This is FDA Patient Safety News. In this edition, a new type of coronary stent that may help prevent restenosis, an alert about counterfeit lipitor, a warning about serious burns from rotary surgical handpieces, and a possible link between syringes and amniocentesis problems. These stories and more on this edition of FDA Patient Safety News. Welcome to the program. For the U.S. Food and Drug Administration, I'm Mark Barnett. And I'm Anita Reiner. Let's start with some medical products FDA recently approved. In a recent news release, FDA announced the approval of a new drug-alluding stent for angioplasty. The device is called the Cypher Serolimus Alluding Coronary Stent, and it's manufactured by Cordus Corporation with a license from Wyeth Pharmaceuticals for the use of the drug. Mark, stenting is a pretty common way to keep occluded vessels open. What's so different about this stent? What's different about this stent is that it gradually releases a drug to help prevent restenosis. The drug is Serolimus. It's an immunosuppressant that acts to help prevent restenosis, possibly by inhibiting the proliferation of smooth muscle and endothelial cells. There are a lot of angioplasties done in this country. I'm assuming this device could have a pretty significant impact. Probably a significant impact in reducing the incidence of restenosis. About 800,000 angioplasty procedures are performed in the U.S. each year, and restenosis occurs in about 15 to 30 percent of them. In a U.S. study of about 1,000 patients, the restenosis rate among those who received the drug-alluding stent was about 9 percent compared to about 36 percent for those who received the conventional stent. The combined occurrence of repeat angioplasty, bypass surgery, myocardial infarctions, and death was about 9 percent for patients with a drug-alluding stent and about 21 percent for the other patients. Any limits on FDA's approval? Yes, the device was not studied under certain conditions. For example, the safety and effectiveness of this device weren't studied for blockages longer than 30 millimeters or for arteries narrower than 15 millimeters. Also not studied were patients who had their occlusions in bypass grafts, those who had previous intravascular radiation therapy, and those in whom the stent might be used during an infarction. Are the company's studies over? No, they're not over. As a matter of fact, there are more studies to come. FDA is requiring the manufacturer to conduct a 2,000-patient post-approval study to assess the long-term safety and effectiveness of the device and to look for rare adverse events that might result from using this product. In a recent talk paper, FDA announced that it had cleared for marketing a new type of diagnostic device to help monitor an asthma patient's response to anti-inflammatory treatment. The test, called the NIOX Nitric Oxide Test System, is manufactured by Erichron AB of Sweden. It works by measuring nitric oxide concentration in the patient's breath. The test is based on recent evidence that nitric oxide levels are increased in asthma patients and that these levels may rise or fall depending on the effectiveness of the anti-inflammatory treatment. In general, a reduction in nitric oxide levels may indicate whether or not an individual's asthma treatment is working. To use the device, a mouthpiece is placed in the patient's mouth connected by a breathing tube to an air supply and computer. The patient inhales air that's free of nitric oxide then slowly exhales into the mouthpiece. The nitric oxide concentration in the exhaled air is immediately displayed on the computer screen. FDA has recently approved three new products used to treat rare conditions. Fabrozyme, made by Genzyme Corporation, is used to treat fibrous disease and aldurazyme is used to treat several genetic disorders, including hurler syndrome. Both of these products are biotech drugs produced by recombinant DNA technology. The third product is Sumovert, made by Pharmacea Corporation. It's a growth hormone receptor antagonist and it's used to treat achromegaly. These approvals were granted under what's known as the Orphan Drug Act. This law provides for research grants and other incentives that encourage manufacturers to develop new drugs and biologics to treat rare conditions, those that affect fewer than 200,000 people in the U.S. One important incentive is that the company that makes the first product developed to treat a rare disease is allowed seven years of exclusive marketing for that product. Considering the small number of patients affected by these diseases, firms wouldn't be inclined to invest the time and money in product development and testing without these incentives. The Orphan Drug Act was signed into law in 1983 and since then it's been used to approve more than 200 products used to treat rare conditions including Crohn's disease, Hansen's disease, sickle selenemia, bleeding disorders like hemophilia A and B, rare cancers and leukemias, and the PCP pneumonia that affects HIV A's patients. FDA is alerting health care providers and patients about a recall of several lots of the cholesterol lowering drug Lipitor. The product in these lots is Counterfit Lipitor and it represents a potentially significant risk to consumers. The label on the counterfeit product says repackaged by Medpro Incorporated Lexington, Nebraska 68850. Health care providers and patients should check Lipitor packaging very carefully before using this product. Patients who have any product from these lots that are labeled as repackaged by Medpro Incorporated should be instructed not to take it and instead return the product to their pharmacies. FDA is continuing to investigate this counterfeigning incident so check our website frequently for updates. FDA has received several reports of serious medication errors, some of them fatal, with the drug Temadar manufactured by Shearing. This drug is a chemotherapeutic agent used to treat adult patients with refractory anoplastic astrocytoma. Temadar comes in four strengths, 5 milligrams, 20 milligrams, 100 milligrams and 250 milligrams. Each of those strengths is available in two package sizes, either five or 20 capsules per bottle. Unfortunately the milligram strength and the number of capsules per bottle appear alongside each other on the label and that's been the source of some of the errors. The number of capsules can be misread as the strength in milligrams and vice versa. One woman who was supposed to receive 20 milligram capsules actually received 250 milligram capsules because the 20 capsules on the label was misread as 20 milligrams. She died 10 days later. The FDA is working with the manufacturer to change the labeling so it's clearer. But in the meantime, Anita, if I'm a health professional what can I do to prevent this problem from occurring? Well there are a couple of things to do. First, the FDA recommends that you circle or highlight the milligram strength on the label to distinguish it from the number of tablets. As an alternative, you can dispense the temadar in unit dose form rather than from a multiple dose bottle. Wasn't the dosing schedule also a problem with this drug? Yes, in fact it was and in certain cases the drug was used too long. The dosing schedule for temadar calls for five consecutive days of treatment in each 28 day dosing cycle followed by 23 days off the drug. In some of the reported cases it was used far longer than that. One patient died after taking the drug for 22 consecutive days and another died after taking the drug five times a week for three consecutive weeks. It's not clear whether these errors were due to miscommunication by the pharmacist or non-compliance by the patient. What's the FDA recommending to prevent this kind of a problem? Well actually we're recommending two things. First, don't dispense more than a five-day supply of the drug at one time and second, be sure to clarify all orders or prescriptions that are vague or unclear about the dosage or dosing instructions. FDA has received several dozen reports of patient burns when rotary surgical handpiece is overheated. Some of the burns have been serious enough to later require plastic surgery. Medical personnel have also been burned by these devices. Surgical handpieces are used in a variety of orthopedic and general surgical procedures to cut shape or drill tissue. Almost all of them have bearings that allow the cutting tools to spin at high speeds. In normal use the bearing lubricant is slowly removed by repeated cleaning and sterilization. If the lubricant isn't replenished regularly the bearings will degrade and eventually disintegrate and the handpiece can overheat. Here's how to help keep the handpiece in safe working order. First inspect and test these devices regularly to look for evidence of overheating and be sure to do this before each use. Check to see when the handpieces were last serviced and lubricated and follow the manufacturer's instructions for servicing and lubrication. Most manufacturers of these devices recommend that the units be returned to them for servicing every year but no matter who does the regular servicing the bearings should still be properly lubricated. FDA has recently received reports in which cell growth was inhibited in amniocentesis cell cultures. This seems to have happened when the amniotic fluid wasn't transferred quickly from the collection syringe to the transport tube. Initial testing suggests that this inhibition of cell growth may be caused by the syringe stopper, the black rubber like grommet, on the end of the plunger rod. If I'm doing amniocentesis work how can I prevent this problem from happening? Well there are at least two things to do. The manufacturers of the affected syringes have sent letters to labs and clinicians suggesting two precautions to help avoid this kind of inhibition of cell growth. First they said minimize the time the amniotic fluid stays in the syringe. The fluid should be transferred to the transport tube as soon as possible and not stored in the syringe. And second keep the amniotic fluid from coming into contact with the stopper by keeping the syringe tipped down until the fluid is transferred. Now do these recommendations apply just to amniocentesis? Well not necessarily. Although the recent reports have only concerned amniocentesis syringe manufacturers note that these recommendations should be followed any time a syringe is used to collect amniotic fluid or other primary cell samples. They also emphasize that these syringes can still be safely used for routine clinical applications like blood collection and intravenous or hypodermic injections. We'll continue to work with syringe manufacturers on this issue and we'll update you with any new information. The Institute for Safe Medication Practices has reported on several cases where a mix up between two products led to unnecessary treatment. The products are the vaccine tetanus de theriotoxoid and tuberculin PPD both manufactured by the same company, Aventus Pasteur. In these situations, a series of patients who are supposed to get PPD skin tests inadvertently received intradermal injections of the TD vaccine instead. The reactions from the TD injections were read as positive PPDs and the patients were started on isoniazid. The errors were discovered after staff noticed a cluster of positive PPD skin tests. The patients were retested and the INH therapy was stopped after the retests were negative. ISMP points out that the similar packaging of these two products may have contributed to the errors. They both come in stylized colorful cartons, although the carton colors do differ. Both products are available in cartons of the same size and both have a circle on the front panel with the number five in it. Both products are stored in the refrigerator and may be located side by side. So if your facility uses these Aventus products, be particularly alert to this possible mix up. ISMP also suggests removing TD and other vaccines from floor stock if feasible and have the pharmacy dispense the vaccine instead. Before we go, we wanted to draw your attention to several recently updated FDA websites. First, there's FDA SARS page. Here you can find out what FDA is doing to help develop SARS treatments, vaccines and diagnostic tools. You'll also find FDA's guidance for blood establishments on safeguarding the blood supply, including recommendations on deferring potential blood donors who have had SARS or may have been exposed to SARS. On a different site, there's revised guidance for blood establishments on assessing donors for West Nile infection. In particular, there's a new recommendation that donors be asked a specific question about whether they've experienced a fever with headache within the week prior to donation. And finally, some people have been asking whether they can use flu vaccine left over from last year for this coming season's immunizations since the composition of this year's vaccine is going to be the same as last year's. FDA does not recommend this because last year's vaccine will be past its expiration date and the potency of the vaccine may have declined. Well, that's all for this edition of FDA patient safety news. Remember, you can get more information on all the stories you've seen here today by visiting our website. We also urge you to use the website to report problems you've encountered with medical products. That's how we learn about problems so we can alert others. We'll be back next month with another edition, so watch for us. Until then, for the U.S. Food and Drug Administration, I'm Anita Rainer. And I'm Mark Barnett. See you next time.


