My fasting blood glucose has been creeping up over several years. (My fasting blood sugar is around 110, and HbA1c=5.7; fasting insulin=3.1, triglycerides=91.) Recently, I tried a continuous glucose monitor for the first time, to see what I could learn about eating and exercise habits that affect my blood glucose. The experiment led me to some reading and thinking that was worthwhile, but the results themselves were disappointing, limited (first) by flaws in the technology and (second) by wide variability that I could not trace to any of the usual behavioral correlates.

Why concern ourselves with blood sugar?

Insulin is generated in the pancreas after we eat, with a cascade of effects on the body. The primary short-term effect is to prevent glucose levels in the blood from getting too high, by notifying the liver of the need to pull glucose out of the blood and store energy as fat.

Loss of insulin sensitivity is a primary hallmark of human aging. Most of the known life extension strategies in lab animals have to do with insulin in one way or another. For example, the worm genedaf-2is the worms only insulin receptor, and mutating (weakening) thedaf-2 gene doubles the worms lifespan. Life extension benefits of exercise and caloric restriction are thought to work, at least in part, through the insulin metabolism.

But glucose is also dangerous, and as we get older we are poisoned by excess sugar in the blood. High blood sugar leads to [list fromMayo Clinic]

So for long-term health, the name of the game is to keep blood sugar down with as little insulin as possible, hence preservation of insulin sensitivity is the target. Metformin is a well-studied drug for keeping blood sugar down without insulin. I have been taking it (irregularly) for the last several years, intermixed with berberine and Gynostemma(Chinese name: jiaogulan =).

This reasoning plus direct evidence for life extension in rodents and indirect evidence of life extension in humans has led me to take metformin, though it is not without side-effects.

Long-term effects of metformin

Metformin is a credible longevity drug, statistically associated with lower risk of cancer, heart disease and especially dementia in humans. Six years ago,this studylaid the foundation for metformin as a longevity drug with the claim that people taking metformin had lower all-cause mortality, despite the fact that a population of type-2 diabetics was being compared to a healthier population. This finding inspired Nir Barzilai to raise support for theTAME study.

But metformin has its risks. A long-time contributor to this site, Dr Paul Rivas pointed me to evidence thatmetformin can interfere with exercise metabolism. Paul notes his personal experience with loss of peak performance while taking metformin. My own experience is consistent with this, though I have never done a rigorous A/B comparison.This study, demonstrating a small but consistent decrease in peak performance, appears to me to be well-designed and analyzed. A plausible mechanism is the interference of metformin with mitochondrial function [ref,ref].This article claims that metformin suppresses synthesis of ATP, which is the reservoir of energy for immediate use in all cell types. Ben Miller has done the most direct and most recently relevant human experiments in this area and his findings suggest the intriguing possibility that metformin blocks exercise adaptations almost completely in about half of individuals, but not at all in the other half. (If you want to know which half youre in, youll have to wait for next years study.)

For the majority of Westerners who exercise little or not at all, metformin may show reduction in long-term risk of age-related disease; but there is no data I know of on the subset of people who do vigorous exercise, comparing metformin to no metformin. Does metformin block the health effects of exercise?Rhonda Patrick citescredible referenceson this subjectas fast as she can get the words out, and her conclusion is that exercise is a better anti-aging program than metformin, and you really cant have both.

Do glucose-control herbs also blunt the benefits of exercise?

I wrote a few years ago listingbotanical alternatives to metformin. Much less research has gone into these herbs, so we must think theoretically about interference with benefits of exercise.

Berberine works by a mechanism of action that overlaps metformin. Both metformin and berberine promote AMPK (which in turn promotes sugar burning). Both metformin and berberine inhibit mitochondrial Complex I (slowing the conversion of sugar to usable energy). There is tentative experimental evidence that (unlike metformin) berberine does not inhibit adaptations to exercise [ref,ref,ref].

Gynostemmais a Chinese herb popularized by Life Extension Foundation in their proprietary compound calledAMPK Activator. Inanimal modelsand in humans,Gynostemmasuppresses blood sugar and blood cholesterol. Like metformin and berberine, it works through AMPK,which appears to be a good thing. It isanti-inflammatory, and has a history in China as cancer therapy, supported bymouse andin vitrostudies. In rodent studies,Gynostemmahas a beneficial effect on strength and endurance [ref,ref,ref]. Theone studyIve found on human diabetes shows modest benefits after 12 weeks. The only counter-indication that I have seen is that itincreases insulin release (in vitro), which I believe to be pro-aging.

