toward Lysychansk.

To seize Lysychansk and its sister city of Sievierodonetsk — both of which lie in northern Luhansk, the other territory that makes up Donbas — Russia pounded Ukrainian forces with artillery for weeks before street-by-street fighting eventually forced Ukraine’s withdrawal. Before Lyman fell, Ukrainian soldiers gradually encircled the town, and it fell last week after just days of intense combat.

Analysts point to Ukraine’s success in cutting off Russian supply routes as key to its momentum. As Russia was pushed out of Kharkiv last month, it lost control of its rail hub in the city of Izium, making it much harder for Moscow to resupply its forces farther south in Donbas and leaving them vulnerable.

Russia announced a surprise military call-up last month, and the country’s defense minister, Sergei K. Shoigu, said on Telegram on Tuesday that Moscow had drafted more than 200,000 troops of a planned 300,000. Although they have had little time for training, new troops from the recent mobilization have begun arriving in Ukraine, the Defense Ministry said on Monday.

Ukrainian soldiers have encountered hungry, poorly outfitted Russian troops, some with little weaponry to defend themselves.

Russia’s military is likely to be faced with a decision about whether to shift resources from other parts of the front to slow Ukraine’s advance or risk losing more ground in Donbas. Some of the nearest Russian reinforcements are roughly 25 miles southeast of Lyman, around the Ukrainian-held city of Bakhmut. The Wagner Group, an infamous paramilitary unit that reports directly to the Kremlin, has battered the Ukrainian defenders there but failed to seize the city.

But the question remains how long Ukrainian momentum can last. In recent days, some Ukrainian soldiers in Kharkiv Province have spoken of exhaustion after weeks of nonstop fighting.

Ben Barry, a senior fellow for land warfare at the International Institute for Strategic Studies in London, said that the advance would most likely reach a “culminating point” after which the offensive would be difficult to sustain because troops would need to be rotated and resupplied.

Ukraine’s gains have not eased the danger to civilians, as fighting continued to produce casualties. A convoy of people fleeing Svatove, in Luhansk, was attacked in recent days and 24 people, including 13 children, were killed, the Ukrainian authorities said. And on Monday, Russian shellfire at a hospital in the Kupiansk district of the Kharkiv region killed a doctor and wounded two nurses, according to the head of its military administration, Oleh Syniehubov.

Russia’s battlefield losses have come even as Moscow claims that four Ukrainian regions where fierce fighting is continuing are now part of Russia, a move that has been met with widespread international derision.

Tass, a Russian state news agency, reported on Tuesday that the country’s upper house of Parliament, the Federation Council, had approved a law to annex Donetsk and Luhansk, as well as two provinces in southern Ukraine, Kherson and Zaporizhzhia.

President Vladimir V. Putin of Russia is likely to sign the law, which follows referendums in the provinces denounced as a sham by Ukraine and its Western partners.

Mr. Zelensky said on Tuesday that, given “Russia’s attempt to annex territories,” he had approved a decision of the country’s security council on the “impossibility of holding negotiations” with Mr. Putin.

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On Portugal’s ‘Bitcoin Beach,’ Crypto Optimism Still Reigns

LAGOS, Portugal — The Bam Bam Beach Bitcoin bar, on an uncrowded beach in southwestern Portugal, is the meeting place.

To get there, you drive past a boat harbor, oceanside hotels and apartment buildings, then park near a sleepy seafood restaurant and walk down a wooden path that cuts through a sand dune. Yellow Bitcoin flags blow in the wind. The conversations about cryptocurrencies and a decentralized future flow.

“People always doubt when to buy, when to sell,” said Didi Taihuttu, a Dutch investor who moved to town this summer and is one of Bam Bam’s owners. “We solve that by being all in.”

melted down, and crypto companies like the experimental bank Celsius Network declared bankruptcy as fears over the global economy yanked down values of the risky assets. Thousands of investors were hurt by the crash. The price of Bitcoin, which peaked at more than $68,000 last year, remains off by more than 70 percent.