Everybody for us to your rip in 2023 tops chrome black baseball hobby 12 box case number 12 pick your team style We've got a shams with the Orioles Aaron K. Padres and mariners Aaron E. Giants Onica with the Royals Byron has the Rangers Ching Wah blue jays Chris B. Marlins Christopher M. Twins Christopher S. Phillies Christopher K with the Mets Daniel LD backs Douglas Nationals Edward Cardinals Eric with the White Sox Hunter Tigers Jesse K. Yankees Jordan Anaraki's Kale F. Brewer's Mark a A's Matthew F. Angels Nate S. Pirates Potion with the Reds Ryan B. Braves Ryan D with the Astros Scott T. Reyes Suginori Red Sox Simon M. Cubs Vaughn has Cleveland and Victor with the Dodgers Thank You Matthew L. Couple spots in master work Getting there in the first master work First master work is down to 11. Love it Love that Like I said two teams left in definitive only Rockies and Marlins affordable teams there with some decent chases for being inexpensive like that and Then one-on-one is nine to go. We usually for that guys two teams for spot tiered case One and one basketball. It's been a minute since you do one-on-one, right? Probably been like almost a week. Maybe since like Sunday. Yeah, that's that's high-risk high reward But there usually is a couple spots. I do super well and that stuff send a Facebook post here. There we go All right, let's do it is just cut more of the tape. I thought I cut enough of it Decently strong tape Hey, good luck CK. What's up scooter? I want to pull a super out of this pretty bad. I Would enjoy that not gonna lie Sure somebody who hits one will be will be happy as well refractor to 499 or to 199 Excuse me, Luis Castillo for Seattle Tom Fletcher. All right first auto of the break is going to be a Peter Lonzo Auto for the Mets. There you go. CK first one going to you Polar Pete very nice Here you go see I can't start a whole lot better than that, right?  Happy Friday to you. Happy Friday to everybody Hey net eight last weekend before the holiday weekends Good stuff, man.  It is Bernie Williams Bernie with the Yanks The cool vet hit. Yeah, I think he'll uh, I Think Boris will make him test for agency for sure I think there's a good chance he was back to the Mets though Volpe rookie base blue refractor to 75 Wanderfranco rays to they hey good stuff, Rich Finalized most of new job details planning to go find in the department generally good stuff, dude And there's our guy rookie refractor auto Red Sox Masatake Yoshida 34 of 150 34 is poppy Jersey, that's a little poppy right there then Actually, I think he might be deaching more this year. Yeah, he's not poppy. He's a great hitter. Love that guy Glad we glad we signed that guy Keep him around Get a get his buddy Yamamoto on the Red Sox get that guy out there Striking out all those fools. Yeah, I'm not sure about yet. Yeah, I'm a motos price. It's just gonna be so high it seems like now Langliers purple mini diamond Bobby went to 150 Kansas City. Those are sharp Byron Buxton Next auto is rangers Marcus Semi and 37 of 150 on the refractor auto. Oh That's a hard-hitting question Victor. That's a hard-hitting question. I think since it's a Christmas party I think I'd say prime rib But either man, I might go I have to go crab legs either way. I'm gonna be like happy and sad I'm going for the crab Think crab legs are more expensive for pounds So I might go crap so good, man. Can I see what they look like before I? Get nice and seasoned right? Oh They got my go crab legs. Yeah, that I'm thinking about I'm like, oh, yeah Green to 99 is Ozzy Abbey's for the Braves. Oh, hoppe And John Smoltz auto for Atlanta It's a Christmas party. You can also if you eat prime rib and then have like two drinks You're gonna pass out. You're gonna fall asleep on some couch or something Bradley's you can just Before I move back up here my guys all you can eat crab legs and dude, I can't I don't know how long we're there, man I'm trying to I think I'm gonna go out since I'm working Monday daytime this year. I'm gonna Take wife out to dinner.   Oh, yeah It's like her favorite that crab place, but my house is supposed to be good. You know what it's called That Sam Sam does he goes there. Okay Sam does blue wave nice rookie Adley Rushman Sorry blue lava Adley 37 of 75 good stuff for Baltimore Sweet Adley was good on the black to love shoemaker There's actually two crap places Hold rookie autograph Jordan Groshan's Marlins 15 of 50 Yeah, I was gonna say if it was like bone and ribeye that might sway it, but if it's primary, I think I'm a crab If it's like a real good ribeye I would tear it up Probably could probably shouldn't Yeah, and if you're allergic to shellfish, yeah Terrible business Boy Garrett call Yankees the 50 and And next is an auto J. Roll for the fills. Let's go new illegal school legal J. Roll Jimmy Rollins There we go, let's go magic get some breaks filled up let's go magic So with the bed thinking I lost this last bed, I mean, I'm like, I don't know this stuff I woke up and I hit it. There you go One team to go in definitive nine to go still on one and one nine in our first masterwork, too Everybody filled up guys. Let's do it Bobby Cox that dude lived to get ejected This John rookie to 199 we got a boba shut for the blue J's refractor Rory does have a great point there What what's better left over so I could take some home then make the other the next day.   All right orange here is rookie Paraza yanks 4 to 25 Yanks Paraza rookie orange nice got Coloss there and then auto for the Brewer's Prince fielder That dude Seriously, that's terrible dude. He demolished the baseballs and food. Yeah That guy lived the dream honestly like the modern-day Babe Ruth. You could absolutely rake God, right Prince was so sick. Dangers Magic. Let's go Anthony black pass. Oh, that's a charge. Yeah Baby refractor to 199 Bryce Harper for the Phillies Yeah, it is where the Hamid his dad did had the exact same career home run total It's so weird man. Baseball is weird like that though. Oh, yeah Base auto Luis Robert White Sox good hit White Sox Remember the one Cecil hit out of Detroit like out of Detroit It was still going up when it was out of that building. It was insane on there for your dad I feel like if you're a Brewer's fan Prince Fielder was like your favorite player. Oh It was like my version of like David Ortiz Yes, so was your favorite Ricky variation nice Tristan cost us for the Red Sox He's vegetarian too, there you go, dude Tristan cost us Ricky for the Red Sox in the variation green wave the 99 Correa for the twins There's one on one last night What was there one in one last night basketball, I don't know there was one last night Green auto to 99 that's awesome D train for the Marlins Dantro Willis That's sick coming earlier today.  That's sick for Florida right there or Miami in the break. Well, Florida Marlins Miami Marlins They should keep they keep Miami name good to go back to the old the old stuff, dude Just change it up to the teal. You can update the logo with the M instead of the F. Yeah, do it, dude Get those teal pinstripes fire Tigers Dantro Willis G's dude. All right numbered cards. We had Bichette Castillo Suzuki Bobby Witt's Ozzy Albee's Reynolds Correa Rutschman blue lava rookie Wander Alcantara Garrett Cole orange Paraza I'm sorry about that. I'm sorry. He's going to three breaks man. That's tough But yeah, fortunately chrome black. It can be like that Lubeb white socks Prince fielder for the Brewers J. Roll Phillies Smolts for the Braves Bernie for the Yankees Bernie polar Pete for the Mets Jayrod for the Mariners Semi into 150 Rangers Yoshida to 150 Red Sox D-Train the 99 for the Marlins Gold Groschans Marlins Marlins to well there and then orange drew waters for KC. Thanks everybody random teams coming up next


Welcome to Toffy TV. It is the Everton News Daily. This video is sponsored by One Football. One Football's app makes it easy to keep up-to-date with transfer news, scores and stats all in one place. To download the One Football app, click the link in the description below. Is that simple? Get it done. Get it done. Onto the stories today. Marco Silva has been speaking after Everton's 2-2 draw with Waffa at the Gwladzun Park. Last night and said that he didn't like the second half performance. Marco, you're not the only one. Don't think any of us liked the second half performance. See, we did not have control of the game in some moments we played with speed but not enough and we have to do better. You also be moan the fact that we give up two goals very quickly and very cheaply. And I think all of us would echo that really poor goal so you can see both of them. And it led a game that we were certainly in the first half. I thought we were in control of the second half. Waffa with a better side. But conceding those two goals, it just let the game slip away from us almost. We had obviously the Guilfee Cigars and Penalty Miss and it's frustrating because we were playing really well. Of late that just dropped off so we just need to pick ourselves back up for a big game at the weekend of course at Manchester City. They got some injury problems of their own as well and have a Champions League game this week. So let's hope we can bounce back at the weekend. Lucas Dean scored his first goal for Everton, that free kick in the 96 minute. Absolutely brilliant left footers strike into the top corner. And in doing so ended an unwanted record of 801 days without a goal directly from a free kick. Since Romelu Lukaku's free kick against Crystal Palace in the Ronald Cuminera. It's shocking and I'm sure we bought a set piece specialist from Swansea for like 45 million who used to make taking free kicks look like having a free shot at goal. But thankfully it's being done now. Everton today have been linked with Abdulai Dekore, the 25 year old Waffa McFeel player who was excellent. Particularly in the second half last night, scored Waffa's second goal of course. A player who Marco Silva knows all about, bought to the club by Marco Silva. He's got seven goals last season from centre of midfield. That was his second of the season last night and just showed us everything what you need to be a box-a-box powerful midfield player last night. Very range, you get about the pitch quickly, presses you know can score goals strong in the tackle. And I think if Everton could get him he'd be a fantastic addition in that midfield alongside Andre Gomez and players like that. So whether we can get him off Waffa there's a different question altogether isn't it? But certainly that link is there again today. Gary Neville has been speaking today and apparently has said that Andre Gomez is good enough for Manchester United and Tottenham.  