Is it more important to suppress postprandial spikes or to depress fasting glucose levels?

HbA1c is a standard blood test for diabetes. It isrelated to average blood glucoselevels over the previous 90 days (= the half-life of hemoglobin in the blood). But the glycation of hemoglobin (as measured by A1c) happenspredominantly during the brief glucose spikes, rather than the much longer periods of average glucose levels. So it might be fairer to say that A1c summarizes peak glucose events over a 90-day period. And we might guess that the long-term health risks of high blood sugar are similarly more sensitive to the peaks than to the average.

I believe that apoptosis is on a hair trigger as we age, and part of the reason for this is too much p53.This studylinks P53 activation to postprandial glucose spikes, rather than to high average glucose levels.This studylinks deterioration in endothelial function (related to arterial disease) with glucose spikes. The same paper lists ROS and oxidative stress as additional risks.

For a long while, it has been established that high fasting blood sugar is associated withcardiovascular risk. Of course, there is also association withobesity and T2 diabetes, but for these, it is natural to think of fasting blood sugar as the result, rather than the cause.

Chris Kressersays the best indicator of metabolic health is blood glucose levels 2 hours after a meal. If you can bring your blood glucose down to normal within 2 hours after eating your insulin sensitivity is good. For me, unmedicated, it was 3 hours after dinner, but less than 2 hours after breakfast. Either berberine or metformin tamed the after dinner spikes within 2 hours.

Kresser claims that these guidelines from the American Diabetes Association are not strict enough, and that statistics show increased future risk of diabetes even for people in the ADA normal range. But he citesPetro Dobromylskyj, who makes an exception for anyone on a low-carb diet (how low isnt specified). Paradoxically, low-carb diets are claimed to be healthy, even though they decrease insulin sensitivity. I have been unable to make sense of this.

Kresser emphasizes that all numbers should be interpreted in the context of a persons other lifestyle and health indicators. In people who are active and not overweight, he is not inclined to worry about statistics in the prediabetic range. (I take comfort in this personally, and who can say if Im fooling myself?) But I can learn something from the way my glucose stats respond to medications, eating and exercising, whether or not I believe the absolute levels are concerning.

Writing inScience Magazinelast year, Charles Piller reviewed the ADA guidelines and found a consensus in the opposite direction that they were probably too strict, and unnecessarily worrisome to a great many people. By ADAs definition, 80 million Americans are pre-diabetic, which is 40% of the adult population. The conflict really is not over the statistics but the interpretation. You can say either People with A1c levels above 6 are at increased risk of progressing to diabetes or equally well, Most people with A1c levels less than 6.4 will never develop diabetes. Both statements are true.

As promised: my experience

The Freestyle Libre was very easy to use and set up. I followed the instructions and used a spring-loaded device to insert the monitor behind my biceps. It was painless. Theres a tiny wire that goes a few millimeters into the skin and an adhesive covering with a button containing the electronics.

The wearable button stores data for up to 8 hours. The other part of the kit is a reader that downloads data every time you bring the reader within an inch or two of the button. As long as you take a reading every 8 hours or less, you wont lose any data. And you can do it as often as you like, to get real time feedback on your glucose state.

The wearable button ($45) is meant to last two weeks, and then it must be discarded. My insurance (Blue Cross Medicare Advantage) wouldnt pay for it because I didnt have a diagnosis of diabetes. I found this out only after several trips to the drug store, interspersed with phone calls to Blue Cross, where I got repeated assurances that it would be covered. The reader ($85) can be reused. Apparently, it doesnt do anything that a cell phone app couldnt do, but Abbott (parent company of Freestyle) has arranged it so that you can only use the cell phone app if you purchase the reader.

To analyze historic data, you can use capabilities built into the phone app, or plug the reader or cell phone into a computer, using a USB cable. The data is uploaded to aweb sitecontaining analysis tools and an option for creating a CSV file for more detailed manipulation in a spreadsheet. (The download button is not so easy to find, but I called Abbotts tech support number, and connected without excessive wait time to a friendly and knowledgeable technician.)

My intention was to vary the glycemic content of my meals, my exercise schedule, eating and fasting schedule, and the medications I was taking (metformin and berberine) to learn what I could about glucose management. The first day I fasted, and I was concerned to see that all day my fasting glucose ranged between 110 and 120. (For reference: the standard healthy range for fasting glucose is 70-100. Below 70 is hypoglycemia. Above 100 is pre-diabetes and above 125 is type 2 diabetes.)