But in this Portuguese seaside idyll, confidence in cryptocurrencies is undimmed. Every Friday, 20 or so visitors from Europe and beyond gather at Bam Bam to share their unwavering faith in digital currencies. Their buoyancy and cheer endure across Portugal and in other crypto hubs around the world, such as Puerto Rico and Cyprus.

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In beach towns like Ericeira and Lagos, shops and restaurants show their acceptance of digital currencies by taking Bitcoin as payment. Lisbon, the capital, has become a hub for crypto-related start-ups such as Utrust, a cryptocurrency payment platform, and Immunefi, a company that identifies security vulnerabilities in decentralized networks.

“Portugal should be the Silicon Valley of Bitcoin,” Mr. Taihuttu said. “It has all the ingredients.”

news outlets covered his family’s story, Mr. Taihuttu’s social media following swelled, turning him into an influencer and a source of investment advice. A documentary film crew has followed him on and off for the past 18 months. This summer, he settled in Portugal and quickly became something of an ambassador for its crypto scene.

He has goals to turn Meia Praia, the beach where Bam Bam is located, into “Bitcoin Beach.” He is shopping for property to create a community nearby for fellow believers.

“You prove that it is possible to run some part of the world, even if it’s just one,” said Mr. Taihuttu, with a Jack Daniel’s and Coke in hand. He has shoulder-length black hair and wore a tank top that showcased his tan and tattoos (including one on his forearm of the Bitcoin symbol).

Ms. Bestandig was among those who Mr. Taihuttu drew to Portugal.

collapse of Mt. Gox, a Tokyo-based virtual currency exchange that declared bankruptcy in 2014 after huge, unexplained losses of Bitcoin.

If cryptocurrency prices do not recover, “a lot of them will have to go back to work again,” Clinton Donnelly, an American tax lawyer specializing in cryptocurrencies, said of some of those gathered at Bam Bam.

Even so, Mr. Donnelly and other bar regulars said their belief in crypto remained unshaken.

Thomas Roessler, wearing a black Bitcoin shirt and drinking a beer “inspired by” the currency, said he had come with his wife and two young children to decide whether to move to Portugal from Germany. He first invested in Bitcoin in 2014 and, more recently, sold a small rental apartment in Germany to invest even more.

Mr. Roessler was concerned about the drop in crypto values but said he was convinced the market would rebound. Moving to Portugal could lower his taxes and give his family the chance to buy affordable property in a warm climate, he said. They had come to the bar to learn from others who had made the move.

“We have not met a lot of people who live this way,” Mr. Roessler said. Then he bought another round of drinks and paid for them with Bitcoin.

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Live Updates: Italy Votes in Pivotal Election for Europe

Credit…Alberto Pizzoli/Agence France-Presse — Getty Images

Italian politicians are on a virtual hunt for undecided voters.

Over the summer, as polls suggested that most of those who had not yet picked a side were under 30, party elders took it to the next level: TikTok.

This month, Silvio Berlusconi, 85, who served four times as Italy’s prime minister, landed on the social media platform that is mostly popular among the young, explaining why he was there at his age.

“On this platform, you guys are over five million, and 60 percent of you are less than 30. I am a little envious,” Mr. Berlusconi said, raising and lowering his voice for dramatic effect. “We will talk about your future.”

The video had 9.6 million views, raising eyebrows among some users.

“You are not so stupid that a video on TikTok is enough to vote for you,” said Emma Galeotti, a young TikTok content creator. “You send the message that we, young people, are so malleable and bonkers.”

But Mr. Berlusconi’s communications team did not give up. His profile is brimming with a mix of snapshots from his TV appearances and classic Berlusconi jokes, as well as political messages recorded in his studio, where he is seen wearing classy blue suits — and often ties.

Viewers have taken notice of his cultivated appearance.

“What’s your foundation cream?” one asked. “The cream is too orange, more natural tones are better,” another wrote.