He's staying as, so put your eyes elsewhere. Otherwise I'm going to start coming down to United and taking the likes of Lukaku and Marcial and Rashford off Mangi. Cos he might just be good enough to get an Everton side. Beautiful. Nicola Vlasic has been talking again today. What a surprise and said that it would be an easy decision for him to stay at CSKA Moscow. He feels like it's his club but it's up to Everton ultimately what happens in the summer. But he'd be happy to remain where he is. He's won the player of the month at Moscow for three months running.  What else have we got? Chris Sutton has said that Phil Foden should join Everton on loan. He's not going to get a Manchester City team, he may get into Everton's midfield. He's said that it would be a really good place for him to develop. Cos he just can't see him breaking into the Manchester City side at the moment. There you go. What more can you say with that? Finally Everton's under-23 clash against Bayern Munich will be streamed live to season ticket holders and members of Evertonia on the Everton website. So that should be interesting, it should be a good game. Let's see what Bayern Munich's under-23s are like. Let's see what kind of side David Moyes will put out, Will Ellis Sims be part of that squad. It's going to be an interesting one to keep an eye out. If you haven't subscribed please do so. It only takes a second if you want more videos. Get over it and join us on Patreon. And if you want to order a Christmas jumper you've only got till Thursday and then that is it. The deadline shuts. Slam shut on Thursday. Thanks for watching. See you soon on Toffy TV.


Next question is from Tones Verone. What are ways to mentally deal with the forever moving goal posts of your fitness goals and journey? I like this. This is a good, by the way, this is a transitory period that you get into when you're stuck. When you do fitness consistently, long enough, right? At first, you're very motivated by the building more, burning more, stronger, improved performance. At some point, you can't possibly keep improving. At some point, you'll hit a limit, right? If there were no limits, I mean, by this point, I should be able to deadlift 8,000 pounds, right? There's always going to be limits. How do you keep yourself motivated when I'm not going to build that much more muscle? I'm not going to gain that much more strength. I'm not going to burn more body fat. You have to learn to enjoy the workout for the sake of the workout itself. You have to enjoy the process and being present. It's like the man who enjoys walking is going to walk much further than the man who's walking to get to a particular point. Like, if you just enjoy walking, you'll never stop. It's the destination. Yes. At some point. The journey, I should say. At some point, you have to just love doing it just for the sake of doing it. And that'll keep you consistent forever. I also think the answer or the strategy to this is to change the walk. Instead of all, change the goal. You know, I think we're always so caught up in the aesthetics, right? What do I look like? Or how strong am I? It's like, man, there's so many neat fitness goals, health goals that you can pursue. You do this all the time. There's a whole multitude of them out there. I mean, I found this early on and I love to do this. And I switch. In fact, if anything, I have a habit of like, a new goal and I do it for a while. I'm already ready for a new goal. And I change, change a lot instead of like probably sticking with something long enough. But that's also what keeps me interested is I might go on a kick, let's say for three months. And I want to get as good as Justin or as close as I can get as good as him at swinging a May spell. And that in itself, there's a lot that goes into that. It's not simply just watching him swing it and then going and doing it every single workout. There's a lot of work I have to put into to be able to get to that ability to do that. And that's a simple goal. Or I want to watch my Turkish getup go from 40 pounds to 100 pounds or I do. Now I want to build all this muscle or I want to get faster or I want to build stamina. Like I just think that it's and I think all of that is great. It's our all great pursuits. And so instead of always getting focused on how strong are you or what do you look like? Try, try changing the journey, try changing the path. Try instead of always moving the goalpost further away, try going for a whole different goal. I totally agree. That was the direction I was going to go. It's just like, dude, there's just so many different modalities out there. There's so many different types of skills that you can acquire along this journey. It's not just build muscle, burn fat. I know that's what draws people in and that's what's the most popular. And this is what I used to struggle with so much as a trainer because I'm trying to voice that there's so many other pursuits within this, you know, this industry that could benefit you on so many different levels like just the overall quality and articulation of your joints, the joint health, like mobility, learning something like yoga in order to then provide peace and calm and meditation in your life that you're probably lacking by pursuing these goals so aggressively for so long, you know, maybe doing completely opposite of what you've been doing is going to benefit. So you're not going to know that until you really step into that realm. Oh, and what's awesome and at least what's happened for me is every time I pursue one of these new goals, I learned something new about myself or I learned something new about training that way that ends up caring and benefiting something somewhere else. For example, the pursuit of the deadlift thing for me, like getting really strong, the deadlift was purely out of like competition with Sal. It's like, oh, we just started hanging out around that time. These guys were strong in the squat and deadlift. I never even once focused. That was never a goal of mine. Okay. I'm going to make it a goal. How strong can I get in the deadlift? While I did it, I had this crazy side effect that built the best back that I've ever had. That wasn't even the goal. The goal was just to catch Sal in the deadlift. Now along the way, I got this great side effect. Same thing happened when I won the mobility kick. I was so frustrated that I had this chronic low back pain and that I couldn't break 90 degrees without my heels coming off and I lacked the ankle mobility and the hip mobility. And I remember Dr. Brink breaking me down and I was like, man, I didn't realize how much I suck. And I was like, I want to get really good at this. What ended up happening is a side effect. I ended up getting this incredibly deep squat. I can now squat less weight and I have the same or better development in my legs than what I had when I was squatting significantly more than that. So when you start pursuing these different goals, a lot of times you start to learn some new things about your body or you see how much it ends up carrying over into another goal that you may want to pursue. You guys make great points because I think people, and by the way, what you'll notice that Justin and Adam just said were all kinds of different goals. I think sometimes people get stuck in the basic goals. Get leaner, build more, get stronger, get faster. Those are all goals, but you can really narrow down to very specifics like I just learned this new exercise. I want to get good at it or I want to work out with more stamina or I want to see if I can work out with lighter weight and get a better pump. Like you could create lots of small, and there's literally an infinite number of goals you can create for yourself. But I do, again, I want to make the point like if you enjoy exercise for the sake of it, you'll never stop. For me, it's extremely meditative. So it doesn't matter if I'm strong. It doesn't matter if I'm weak. It doesn't matter if what's going on in my life. I've had terrible things happen and then my workouts become a way to help myself process. I've been through times when my body feels great and strong and how I'm training completely differently. It's a tool and it'll benefit you and it can be molded to benefit you and improve your quality of life in tremendous amounts of ways. And when you do that, it's something, and I remember I learned this from some of my old members. They would come in and work out and I remember, how did you stay so consistent? Like, well, it makes my life better and it really doesn't matter. I'm always going to do something and I think that's a good place to be because at some point you get older and your performance is going to decline. You could be the absolute most fit person, most consistent person, but at some point you're going to end up losing strength no matter what you do. You're going to lose endurance no matter what you do.  It's because it's something that improves the quality of your life regardless. Along those lines, if you haven't gone through the webinar that Justin did for Prime, so mapsprimewebinar.com. It's free. Watch it. He takes you through the three tests. Sal talking about training to enjoy the process and being more meditative and feeling better. When was the last time you ever built a routine around literally all the things that your body needs to feel better? Forget getting super strong or buff or ripped. I used to love doing this where do go through an assessment right there, find all your imbalances on your body, and then the way you build the routine is around the fortification sessions. It's all around things that is going to improve your posture, improve your health, and make you feel better.  You walk out of the gym and you're like, whoa, I feel so good. I've never felt that good before because I've switched my mentality of the way I'm training right now. Another great pursuit, if that's all you're looking for is to feel better. I agree.