I ate a meal, and glucose shot up to 179 before bedtime, only gradually coming back down during the night. As it turned out, 179 was my high for the week.

The data is cut off after 10 days, though the monitor is supposed to have a lifetime of 14, because it fell off my arm. I looked for patterns in my data, and was able to learn only four things:

(In a long phone support session with an Abbott representative, they acknowledged the reality of my experience: that the monitor can loosen over time, resulting in readings that are anomalously low. They were happy to replace the monitor, and advised me against long periods of swimming. )

Unresolved

I was left wondering all the things I wanted to discover at the beginning of my experiment.

The thing that impressed me most was the natural variability of blood sugar, changing from hour to hour, uncorrelated with either food or exercise. I trust the body knows what its doing. Le corps a ses raisons que la raison ne connait pas.*

I hope to try the monitor for 2 weeks again when swimming season is over.

In the meantime, I am taking a modest, common-sense approach. I am going to leave out metformin but continue daily exercise and low doses of berberine andGynostemma, lightening my evening meal and ending the days food 3 hours before bedtime.

Walking burns calories (pulls sugar from the blood) 3 to 5 times as fast as sitting, and walking after a meal feels like a natural and pleasant thing to do. My doctor recommends it. Im going to try walking half an hour after breakfast and dinner, pending my next experiment with the CGM.

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What I Learned from the Glucose... - ScienceBlog.com

Regarding proposals on how best to commemorate the 100th anniversary of the creation of the state of the six counties of Northern Ireland, the initiative of the Irish National Caucus has already been endorsed by thousands of Irish-Americans, Irish in Ireland, and Irish worldwide. And it keeps on growing in support. As of this writing, it has been endorsed by almost 15,000 people who are committed to international human rights, national self-determination, justice, solidarity, non-discrimination, equality, reconciliation, unity and peace.

The initiative is the Caucus internet Petition: Ireland, too, has the right to be One Nation under God, indivisible, with liberty and justice from all. http://www.change.org/IrelandOneNation.

Our petition although inspired by, and based on, the famed American Pledge of Allegiance is universal in its appeal and intention, evoking what is best in the human heart regarding the fundamental issue of justice and peace.

The Petition is ecumenical, inclusive, all-embracing for Protestants, Catholics and Dissenters. That is the implication of The Beloved Community.

The new mini-state of the six counties came into existence in 1921 but the imperial, racist/sectarian Act (Government of Ireland Act, Partition Act) was enacted December 23 1920, in Englands parliament.

So, the buck stops there and nowhere else. It was not the unionists who created Northern Ireland. No amount of fudging or abuse of language can deny or cover-up this reality. Englands ridiculous border in Ireland is not just a line on the map. It is a construct of discredited empire thinking and hubris. Far from being just a line it had the power to cause death and destruction for almost a 100 years. And, it has currently the power to pull the north out of the European Union some line, eh?

I use the term Englands empire rather than the British empire because we can hardly blame Wales or Scotland especially since Scotland now seems to be heading towards independence. It was always England that was the major culprit; it just dragged Wales and Scotland along in its evil empire that spread and institutionalised racism/sectarianism across about one-quarter of the earth just lines on the map of course, thats all, eh?

And while we must always be committed to reconciliation, with God and with all Gods children, we must never be reconciled to injustice, inequality, racism and sectarianism on the island of Ireland or anywhere in the world, because, the doing of justice is the primary expectation of God. And as we are talking about lines God says: I will make justice the line and righteousness the plummet. (Is.28: 17-18).Now thats the line this Kinawley man can live with.

FR SEAN McMANUSPresident Irish National Caucus, Washington DC

Sinn Fin continuing to play politics with survivors pensions

Sinn Fin has continuously and incessantly worked to stonewall the payment of pensions to survivors of the Troubles. Last week, Martina Anderson MLA said that 800m for pensions would be going to agents of British collusion and those who fought the Brits dirty war meaning that anyone who needs the pension, either colluded with the British during the Troubles or helped fight the dirty war. What a disgusting statement, but sadly SF have shown form in this regard. An issue I and thousands of others have campaigned for is that eligibility for pension payments would be extended to those suffering from psychological injury and PTSD. Our campaign was successful, but now Sinn Fin has

been stonewalling the payment of pensions at least partially on this issue.