“The rebound was comic or grotesque, but being on TikTok allowed him to be central to the electoral debate,” said Annalisa Ferretti, the coordinator of the social media division at the Italian advocacy group FB & Associati, who noted that the number of people following Mr. Berlusconi’s profile had surpassed 3.2 million in three weeks.

“The problem is that this generation rejects the political class overall,” she said, adding that such social media popularity did not directly translate into votes.

Other politicians have chosen different paths. Matteo Salvini, 49, of the far-right League party, who has been on TikTok for years and has 635,600 followers, uses the platform mostly as a mouthpiece for his meat-and-bone topics — security and immigration.

Giorgia Meloni, 45, the leader of Brothers of Italy and possibly the next prime minister, does not seem to be doing as well on TikTok, despite her successful electoral campaign. She has 197,700 followers.

University students seem to like the leader of the centrist party Action, Carlo Calenda, 49, who posts short political messages, answers questions received on the platform and discusses books, Ms. Ferretti said. But he has only about 24,300 followers.

The center-left Democratic Party is the only party that offers a plurality of voices on TikTok. They post thematic videos with topics discussed by politicians who are the symbol of such issues, like Alessandro Zan, 48, for the civil rights battle. Enrico Letta, 56, a party leader, recently encouraged users to go vote — for whomever they liked. “The others should not decide for your future,” he said.

Despite the efforts of politicians to reach a different audience, abstention still seems to be the main threat to the parties, and to Italian democracy.

“They used to say, ‘Squares are full and the ballot boxes are empty,’” Ms. Ferretti said. “Now it’s more social media is full, and the ballot boxes are empty.”

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How a Hospital Chain Used a Poor Neighborhood to Turn Huge Profits

RICHMOND, Va. — In late July, Norman Otey was rushed by ambulance to Richmond Community Hospital. The 63-year-old was doubled over in pain and babbling incoherently. Blood tests suggested septic shock, a grave emergency that required the resources and expertise of an intensive care unit.

But Richmond Community, a struggling hospital in a predominantly Black neighborhood, had closed its I.C.U. in 2017.

It took several hours for Mr. Otey to be transported to another hospital, according to his sister, Linda Jones-Smith. He deteriorated on the way there, and later died of sepsis. Two people who cared for Mr. Otey said the delay had most likely contributed to his death.

the hospital’s financial data.

More than half of all hospitals in the United States are set up as nonprofits, a designation that allows them to make money but avoid paying taxes. Although Bon Secours has taken a financial hit this year like many other hospital systems, the chain made nearly $1 billion in profit last year at its 50 hospitals in the United States and Ireland and was sitting on more than $9 billion in cash reserves. It avoids at least $440 million in federal, state and local taxes every year that it would otherwise have to pay, according to an analysis by the Lown Institute, a nonpartisan think tank.

In exchange for the tax breaks, the Internal Revenue Service requires nonprofit hospitals to provide a benefit to their communities. But an investigation by The New York Times found that many of the country’s largest nonprofit hospital systems have drifted far from their charitable roots. The hospitals operate like for-profit companies, fixating on revenue targets and expansions into affluent suburbs.

borrowing tricks from business consultants, have trained staff to squeeze payments from poor patients who should be eligible for free care.

John M. Starcher Jr., made about $6 million in 2020, according to the most recent tax filings.

“Our mission is clear — to extend the compassionate ministry of Jesus by improving the health and well-being of our communities and bring good help to those in need, especially people who are poor, dying and underserved,” the spokeswoman, Maureen Richmond, said. Bon Secours did not comment on Mr. Otey’s case.

In interviews, doctors, nurses and former executives said the hospital had been given short shrift, and pointed to a decade-old development deal with the city of Richmond as another example.

In 2012, the city agreed to lease land to Bon Secours at far below market value on the condition that the chain expand Richmond Community’s facilities. Instead, Bon Secours focused on building a luxury apartment and office complex. The hospital system waited a decade to build the promised medical offices next to Richmond Community, breaking ground only this year.

founded in 1907 by Black doctors who were not allowed to work at the white hospitals across town. In the 1930s, Dr. Jackson’s grandfather, Dr. Isaiah Jackson, mortgaged his house to help pay for an expansion of the hospital. His father, also a doctor, would take his children to the hospital’s fund-raising telethons.