Welcome to CSIS. My name is Andy Kutchins, and I'm director of the Russia and Eurasia program. And I'm very pleased to welcome to CSIS an old friend and colleague, Dr. Mikhail Dmitriev, the president of New Economic Growth. Dr. Dmitriev has become known of late in Moscow and even referred to by the Moscow Times as Russia's Nostradamus. He doesn't like it when I say that because it puts a lot of pressure on him. But he and his colleagues several years ago wrote a couple of reports in 2011 that on the basis of working with focus groups and also a lot of empirical research, sociological, economic, demographic, and looking at how the social attitudes in Russia are changing and what their implications were for political change and political stability in Russia. And I think it is fair to say that nobody came closer than Dr. Dmitriev and his colleagues to predicting what could possibly happen if there were a sense that the Duma elections of 2011 would be falsified. It's quite remarkable. But Dr. Dmitriev has a long and distinguished history of both research and policy making in Russia. From 2000 to 2004, he was the first deputy minister of economic development and trade and very, very active in beginning to implement what was then known as the GRF program, which he had worked together with German and others to develop before taking that position. He was also first deputy minister of labor and social development from 1997 to 1998, a member of the commission on economic reforms of the government of the Russian Federation in 1994-1985, and a People's Deputy of Russia to the first democratically elected parliament in Russian history. He's also worked in a number of Russia's leading think tanks, the Carnegie Moscow Center, the Institute for Economic Analysis, and the Center of Strategic Research where he served as the president. He's played a major role in designing Russia's public sector reforms, pension, health, education, and administrative reforms. And I can only say that every time I have a discussion with Mikhail Dmitriev, I learn a lot, and I think you will too this afternoon on a very interesting topic of changes in social attitudes in Russia and their political implications. Nisha, welcome to CSIS. Thank you. Thank you, Andrey. Very recently we have completed our new report, which was focused on something which seems to have appalled many observers and Russians themselves. Why did the Russian public opinion and the political situation in Russia was subject to such wild series of fluctuations, which leave an impression of something near to chaos, which is so randomized, that difficult to predict and explain. And on the other hand, the situation in which Russian society finds itself today prompts to somewhat simplistic explanations of what has happened. And the simplistic explanation is something which is reflected in the world values map, which you see on this chart. Basically, that Russia has slide into a sort of value divide with the West, which is almost insurmountable. And this gap is the major reason why Russian society is somewhat stepped away from the mainstream social modernization pattern, which was so promising during the previous decade. In my view, both extreme agnosticism, which suggests that it is almost impossible to explain and predict the current developments in Russia, and this extremely pessimistic oversimplification of a sort of the clash between the Russian and the Western civilizations, both are not the best ways to understand and explain what's happening in Russia. And our recent report attempts to try to more thoroughly scan the data available. And what we did, we did some sequencing of all the information which we have for the period which begins from the year 2000. This is not only the year when Vladimir Putin was first elected President of Russia, but this is also the year which preempted the period of very fast economic growth. And what we discovered is that many dimensions of Russian social dynamics, including social priorities and attitudes, approval of the authorities, protest propensity, and the role of official media, do really change in some sort of synchronization with some fundamental changes in public attitudes. But these changes are not about values. Russian values were somewhat inert. They were actually converging with the values of the advanced economy, but very slowly. It may take a couple more generations to full conversions, which I'm quite confident will happen with time. But what was changing more fast and less predictable were the current economic attitudes and priorities. This attitude change was very closely linked to economic growth and growth of Russian consumption. And these changes in economic priorities of the Russian population somehow coincided with many other political and economic changes. So this sequencing seems to be quite promising, not only in explaining what happened with the Russian society during the last few years, but may also be quite useful in making some scenarios which may help to predict and understand not for the long term, but at least in the medium term for the next couple of years. So my final part of the presentation will be focused on these scenarios, but to really understand why these scenarios seem to be feasible and plausible. I would first try to go along this sequence of change which the Russian society undergone. And this is where it all began in the year 2000. This chart plots the priorities of Russians according to one of the opinion polls of the Publication Union Foundation in 2002. And there were many similar polls during that time which indicated the same set of priorities. These priorities reflect the outcome of the deep and protracted recession of 1990s, when Russians suffered so much that the only emphasis in their expectations was current consumption. Everything else was of much lesser priority, particularly the issues of development such as education, here anything related to problems of culture, science, health and education, only 5% of respondents. Housing 2% of respondents. Even the threat of civil war with regard to the Chechen agenda, which was quite important at that time, it was no longer important at all. Everything was focused on current consumption. And that was the major dimension which changed in the aftermath due to a very simple development. What followed was an unprecedented period of the growth of current consumption. There were many changes in the Russian economy, but nothing changed so fast as current consumption of the Russian population. In just 13 years from 1999 to 1913, Russian household consumption, in real terms, as a component of national accounts, increased two-point style. This is incredible for Russia. It never happened before in the whole history of the country. And as we discovered, it turned to be a sort of defining point in the attitude change and political behavior which followed it. As soon as 2012, we discovered that Russian public priorities had somehow shifted towards a very different set of issues. Here's the chart which reflects our own survey carried out in 2012. Such a distribution of priorities before was observed only among the middle class, which was still a minority of the Russian public. Not a negligible minority, but still a minority. But by 2012, we suddenly discovered that majority of the Russian public expressed as a number one priority, housing and utilities agenda, then health, good governance and education. Current consumption, here is the smallest circle in the lowest part of this diagram, was mentioned only somewhere around the lowest quartile of the whole list of problems. It suddenly stopped to be important. And the reason is clear. Current consumption of Russians by that time has already been nearly saturated. 2013 was the year when Russia's per capita incomes on purchasing power parity achieved a historic ever maximum by comparison to those of the United States. 46%. It was never achieved before. And if we take current consumption in this regard, the gap was even smaller. In fact, in many dimensions of current consumption, it has already neared the levels of advanced economy. For example, the motorization of the large and medium sized cities in Russia. Some of them, particularly the largest ones like Moscow, St. Petersburg and Yekaterinburg, have a larger number of cars per 100 households than Paris, Helsinki or London. By the number of cell phones per 100 households, Russia number number two or three in the world. And as well ahead of the vast majority of the advanced economies too. And there were many other areas including the consumption of expensive electronic gadgets like smartphones, flat screen TVs, computers where Russia was catching up very rapidly. And quite naturally with per capita GDP, 24,000 dollars on purchasing power parity today, this excessive emphasis of current consumption could no longer have delivered any more marginal utility. Basically, you can't just consume more of these smart gadgets or computers if you have already two or three of them in the households as many Russian households do really have. But on the other hand, there was a clear lag behind this progress in those areas like health, education and housing. And of course the rule of law and quality of governance. And when the priorities of Russians began to shift towards those areas of public good, which were under-delivered and under-consumed, what we discovered that the capacity of the economic and social system to deliver them was rather poor by comparison with the growing demand. Here we have two similar surveys which were carried out with support of the Erhard Foundation and the Institute of Sociology in 2003 and 2014. Both surveys were focused on the middle class. And this spreadsheet indicates how large share of the Russian middle class registered any of their achievements in different areas in three years preceding the poll. And as we see from this table, the ability of the middle class to achieve something on improving their education, getting a better job and promotion, starting new business and improving housing, all these possibilities have considerably deteriorated in the three years preceding 2014. Exactly when the priorities shifted towards those issues of human development and self-achievement and expression. And in some areas like starting a new business, getting promotion or, for example, improving education and qualification, this decline was somewhere between two to three times. Very considerable. So when these issues were not at all the priorities for majority of Russians at the break of the millennium, the possibilities to achieve in those areas was much larger than when these issues became a priority. No one that at least generated a lot of tension and frustration. This is by no coincidence that exactly during this period we had a mass wave of new type of political protests, which for the first time erupted in the larger cities like Moscow and St. Petersburg and were focused not on current consumption, incomes and social transfers as the Russian protests before, but were focused mostly on the civic agenda, better governments, reduced corruption, fair elections, better environments and improvement of health and education services. So this was coming hand in hand, very closely all together. And provided that protests didn't help and the ability to achieve improvements in such areas as health, education or housing were not making any further progress during these three years. We've got a sort of climax of disappointment, not during the protests of 2011-2012, but by the end of 2014, exactly before Russia incorporated Crimea and exactly before this dramatic turning point in the public opinion. By the end of 2015, both the survey data and here we have various charts which reflect this