Sinn Fin has also refused to nominate the Justice Department to administer the scheme where the cost is to be borne by the executive. A Belfast High Court Judge ruled that this refusal violated the clear, unqualified and unconditional obligation they are under to designate a department to progress and administrate the scheme. This was to be done by establishing a victims payment board by May 29. It is now September without any nomination or groundwork having been done.

SF has slighted the survivors of the violence of the Troubles, has compared them to agents of British collusion and violated its legal duty to provide for pensions. They are playing politics with the lives and suffering of survivors shame on them.

Cllr DENISE MULLENAont, Mid Ulster District Council

Feeneys contention is easily supported by facts

Brian Feeneys contention (August 26) that Northern Ireland is a failed political and economic entity is easily buttressed by the facts. The political failure was ensured in 1922 and the Stormont regimes that followed until after Terence ONeill. Economically, Professor Peter Shirlow should consult a graph of economic and social development in both Irish jurisdictions over the last 100 years and open his eyes to the facts. Brian Feeney hits the headline numbers and repetition is unnecessary. The health service in the Republic has better outcomes than the NHS for perinatal and maternal mortality figures and for longevity of both males and females (80 and 83 years respectively). Medical cards for kids, long-term illness and the elderly over 70 have free health care. The myth of the superiority of the NHS is just that, a myth. Housing prices reflect success and the steady increase in the population where about 16 per cent are not Irish-born speaks for itself as reflected in housing shortages and prices. Covid-19 and work changes will change the housing demands now. The 10 billion free from London every year is a nice deficit filler. That would be about 24m prorata in the Republic. There is also the issue of self-respect and I am proud of the Republic. I remain most concerned about Derry and the north-west in economic terms and hope that the 10bn transfer (handout) continues.

Prof BILL TORMEYBeaumont Hospital, Dublin

Possible MLA savings for taxpayers to ponder

Scotland has one elected representative per 41,756 people (pop 5,470,000 131 elected reps).

Wales has one elected representative per 53,840 people (pop 3,230,490 60 elected reps).

Northern Ireland has one elected representative per 20,907 people (pop 1,881,641 90 elected reps).

If instead off five MLAs per constituency we cut the number to three (40 per cent reduction from 90 seats to 54 seats) it would still leave Northern Ireland with one elected representative per 34,845 people and result in the following estimated annual cost savings to the taxpayer.

Salary 2,020,800 (40 per cent of annual 5,052,000 MLA salary bill)

Expenses 2,246,169 (40 per cent of 2018-2019 5,615,422 MLA expenses bill)

Total annual savings 4,266,969. Maybe the savings could be used to bring back some furloughed workers?

JOHN COYNEOntario, Canada

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England's ridiculous border in Ireland is not 'just a line on the map' - The Irish News

I Hate Suzie (Sky Atlantic) | sky.comThe Unbelievable Story of Carl Beech (BBC Two) | iPlayerThe Truth About Cosmetic Treatments (BBC One) | iPlayerPeter: The Human Cyborg (Channel 4) | 40DA Suitable Boy (BBC One) | iPlayer

Not Billie Pipers intent, no doubt, to outshine every other actor on screen. It just comes naturally. Her latest outing, I Hate Suzie, which she co-created with Lucy Prebble, is a humdinger, and despite genuine in-depth quality to the cast Leila Farzad, Daniel Ings the eyes are drawn remorselessly to Piper, even walking through a crowd or filling a glass in a corner of a vast country kitchen.

Suzie Pickles is a thirtysomething ex-teen star (as is Piper herself) whose phone photos are hacked from the cloud and leaked online. Cue shame, humiliation, public disdain, marriage meltdown and a wholly new questioning of what it means to be famous in an age famed for its censorious hypocrisy.

Piper is now quite the feted actor she remains, for Yerma at the Young Vic, unique in record-breaking critical garlands and quite the grown-up former teen star, quite apart from a couple of interesting marriages (Chris Evans, Laurence Fox). Yet even she, with relative power, has spoken of frustration at getting broadcasters to admit there might be room for possibly more than one drama about a woman falling apart before our eyes every couple of years.

She and Prebble, then, have saved their powder for Sky Atlantic, and it has done them proud. The opening episode (of eight), shown as part of a double bill on Thursday, certainly showcased this as mainly witty and wise; later it will get significantly darker, and all the better for it.