Cassandra Newby-Alexander at Norfolk State University.

got its first supermarket.

according to research done by Virginia Commonwealth University. The public bus route to St. Mary’s, a large Bon Secours facility in the northwest part of the city, takes more than an hour. There is no public transportation from the East End to Memorial Regional, nine miles away.

“It became impossible for me to send people to the advanced heart valve clinic at St. Mary’s,” said Dr. Michael Kelly, a cardiologist who worked at Richmond Community until Bon Secours scaled back the specialty service in 2019. He said he had driven some patients to the clinic in his own car.

Richmond Community has the feel of an urgent-care clinic, with a small waiting room and a tan brick facade. The contrast with Bon Secours’s nearby hospitals is striking.

At the chain’s St. Francis Medical Center, an Italianate-style compound in a suburb 18 miles from Community, golf carts shuttle patients from the lobby entrance, past a marble fountain, to their cars.

after the section of the federal law that authorized it, allows hospitals to buy drugs from manufacturers at a discount — roughly half the average sales price. The hospitals are then allowed to charge patients’ insurers a much higher price for the same drugs.

The theory behind the law was that nonprofit hospitals would invest the savings in their communities. But the 340B program came with few rules. Hospitals did not have to disclose how much money they made from sales of the discounted drugs. And they were not required to use the revenues to help the underserved patients who qualified them for the program in the first place.

In 2019, more than 2,500 nonprofit and government-owned hospitals participated in the program, or more than half of all hospitals in the country, according to the independent Medicare Payment Advisory Commission.

in wealthier neighborhoods, where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals to take advantage of 340B.

to a price list that hospitals are required to publish. That is nearly $22,000 profit on a single vial. Adults need two vials per treatment course.

work has shown that hospitals participating in the 340B program have increasingly opened clinics in wealthier areas since the mid-2000s.

were unveiling a major economic deal that would bring $40 million to Richmond, add 200 jobs and keep the Washington team — now known as the Commanders — in the state for summer training.

The deal had three main parts. Bon Secours would get naming rights and help the team build a training camp and medical offices on a lot next to Richmond’s science museum.

The city would lease Bon Secours a prime piece of real estate that the chain had long coveted for $5,000 a year. The parcel was on the city’s west side, next to St. Mary’s, where Bon Secours wanted to build medical offices and a nursing school.

Finally, the nonprofit’s executives promised city leaders that they would build a 25,000-square-foot medical office building next to Richmond Community Hospital. Bon Secours also said it would hire 75 local workers and build a fitness center.

“It’s going to be a quick timetable, but I think we can accomplish it,” the mayor at the time, Dwight C. Jones, said at the news conference.

Today, physical therapy and doctors’ offices overlook the football field at the training center.

On the west side of Richmond, Bon Secours dropped its plans to build a nursing school. Instead, it worked with a real estate developer to build luxury apartments on the site, and delayed its plans to build medical offices. Residents at The Crest at Westhampton Commons, part of the $73 million project, can swim in a saltwater pool and work out on communal Peloton bicycles. On the ground floor, an upscale Mexican restaurant serves cucumber jalapeño margaritas and a Drybar offers salon blowouts.

have said they plan to house mental health, hospice and other services there.

a cardiologist and an expert on racial disparities in amputation, said many people in poor, nonwhite communities faced similar delays in getting the procedure. “I am not surprised by what’s transpired with this patient at all,” he said.

Because Ms. Scarborough does not drive, her nephew must take time off work every time she visits the vascular surgeon, whose office is 10 miles from her home. Richmond Community would have been a five-minute walk. Bon Secours did not comment on her case.

“They have good doctors over there,” Ms. Scarborough said of the neighborhood hospital. “But there does need to be more facilities and services over there for our community, for us.”

Susan C. Beachy contributed research.

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