shift by the end of 2014. There was a Levada sensor pulse to slide those charts which indicate that by 2015 social sentiments have deteriorated to record low, approval of authorities declined, support for the centralized political system has declined, support for Vladimir Putin, at least according to Levada data, was reaching the lowest points in the previous three years. And the respondents were somehow losing, almost completely losing faith in the ability of Russia to develop. It was a very gloomy pessimistic period. Our own qualitative survey was carried out exactly at that time in December 2013 and after this, the data collection, we even decided not to publish it because the shift in public opinion was so radical that we thought we need to verify the data and we were planning for a more comprehensive quantitative study in spring of 2014. But in spring of 2014 this confirmation study was no longer sensible because the public opinion has already switched towards a completely different agenda. And what we feel that without this very gloomy, most, I would say, pessimistic point in the history of public attitude change in Russia in the end of 2014, the extreme overshooting of the public opinion which happened around the incorporation of Crimea was accompanied by the boost to record high of approval of Vladimir Putin political system, consolidation of the society around foreign policy agenda and enormous, incredible increase in the influence of the official media. This overshooting would not have been possible if not for this particularly gloomy period which preceded the incorporation of Crimea in 2014. The peculiar feature of this period was that public frustration began to be redirected towards some specific subjects at home. We suddenly discovered both in our data and this is the divided data which is pretty consistent with what we discovered from our own service was that suddenly an aggression towards ethnic migrants increased quite dramatically. And there were two particular social categories to which the aggression of respondents was redirected at that period. One were ethnic migrants and the second were public officials, not the top of them, not Vladimir Putin himself, but just rank and file civil servants whom the respondents were blaming for many of the troubles which were blocking in their view the sustainable progress in countries economic and social development. And then suddenly we had this sudden swing of public opinion when Russia carried out Olympic Games which were considered as a great success and a huge reputational benefit for Russia. At least the Russian public considered it that way, that Russia was really a big success. Russian team was unprecedentedly effective and over performing throughout the whole history of Winter Olympics and the majority of the public was very proud and then suddenly just less than a month from this event Russia managed to incorporate Crimea and at that time it happened rather smoothly without any large-scale military confrontation it was an easy event which triggered a lot of symbolic resonance in the public opinion. Basically the Russians, this is the date from September the same year it indicates which were the major sources of approval of the Russian government from the majority of the public opinion. We see that the public was particularly appreciative at that time on the achievements of the government in the foreign policy area. So lack of progress at home with all the development agenda with the economic growth with social environment and effective governance suddenly was compensated by a flow of achievements outside in foreign policy. The perception of Russia as a proven world power which prevailed at that time in the Russian consciousness was associated with compensating achievements outside the country which somehow distracted public concerns at home and this is why there was so much overshooting. Public pessimism has found a sort of rewarding area where they found a lot of opportunities for countries self-esteem and self-assertiveness and for some time it really was boosting public opinion in a very optimistic way. But this period was quite short historical. What happened next was that in the second half of 2014 the negative side of foreign policy developments began to show up. Economic sanctions, decline of oil prices, and the beginning of economic crisis particularly a deep rubble currency devaluation strongly affected the state of public mind and majority of Russians at that time reassessed their attitude towards foreign policy. It was no longer considered as a source of successful achievements. It was reconsidered more as a source of existential threats, the source of potential war, conflict and economic crisis. And at that time the issue of foreign policy and Ukrainian conflict has already become part of new national ideology. So because of that the public opinion in the polls was somehow self-sensitive. People were inclined to give on those issues sort of normative answers not because they were afraid to be suppressed by the officials. This was not right and we saw that from our own sociological data as well but because they thought it was morally improper to give different answers. This is why to somehow measure more accurately how the economic crisis and adverse developments around international conflict affected Russian public opinion we used psychological methods, standard projective tests which we applied to the public to test the attitude, the perception of the effectiveness of the foreign policy. What we did is that was in December 2014. Waxed our respondents to associate Russia and the president of Russia with any animals of their choice. And we asked them to do this for two specific periods of time, the beginning of the year and the end of the year. What we discovered was that relative informal statute of the animal in the animal kingdom has declined by majority of respondents. Animals were bigger and stronger in the beginning of the year but they were smaller and weaker in the end of the year. And two thirds of respondents really associated Russia with weaker animals in the end of the year. We must remember that by that time rubble divided by almost 50%. And that was a shocking event. People were quite frustrated. Focus of public opinion was shifted towards economic problems at home and basically this on a subconscious level was reflected and associated in the assessment of Russia's might as a great international power. When we used another proxy, when we measured the weight of each particular animal on Wikipedia and calculated average wage of an animal in the beginning of the year and in the end of the year we received this chart. Actually the decline in the average wage almost neatly coincided with currency devaluation from January 10 to December 10 that year which really indicates how closely the economic difficulties of Russia were translated into perception of the foreign policy and ability of the country to achieve as a great power at the international arena. And this sort of disappointing outcome was accompanied by growing frustration. But this time these were not any social groups at home which became the focus of this aggression. The aggression switched towards outside. And here's the chart from Levada data which indicates attitudes of Russians towards the United States. Just within nine months between January 14 and September 14 negative share of Russians which indicated negative attitude towards the United States jumped more than four times from relatively small 18% to 82% which was record breaking for the whole history of observations. And to some extent the West became a sort of lightning rod which refocused on itself in aggression and dissatisfaction with an ability of achievement not just at home but also in the foreign policy which has become already clear by the end of 2014. That was not the only development because another important development in the attitude change which closely correlated with political behavior was that economic crisis and growing foreign threats as they were perceived by majority of Russians in that period they have crowded out completely the development agenda from the public consciousness. Here we see the public opinion foundation questionnaires which were pulled from September 2014 to January 2015 several times and we see that the agenda which was gaining in importance was consisting of just two components the issues of economic crisis and the issues of foreign policy threats. Everything else particularly the development issues were coming down quite dramatically for example the issues of health and education were among the highest priorities very recently in September 2014 but by January 2014 they were entirely crowded out by the foreign policy crisis the threats of war and the economic agenda. And these concerns all other issues related with development roads, efficient governments, health, alcoholism, drug addiction, culture, moral effects everything was going down to low single digit figures. Basically here is a sort of comparative chart which gives an idea how Russian public opinion has made a sort of U-turn during the last 15 years. We started from the chart which I have already shown at the beginning the priorities of Russians in 2002 and the chart at the right side are the priorities of Russians which were revealed in the same type of questionnaire by the public opinion foundation which type of questions the Russians were prepared to ask to Vladimir Putin during his recent direct line which took place on April 16 this year and we see that these charts are in a way quite identical number one priority in both of them are current consumption because of the crisis current consumption declined and it crowded out all the rest of the agenda even the problems of foreign affairs are no longer so important at least according to this poll. The health education once again they are in low single digits 3% are concerned with health education and housing this more complicated advanced development agenda is not important until there is a recession and until the issue of declining income will not have been resolved but the difference perhaps is the lowest column in the left chart the lowest column it's quite big 26% indicates no answer or irrelevant answer but the meaning of the same column in the right chart is very different and we must notice that this is the largest column in the chart 46% what happened with that column in April 2016 was that it reflects the number of Russians which were not interested to ask questions to Vladimir Putin and the public opinion foundation specifically mentioned that one of the most widespread reasons why Russians were reluctant to ask questions as they themselves explained was that they considered Putin's direct line as a sort of window dressing the event which doesn't give real answers to the most important problems which are of public concern today so people were quite skeptical and this skepticism was not observed in 2002 that's perhaps the major difference between the two charts which we see in this table all these changes were somehow synchronous with the changes in the protest behavior and here are the main findings from the protest data which we can find what was happening is that Russia during the last 25 years experienced several big waves of protest activity but until 2011 these waves of protest activity were very similar to what was happening in other medium income countries with more or less non-democratic political regimes these were economic protests scattered outside the capital with almost exceptionally economic demand wage areas, higher wages, lower inflation, lower utility tariffs, higher social benefits that's it, not about politics, not about human development, not