I especially loved the fact that on the fateful morning, when first her mum and then her scary best friend/agent (Farzad) call to tell her of the leak, the team of hipsters that trooped through her door for a photoshoot pot-plant carriers, dog stylists, photographers et al were supremely aware of Suzies fame, but it was just fame as a nebulous aspirational concept: no one knew what she actually did, because none of them watched telly. This is one of the more obviously in-jokes in a bittersweet satire that teems with subtler digs about the many prices of fame, and those who have the power to confer and wilfully destroy. Immense.

The Unbelievable Story of Carl Beech, aka the Nick of the entirely fabricated VIP paedo ring, must still give some hardened coppers midnight sweats. Its not just the lack of even the most cursory investigation of the laughable list of injuries (snake bites?) imposed by the alleged torturers Edward Heath, Leon Brittan etc, and they didnt even interview Beechs wife until about two years later. But its mainly that.

The normally impressive film-maker Vanessa Engle, while still forensic in her processing, may have let off too lightly both Tom Watson and a few of the media organisations, the BBC included, which had taken up the cudgels (I suspect the programme was carefully lawyered). But she certainly illuminated, by pointing out the danger, post-Savile, of the pendulum being allowed to swing in the entire opposite direction. Surely the absolutism of believing every word a victim ever says is the same absolutism as believing nothing they ever say?

I wish I hadnt watched in the same direct timeline The Truth About Cosmetic Treatments doc and Peter: The Human Cyborg, though at least I managed it in the right order. Had I tackled the impossibly brave story of Peter Scott-Morgan first, I honestly doubt whether Id have had the compassion to tackle a few whiny niggles about crows feet with anything other than withering savagery.

As it was, Michael Mosley, in a double-hander with Mehreen Baig, performed a valuable service in highlighting the strange lacuna that makes the UK about the only place on the globe where the 3bn annual cosmetic industry is almost entirely unregulated. In one survey, 83% of practitioners were found to have no medical training.

For this was not about outright surgery but soft surgery injections of hyaluronics and Botox, of limited longevity, which can be administered on the high street, in salons or by Superdrug, and demand for which has grown exponentially during lockdown. Soft surgery lies, I took from this, somewhere between the hilarious super-scam of sugar-pill homeopathy and the less fun stuff under knockout gas on the slab. And its growingly acceptable even for twentysomethings, who really dont have anything to worry about yet. Yet even Mosley grew, for him, almost cross when he said: I would certainly recommend that you check the qualifications of the person whos about to stick needles in your face.

The concluding episode this week will ask Are selfies to blame for our obsession with cosmetic surgery?, which means at least a third of an hours programme will be about a question that could simply be dealt with in a three-letter answer.

And so to Peter Scott-Morgan, an impressive ebullience of a man who was diagnosed with motor neurone disease a few years ago and decided technology was his only way out of a death sentence. Helped immensely by his being one of the worlds leading roboticists and possibly the leading expert on complex-system dynamics.

From his home in Torbay, Scott-Morgan and his partner of 40 years, Frank, have for four years planned his transformation into a human cyborg. We saw Scott-Morgan, astonishingly, standing, breathing and feeding anew, every vicious little MND attack countered by sheer clever. He was stoic and cheerful in the main, although the poignancy of having to choose ones last few spoken words before the tracheotomy consigned him to voicebox forever, was terribly affecting. This documentary left him in mid-March. An urgent update from Channel 4 soonest, please! Just to let us know hes surviving lockdown lock-in.

A Suitable Boy ended its Sunday run with garlands and sweet smiles, a breathless railway station proposal, a be-petalled wedding, sunsets all round. Lata married the nice safe shoemaker, who unselfishly loved her, rather than eloping with passion; Im hoping the entitled poet and (especially) his truly crap verse never really got a look-in.

While going down well enough with some audiences, Ive always been conscious of this series frustrated desire to do justice to Vikram Seths anvil of a novel, hence it has seemed underwhelming. The performances, and certainly the settings, were there; the ambition wasnt. It suffered perhaps from a six-week-only run, although maybe budgets wouldnt stretch to 10.

I think the mistake was, from the off, to have all characters speaking not Hindi or Urdu but either cut-glass English or an unfortunate singsong simulacrum of the same that just reminded one of dire Milligan-Sellers head-waggery. Subtitles are no longer to be feared: the BBC surely learned that from its Saturday Beeb Four Scandi-dramas, so why not for its mainstream Sunday nights? Patronising? Oh, how clever of you to notice

Once-feted adapter Andrew Davies did well to cram a lot into a relatively tiny sack, and some at least will have learned a vague little about the tense dual birth of the Indian subcontinent. Yet, coming soon after his rightly maligned Sanditon, I suspect Davies will not be counting 2019-2020 as a most suitable year.