about environment, not about anything else and the prevalent repertoire of protests were somewhat self-damaging forms of protest like hunger strikes, strikes or road blockades what happened recently when the public priorities shifted towards the development agenda from survival and current consumption was that we had an outbreak of very different type of protests in 2011-2012 these were the protests which were centralized in the capital in Moscow or at least in major, larger metropolitan areas in cities like St. Petersburg, Katerinburg, Konizhny Novgorod they were the protests which were focused not on economic agenda but on political and civic problems like good governance, fair elections or environment and in the protest repertoire the demonstrations dominated over any other type of protests this pattern is pretty similar to the type of protest activity which is typical to advanced democracies this is not our own survey, this is the paper series of research which was carried out by Graham Robertson during 2010-2012 he worked with pretty comprehensive databases on protests and these are his conclusions and we see that the transition to a more modernized pattern of protest behavior in Russia coincided with a shift towards priorities of development from current consumption and priorities of survival what was also particularly interesting that very recently in the end of 2014 we discovered that when the priorities of Russians detached again from the development agenda and the maiden U-turn towards more traditionalist agenda of survival and current consumption Russians re-evaluated retrospectively their attitude towards the protests of 2011-2012 towards the modernized wave of protests typical to advanced democracies development agenda was no longer a priority and majority of Russians turned their attitude to this wave of protests into a negative we were quite surprised by that but when we mapped this with the attitude change it was quite understandable, development priorities were no longer an agenda and the type of protest which was focused mainly on human development and modernization was no longer relevant and majority of Russians were now associating the protests in Moscow which took place during the election period of 2011-2012 with the Ukrainian revolution on Maidan in early 2014 they associated this protest with a sort of pretty politically disruptive event which caused huge economic problems for the country actually generated a very deep economic recession was disruptive in political terms and eventually brought the country to the edge of territorial disintegration so now Russians associate this completely different type of protest technically it is hard to associate the protests of 2011-2012 with Ukrainian Maidan because Russian protests were nonviolent and they pursued pretty different agenda from what happened in Maidan but in mass conscience they are associated and the general attitude turned to the negative and still does it mean that Russians are no longer going to protest? Not at all economic sentiments because of the crisis has gone down to record low here are different measures of economic sentiments of Russians one to the left is the chat of Frostat and another is the index of financial sentiments by Sberbank both are very low and because everything is focused on economic performance the major motivation for protest which stands still very high this is the date of October 2014 are the protests on economic reasons the protests which were typical for Russian society in late 1990s and immediately in the aftermath of 2008-2009 economic crisis we had similar wave of protests in 2010 22,000 protest events in just two months May and June 2010 so now once again Russian society is focused on traditional type of economic protests not typical to advanced democratic societies but rather typical to medium income non-democratic economies and all other reasons for protests stand very low clearly propensity for economic protests is associated with economic sentiments if you look at the right chat at the extreme end of the lines in the right chat we see the dense green line which is going very very low these are the financial sentiments of Moscovites Moscov by February this year was the most strongly negatively affected by the crisis in terms of economic perceptions and this is by no accident that's Levada opinion polls carried out in February indicated that protest intentions in Moscov were much higher than in any other major type of settlements across Russian Federation economic sentiments were down and protest intentions were also rising when Russia may be hit by a new wave of economic protests however there is usually a lag we are still at the lowest point of economic recession but from our past experience for example from the experience of 1990s and from the previous crisis of 2008-2009 we know that usually the protests envelope by the end of recession then when economy already begins to exit from the recession enters the recovery period and then economic protests envelope so it's a little bit too early to expect immediate wave of economic protests in Russia but still they may quite possibly happen later not before the autumn of this year but maybe in the end of the year or in spring of 2016 how all this affected the dynamics of political ratings the approval ratings of the Russian president until very recently all the evidence collected by Daniel Trisman on the basis of Levadas and opinion polls and here is pretty similar evidence from the FCM servers plotted by the GP Morgan analysts they indicate all the same that approval ratings of the Russian presidents are closely linked to economic sentiments of Russians as soon as economic sentiments declined approval ratings of the presidents usually go down as well historically in the past there was not a single period when approval ratings of the president did not decline after the economic sentiments considerably declined here we see that during 2009 this happened with a lag according to FCM survey economic sentiments went down rapidly this is the thin black line going down in 2009 and the approval ratings of the president were declining somewhat slowly but in three years the lines came together once again to a standard trend level which means that approval ratings of Russian presidents did eventually adjust to economic sentiments but if we look at the extreme right part of the scale here is somewhere around 2015 we shall discover that for the first time we have some sort of departure from this trend that is economic sentiments are already very very low this is a measure it doesn't show too dramatic decline but according to all other measures the decline is very deep compatible to what happened in 2009 but the approval ratings of Vladimir Putin did not decline on the contrary by March this year and he is one of the measures of electoral rating of Vladimir Putin by public opinion foundation they reached historic maximum ever 75% electoral rating, approval ratings over 80% this can no longer be explained by economic sentiments and the reason why it happened we see with the overshooting of the public opinion which happened because of international crisis we actually discovered that defensive patriotism was already quite important in terms of defining some sort of damage proof ceiling for the presidential approval in 2013 we carried out a number of psychological tests which indicated that Russians were very serious about associating Vladimir Putin with a leader who is capable of defending country from the foreign threats and this was very important in defining how many Russians do really approve the president but at that time no foreign threat was considered as activated this defensive patriotism attitude was still in a latent form but during 2014 foreign threats became real at least as they were perceived by majority of Russians so the defensive patriotism factor was converted into an activated form and this is the main reason now of you which sustains approval ratings of the president and record high level in spite of declining economic sentiments and before we are turning to trying to formulate possible medium term scenarios of political and social change in Russia I would like to make a few comments on the role of official media as I have already mentioned official media has suddenly surprised everyone in 2014 by how much influence it suddenly obtained up to 95% of Russians were responding in the polls that were exceptionally receiving information about the Ukrainian international conflict which is associated with Ukraine through the major official television channels this is particularly striking because just couple of months before in the end of 2015 opinion polls indicated that the influence of official television channels was standing at record low basically the balance of individuals who trust and mistrust official TV was only 1% only 1% more trusted official TV than mistrusted it if we take for example news websites FM radio or printed media which was much more independent and less affected by the official ideological control the approval ratings or trust ratings of this channel were much higher the balance of trust for example for the websites printed media and FM stations were right between 14% to 20% much much more than the official TV channel and suddenly they became just a few months later they become much less trusted than the official TV this overshooting could only have happened because the messages which the official propaganda was channeled during 2014 resonated very naturally with the prevalent public attitudes public attitudes switched to foreign policy agenda it was initially interpreted as in terms of enormous achievements of Russia which compensated for the lack of achievements at home and the official media very skilfully resonated to this public attitude and this explanation now of you seems to be quite convincing if we plot the periods of declining and increasing influence of official media retrospectively we actually had a sort of roller coaster game roller coaster ride of official media influence during the past 15 years of Russian history and if we take the periods when the influence of the media stood very low these were the periods when the media was trying to influence public opinion against the tide, against the direction of the tide against the fundamental change, direction of change of the public opinion which was generated by some basic social and economic factors for example one of the striking periods was the privilege monetization in 2005 when the government attempted with one strike to abolish the traditional Soviet social privileges for the vulnerable groups which were inherited from the Soviet social security system this proved to be so that unpopular that any efforts of the media were completely rare because the survivor status of the population run completely against this type of reforms and the media was entirely helpless, presidential ratings went down there was a wave of public protests, authorities were pretty concerned nobody listened to official media the same happened by the end of 2013 at the peak of public disappointment with development agenda official TV channels proved to be completely helpless and were losing influence very rapidly but on the other hand when their impact coincided with fundamental change for example when Dmitry Medvedev in 2007 launched priority national projects which were the topics of these priority national projects which were health, education and housing in five years from that health education and housing came to the top of the priority agenda of majority of Russians not because of the official propaganda or official policy priorities because these official propaganda and priorities nicely coincide with fundamental vector of change of the public opinion and in 2014 it happened the same way the excessive strength of the official media which was appalling simply became possible only because it very naturally resonated with the fundamental attitude change of the Russian public at the eve of Ukrainian crisis and because of growing foreign threats and official media is still trying to ride this wave, to serve this wave in the direction of growing anxiety with the foreign threats and aggression towards the West as the population perceived the West as an adversary but what may happen if for example the conflict in Ukraine is diffused that there is a sort of peaceful settlement tension around Ukraine goes down and the priorities are fully focused on the current economic recession most likely the support towards all of official media and presidential ratings which stems from the foreign policy agenda will go down and then negative economic sentiments will work their way the influence of media in that case will become to diminish as it happened during the monetization reform or during 2014 simply because the media will try to run against the mainstream direction of the wave it will try to change the fundamental vector of the public opinion and it was never successful in doing that so if we turn to the medium term scenarios I'm strongly skeptical that we can make confident assumptions of what can happen in Russia for longer than a couple of years this is our focusing horizon for the moment but in this relatively short to medium term the major switching factor which can affect political and social scenarios in Russia is the Ukrainian conflict if the Ukrainian conflict is diffused it is very likely that public opinion in Russia will pretty soon shift once again towards the mainstream development agenda why will it happen? because Ukrainian conflict at the moment drags down Russian economy which creates an atmosphere of uncertainty for the business and economic sanctions also work quite negatively in terms of economic performance so if the sanctions are lifted and the anxiety with regard to the foreign policy uncertainty comes down most likely exit from the recession will be rather fast and as soon as economic growth resumes excessive focus on current consumption and current economic survival will disappear with the current per capita incomes of 20 per capita GDP of $24,000 per person in Russia it's impossible to get focused too much and for too long on current consumption anymore once again priorities which switch to a more broad and more complex development agenda health education, effective governments, rule of law, housing and so on and the government will be confronted once again with the challenges of delivery on these issues this also means that the approval ratings of the president are likely to go down first because of very low economic sentiments and later on possibly because of the disappointment with the delivery on human development priorities but what may happen next will strongly depend on the ability of the government to refocus their own agenda on the development priorities whether or not the government will be able to come up with a credible development agenda which will seem to be credible to the majority of the public and we don't know if this will happen or not and that will define the public environment around presidential elections of 2018 so we don't know what may happen still the worst scenario is a sort of modernization and middle-income trap in which Russia may find itself if the Ukrainian conflict is protracted in a sort of hot form without long-term lasting peaceful settlement in that case Russian society may easily slide into a sort of visual circle of international conflict combined with economic underperformance they will come hand in hand together and international threats and intense perception of international threats will feed the isolationist attitudes of the public will block trade and cooperation with the advanced economies and also complicate technological transfer public sentiments will stay focused and home on survival without development agenda and basically the society for a sustainable period of time will remain quite disinterested in development and modernization most likely that will mean that in spite of relatively high approval ratings of the president which may be possible in this environment because of foreign threats remaining strong influence of the official media which will be sustained because the perception of the foreign threats will be a dominant factor in the public opinion still we shall have mounting longer-term problems and longer-term problems will be a conflict fatigue people will simply get tired of intense international conflicts and foreign threats and with time they will be more and more concerned with the economic underperformance and these are the longer-term challenges of this scenario it may be tempting to sustain the intensity of foreign conflict in the short term because it really boosts approval ratings of the president and helps to sustain the influence of the official media but in the longer run this will gradually erode and will not working anymore so these are the potential scenarios still I repeat again we cannot make any reliable predictions for the longer horizon this is only about a couple of years ahead no more because indeed Russian society is highly volatile it is in the state of transition and this transition can generate a lot of unpredictable swings thank you Misha that's a remarkably insightful and comprehensive presentation let me take the prerogative of the chair and ask you a couple of questions because it seems to me that we are very close to an inflection point which could lead Russia into one of the two scenarios that you just outlined or perhaps even a more dark scenario than you outlined and by that I mean that the situation today on the ground militarily in Ukraine the question is to whether the Minsk-2 ceasefire agreement will hold and I think that if there were an attack on a clear offensive on Badi Opel by the insurgents or another large city but Badi Opel seems to be the most likely candidate on the Black Sea then that would be interpreted by the West as a breakdown of the Minsk-2 ceasefire and likely tougher sanctions, economic sanctions both by the United States and the Europeans although the Europeans would be somewhat more reluctant and probably likely also the decision on the part of Washington somewhat reluctantly by the Obama administration for sure to start sending lethal defensive weapons to Kiev and my sense is that this would send Russia into the second darker scenario with a longer economic downturn, a longer period of conflict with the West, etc. whereas if the ceasefire agreement manages to hold then there is certainly greater possibility that there could be a de-escalation of the conflict and the more positive scenario that you outlined which one do you think is more likely right now and secondly what would be your advice since we're here in Washington to the policy community, specifically the Obama administration about how to, is there a way that we can somehow influence the outcome to the more positive first scenario as opposed to the second what would be your counsel to policymakers here? Well with regards to the likelihood of the outcome of various outcomes of Ukrainian conflict basically the problem is complicated that no one is in control and the conflict may escalate by a sequence of events in which many sides can be engaged and many sides may contribute in different ways for example there may be some sort of escalation of hostilities in Mariupol which may be accompanied by sending the lethal weapons to Ukraine by United States this will in its turn serve as another boost to escalate the conflict and it will be a sort of self-perpetuating circle of escalation and nobody alone could have been blamed for this outcome because there are many parties and each has a stake and each has an influence in the process so I wouldn't be brave enough to say which probability is higher sustainable peaceful settlement and that means two ceasefire holds or escalation of hostilities in Mariupol both outcomes still remain possible and because the situation is so unpredictable this is the major switching factor between scenarios this is the factor on the outcome of which other elements of Russia's social and political development depend very closely and what the West can do in my view it's important to avoid a sort of considering Russia as an adversary any shift I would say any shift in the attitudes towards Russia as basically the sort of threats would be only contributing to the invigorating of forces inside Russia which isolationist and anti-Western and in this regard it will help to close the counter-modernization trap in which Russia might find itself as a result of Ukrainian crisis so in my view the attitude of the West needs to be highly balanced it should really always keep in mind that Russia society is not lost for economic and social modernization and that in the end there is a high probability of continued convergence economic and social convergence of Russia with the advanced economies they're already considerable wealth accumulated by Russians and relatively advanced state current state of Russian society prompts the continuity of modernization and convergence okay we have some time for questions and discussion please identify yourself for the Dr. Dmitriev and those that are watching our video we have yes right here then Alex say Rick my name is Richard Burt consumption fulfilling consumption needs on the one hand and broader longer-term developmental needs on the other and the different constituencies maybe for those attitudes my only concern here is in terms of your discussion of the last two options because I'm not sure that they're equivalent in the sense of I understand the case you make or the likely implications of a worsening of the situation and escalation and what might flow from that but your first option isn't actually an alternative which would be an overall settlement on the whole question of Ukraine because that really isn't being discussed or on the table now we've talked you and Andrew talked about the Minsk-2 Accords but that's not a settlement that's simply trying to put in case put in place a kind of stable ceasefire for the short term it doesn't address the bigger questions of where Ukraine fits into Europe whether Ukraine is going to migrate into the western orbit whether it will ever become a member of NATO and some of the broader issues that the Russian side has raised for example in the past about some maybe new security framework or structure sorry my phone's just ringing right now how embarrassing but so given that fact isn't there a middle option that's the most likely which analysts are talking about now which is a frozen conflict where there's neither a de-escalation on the one hand but there's neither a settlement on the other and that the Russian government decides that it wants to keep the pot boiling not too much but enough to keep the Ukrainian side off balance to make it impossible for the Ukrainians to carry out kind of deep reaching economic reforms and other reforms they need to do at home it's going to block them from moving closer to Europe and give in a sense the Russian side a kind of permanent voice and maybe even a veto in important questions taken in Kiev so you've got this kind of continuing migraine headache in Europe that continues to keep everyone a little bit off balance intense and concerned and in that case how does that affect Russian opinion over time? Would you like me to ask a question? That's quite a possible outcome but from the point of view of domestic policy perspective