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The week in TV: I Hate Suzie; Peter: The Human Cyborg; A Suitable Boy and more review - The Guardian

When the Arab Spring protests erupted in 2010, many political pundits predicted the uprisings would ripple through the entire region and ultimately reach the oil-rich Gulf states, sweeping away monarchies.

But ultimately, the Gulf monarchies of Kuwait, Oman, Qatar, Saudi Arabia, the United Arab Emirates and to a lesser extent, Bahrain were the least affected by the Arab Spring. These six Gulf monarchies were more successful in weathering the political storm than their republican neighbours, which in some cases were plunged into civil wars with a heavy humanitarian and economic toll.

I spent a good deal of my life in the region and during the uncertain times of the Arab Spring, so curious colleagues ask me how the Gulf monarchies continue to hold on. In response, I draw not on my memories but on my political training. And I believe there are lessons to learn from the durability of these regimes that could enhance global efforts to understand the region and build sustainable peace in the Middle East.

I generally scoff at the argument that Gulf monarchies have only managed to navigate the tricky waters of the regions geopolitics and avoided a mass exodus of their citizens because of their oil wealth. This popular wisdom holds that petrodollars allow the Gulf monarchies to coax people into submission, and thats why they endure.

Missing from this assessment is acknowledgement that the Gulf monarchies arent the only countries in the broader region with ample hydrocarbon riches. Yet petrodollars in the broader region that often benefited citizens of those countries didnt prevent public anger or major challenges to authority.

Brief comparisons between the Gulf monarchies and other oil-producing countries in the region reveal other common ground besides oil, such as culture and religion. Yet their respective trajectories since the 1950s Gulf monarchies modernized quickly, while other oil-exporting countries (for example Iraq, Libya, Algeria and Iran) have undergone political crises, coups and even regime change. Thats only added to the sense that Gulf monarchies and other oil-producing countries in the region are heading in different directions.

So oil alone doesnt explain the longevity of the Gulf monarchies. Other factors help explain their success.

First and foremost is whether people in the Gulf region see monarchy as a legitimate form of government. In Western political thought, elections represent one of the key benchmarks for judging the legitimacy of government. This is the foundation of participatory democracy.

By this token, only leaders from presidential republics pass muster in terms of Western legitimacy. After all, these countries hold regular presidential elections.

But are those elections themselves legitimate?

In 2011, at the height of the Arab Spring, Elliott Abrams, deputy national security adviser to former U.S. President George W. Bush, wrote that Arab monarchies are more legitimate than the false republics. This assessment raises two critical issues.

The first is the reliability of elections in the Gulf. Presidential elections in Middle Eastern republics have often been fraudulent. It would make a mockery of democracy to consider these elections proof of legitimacy.

The second concerns the compatibility between society and its political institutions. This is one of the pillars of stability in any society. Hereditary monarchies like the ones in the Gulf arent a novelty for the native cultures of the region. These monarchies therefore derive legitimacy from the fit between their royal institutions and the cultural norms of their people. This is a traditional form of political legitimacy.

With their emphasis on tradition, hierarchy, loyalties and social alliances, monarchies are accepted by many of the cultures of the Arabian Peninsula. The Gulf monarchies were borne out of their own socio-cultural heritages, and this gives them more legitimacy.

This legitimacy however sets certain limits on executive authority and places demands on the monarchs, who are expected to be arbiters between competing interests benevolent stabilizers, so to speak. In fact, problems have arisen when monarchs fail to project this image or perform this role.

An example is Bahrains mass protests in 2011, when many citizens felt their king showed little commitment to the principles of compromise and moderation that had largely characterized his predecessors reign.

The arbiter status gives the monarchs respect and authority, which enables them to rule at distance.

This has helped them maintain power with less reliance on force than their non-monarchy neighbours, which base their claims for legitimacy on political ideology like nationalism and independence. More often than not, these ideologies dont resonate with people. This poses a major challenge to their ability to maintain power, so the republics rely more on force and security to maintain power.

This best expresses itself in Syria, where the Al-Assad regime has ruled for decades through a network of overlapping security agencies to enforce questionable legitimacy.