this outcome is still likely to detach public attention from foreign policy because public attention today is drawn to foreign policy simply because of intensity of existential threat which means a threat of war if the conflict is outfrozing this means that public is likely to refocus on a pretty hot priority domestic issue which is a recession and current consumption decline this means intensifying economic protests and decline of approval ratings of the president as well as the declining influence of official media so this scenario may seem to be more close to the first one when the public attention will switch to the agenda at home and sooner or later as soon as the country exits from the session and the exit from the session in this scenario is quite likely the public opinion will public attention will switch again to development agenda because high incomes, high level of consumption today does really dictate that this agenda still is the major long to medium term priority that's how I understand these type of developments around Ukraine Alexei? Alexei Sapchenko and my question is the following on one of your charts there was a fascinating bifurcation between the popularity of the president and drop of economic expectations and it happened exactly in 2014 when presidential popularity went up while economic expectations went down which was a contradiction contradicted to the previous trends in other words I have a hypothesis and please tell me if I'm wrong or right but my hunch is that Putin is a very astute political animal he has a very good sense of what Russians want and he is not an imperialist he couldn't care less about Ukraine or Crimea or Ossetia what he does he would like to basically he does what the society wants him to do and in this case he plays a nationalistic card because he knew that the prices were going down he knew that the socio-economic expectations would go down too and basically he was throwing this nationalistic monkey wrench to keep himself going up instead of going down with the economic expectations am I right or wrong? I think you are quite right in terms of the issue of patriotism and the kind of nationalistic attitudes of Russians was taken into account in the whole agenda of decisions around Crimea and Ukraine but as I think what happened a year ago was that the sudden consolidation of Russian society around the Crimean agenda has overshot even the wildest expectations of anybody including the top Russian politicians nobody really expected such an outburst of enthusiasm and in my view it only can be explained because just a few months before the Russian society has found itself in a very depressed state almost hopeless and this sort of sun shining through the dark clouds as Russians perceived Crimea and the Olympic Games was a sort of sign of hope which brought quite a dramatic overshooting of expectations and in my view nobody could really expect that including Vladimir Putin this was a nice surprise for him but it was still a surprise We have time for one other question David As you were talking about the impact David Sedney I'm a senior associate here at CSIS a non-resident you were talking about the validation that the Olympics provided on the positive foreign policy side I was wondering what do you think of the potential for the upcoming celebration of the end of the Second World War as being used in the same kind of way Well of course the Second World War agenda is strongly resonating with this new wave of patriotism and emphasis on foreign policy and it really in a sense should be considered as an attempt to boost this emphasis on foreign policy on the appreciation of the role of Russia as a great international power and boost the pride for the past historic achievements which the parallels can be drawn with what happened in the eyes of Russians in 2014 This is right but in my view as soon as the foreign policy agenda today stops being in the focus of public opinion even the Second World War agenda will also not be so much mobilizing to the public opinion not so much resonating as it would be when everybody is thinking about foreign policy So it of course helps to consolidate public opinion but up to a point until public opinion in itself is naturally focused on foreign policy As soon as it switches to domestic economic problems even the Second World War celebrations will not help to refocus public opinion on more positive aspects of the situation Okay one last question right here on the front please Thank you very much Mr. Dmitry if my name is Daniel Kadribyakov visiting scholar at SIS My question is regarding the newly created economic union and where do you see that union considering that foreign policy foreign policy has been setting the agenda for the Russian people and Putin how is it related to this because Central Asians and former Soviet countries are very negatively viewed by the Russians at the moment because they always think that this is a burden they need to get rid of but in the light of creating and putting putting really hard pressure on the leaders of those countries to get inside of the union and what do you make of this whole situation Thank you Symbolically this economic union which is comprised of certain small former Soviet Union states is important for Russians as we see from opinion polls but the problem with that is that economically this union is not so much important because most of Russia's foreign trade and trade and investment today is with Europe and in the future it will be with China but not with these small economies so the major real problems for Russia are the balance between economic integration with Europe which is now somehow blocked because of the Ukrainian conflict and the future potential for economic integration with China and the states of the former Soviet Union particularly if you deduce the largest economy in Ukraine are sort of economically relatively small factor in this problem and they themselves are also facing the same dilemma they have not just thinking about integrating with Russian economy but also integrating with Chinese economy or partly with European economy so it's the same trade-off for all the countries of the region and even if they somehow converge in some kind of economic integration process this dilemma will go nowhere the problem is with whom this economic union will trade and cooperate more with China or with Europe Thanks I noticed that some of you were taking photos of some of the slides let me just say that Dr. Dimitriyov has agreed to have the slide presentation available on the CSIS website and we will get that up as soon as possible and secondly the report in Russian in which much of this presentation is based is going to be translated shortly into English It is already translated we are doing some final editing and we shall make it available as soon as the editing is ready Ok, great Let me take this opportunity to thank Dr. Dimitriyov for a remarkably insightful, comprehensive and really sophisticated presentation and interpretation of changing social attitudes in Russia and impact on politics Thanks so much for sharing your thoughts with us


Mocha, QUnit, Jasmine, Chai, ProxyQuire, Synon. See, some people say that we have tooling fatigue in the JavaScript community. I don't know what they're talking about. No, never mind. I really don't. So, let's see. We had QUnit back in 2008. It was pretty popular. Yeah, that's the one. Still, people still use it. That's the one that runs in the browser. Yep. It was popularized, I think, by the jQuery project, ran well in CI. Didn't have amazing support for async testing back then, or headless testing support. Yep. Then we had Jasmine come after that. It looks super similar to Mocha, that one. Yeah. Required you using Karma or Jasmine Node for your test runner. Had a headless testing setup out of the box. Lots of CI support, BDD. Nice. Then you had Mocha, which you wanted to talk about today. So, Mocha is like, it's the main reason I like it. You can run it in Node. You can run it in the window. You can run it in a worker. Which, at the moment, I'm doing a ton of stuff testing across browsers, which helps with Node. A ton of stuff where I'm testing like caches in the window, and then service workers, which are workers. So, having Mocha run in all three things is like super nice. And basically the way it works is you just call describe function, pass in a string, and a callback. String defines the test suite, and then the callback is just the thing that gets called by Mocha. And then you start running your tests. Cool. So, a single test is basically called it. Pass in a string of describing what the single test should do, and then another callback, which is like your actual test. You do certain things, and then you'd use like an assertion library to then basically say, this is the thing that I expect to happen. Make sure that this is it. And Mocha's got like async testing helpers like done, but you don't have to use that. No. So, you can pass in done to your callback, and when you call it, that's basically telling Mocha, hey, I finished the test, move on to the next one. But you can also just execute like synchronous code, and it will just figure it out. Or if you return a promise, it'll figure out what to do based off of that. Sure. Normally what you'll end up seeing is people using it with a thing called CHI, which is an assertion library, which basically CHI has two modes. You either use expect or use should. And the difference is meant to be the kind of testing you do. I don't know enough about that to really comment on it. Generally, I use a thing called should from CHI. And basically what that means is whenever you get a value from a function or something, should like adds a ton of stuff to the prototype.  And that's basically the assertion bit. Because if value doesn't equal four, then the whole test will fail, and then Mocha will go, ooh, it doesn't make sense.  So Mocha, CHI, Jasmine, it sounds like you need a lot of caffeine to make it in this industry. Yes. I kind of want us to do our own test runner and just call it like triple venti, half-sweet, caramel, macchiato, Dutch AS. You nearly messed that up. I nearly did. But you pulled it off. I did. I did. I feel good. I feel good about that. I want to get the top of Hacker News with that. Be great. Be great. Just the fact you said that statement means you're going to get downvoted heavily. Most likely. But you're assuming anyone actually watches this show. That sounds so true. So frameworks generally use some of the tools that we talked about just now. And some don't. Ember people, I think, still use EmberQ unit for their stuff. Do these just have helpers around? I think it's just helpers around it mostly. The Angular team for Angular 2, I believe they're still using Jasmine and Karma for their stuff. And on Polymer, we're using Mocha and CHI still with Web Component Tester. So on the whole, it's not entirely all crazy. And then there's Cinder's new one, the Ava. Ava. So Ava is like a concurrent. So I think that's the nice thing about Ava is there's a clear selling point there is the fact that it will run multiple tests simultaneously. I was actually going to try that out, but I hit enough problems with service workers that I wanted it to do bit by bit. But I am hoping that I can kind of switch to Ava as soon as it kind of gets browser support as well. It's got a beautiful logo. Ava's also good for when you're working with tests that are particularly IO heavy, it just deals really well with those. Nice. But yeah, we've probably not covered all of the test runners and libraries ever created in the JavaScript community. 23 more have probably been invented while we've been shooting. Just make sure you use one of them.