Thats why the regional republics were hit harder by the Arab Spring. Popular uprisings there were fuelled by greater discontent.

This has spared the Gulf monarchies from frequent legitimacy crises and allowed them to divert resources to other aspects of governance, like building state capacity. This refers to the ability of governments to employ administrative and technical processes, rather than force, to address societal challenges and create stability.

State capacity is bound with a countrys investment in education and human capital, which in turn create a capacity for informed decision-making. This is evident in the volume of publications by Gulf universities. Despite the relative youth of universities in Gulf monarchy states most of them were founded in the mid-1970s they outperform their counterparts in Arab republics in terms of quantity of publications.

The future success of the Gulf monarchies probably hinges on further investment in education.

Doing so will enhance the quantity and quality of intellectual activity and produce citizens who can share power, steer economies in response to societal and technological challenges and guarantee long-term stability.

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Why the Gulf monarchies have survived - The Conversation CA

Dozens of Nova Scotians took to the streets of downtown Halifax on Tuesday, protesting on behalf of relatives in long-term care homes (LTCs), who have seldom been able to see their loved ones during the COVID-19 pandemic.

The marchers alleged the isolation LTC residents experienced is a violation of basic human rights. They called on the provincial government to immediately empower family caregivers to tend to their relatives inside these facilities.

We dont have years to deal with this, or months. We need to do something now, said Catherine Johnston, whose father has severe Parkinsons disease and lives in the Camp Hill Veterans Memorial Building.

Long-term care patients have had such severe restrictions, they dont have the same human rights the rest of us have.

Under current provincial restrictions, outdoor visitation with up to five visitors per resident is permitted at LTCs, and indoor visitation is allowed closely supervised and with personal protective equipment for one person per resident at a time.

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Family can accompany LTC residents to medical appointments and there is no cap on the number of people a resident can designate for indoor visits.

The Department of Health and Wellness has said these rules reflect safety as its top priority.

It said it recognizes the valuable role played by family caregivers, but visitation will remain limited in accordance with Public Health guidance and the abilities of each LTC residence.

We understand that COVID-19 has been particularly difficult on those who live and work in long-term care, as well as their loved ones, wrote spokesperson Carole Rankin on Tuesday.

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Recent outbreaks in long-term care facilities in Manitoba are important reminders of how quickly it can spread We continue to monitor the epidemiology and risks in LTC facilities to implement appropriate directives and policies that balance the needs for social interaction and the safety of residents and staff from an outbreak.

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Given the staffing and space restrictions at many facilities in the province, however, families say they often remain limited to one visit per week at arms length, lasting less than an hour in total.

As the rest of Nova Scotia enjoys the freedom of mobility and access to goods and services, families at the protest say their loved ones health is deteriorating.

I have a tough time here, I hate this place, Trudy Needler read from a letter her father at Northwood Halifax wrote on Friday.

I eat crappy food three times a day, but have had to stay indoors all the time, laying on my bed, staying in my room Mostly in the jail here.

The families are demanding daily access to LTC residents for at least two designated and trained family caregivers. They demand the government funds the training, which would educate caregivers in testing, screening and infection control requirements in LTCs.

They say training, combined with personal protective equipment, would alleviate some of the burden on LTC workers and allow them to provide critical care while posing a minimal risk of transmitting the novel coronavirus.

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We understood that for the first two months, there were big concerns about transmission, said Lesley Barnes, whose father Terry Barnes lives at Camp Hill.

The institution looks after the physical needs of the patient extremely well, but the psychological, emotional health really affects longevity.

According to a July report from the National Institute on Ageing, the restrictive visitation measures in place during COVID-19 have caused significant concern among experts that substantial and potentially irreversible harm may be done to LTC residents.

It also says some restrictive visitor policies may violate the rights of residents to make informed and risk-based decisions which prioritize their access to visitors over the risks of them contracting COVID-19.

That report, providing an evidence-informed guidance document for re-opening Canadian LTCs during the pandemic, advocates for a more balanced approach that differentiates between general visitors and essential family caregivers.

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It recommends dropping restrictions on the length of time and frequency of family caregivers visits, provided it doesnt hinder other LTC operations, along with unhindered indoor and outdoor access to LTCs for those caregivers.

2020 Global News, a division of Corus Entertainment Inc.

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I hate this place: Families protest on behalf of long-term care residents, compare isolation to prison - Global News