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Dying of loneliness: How COVID-19 is killing dementia patients

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Teresa Palmer is sitting on the back porch of her home in San Francisco when the mobile phone in her hand starts to buzz.

A kind, raspy voice inquires from the other end of the line: “Did I wake you?” If the question surprises Palmer, she does not show it. Her reply is plain and swift. “No,” she says: It is past one in the afternoon. She has been awake for hours.

Her mother, Berenice Palmer, is 103 years old. She lives at the San Francisco Campus for Jewish Living, a 15-minute drive south from the cheery blue house where Teresa, 68, and her husband live.

But since March, Teresa has not been able to see Berenice, except for the occasional doctor’s visit, plus that one time Berenice fell and had to get stitches at the emergency room. Teresa was given permission to drive her mother back to the nursing home.

Otherwise, all visitation stopped. Until September, even outdoor visits and window visits – where a patient looks through a window to see a loved one outside – were barred under measures the San Francisco Department of Public Health implemented to stop the spread of the novel coronavirus.

It was a devastating development for dementia patients like Berenice, for whom routine interaction and careful observation are key.

Commonly characterised by a deterioration in memory, thinking and language skills, dementia is a syndrome that can result from any number of diseases or injuries to the brain. Sometimes it is Alzheimer’s. Sometimes a stroke. Sometimes something entirely different.

It is so common, especially among older adults, that the World Health Organization (WHO) estimates that upwards of five percent of the world population over the age of 60 lives with dementia. That is approximately 50 million people worldwide.

Berenice is among the more than 5.8 million with the syndrome in the United States. And today, she is worried. She wants her daughter to find the box with her medical records. She fears her cancer might have returned.

Teresa, herself a retired nursing home doctor, calms her down. She has heard these anxieties before. She is more alarmed to hear Berenice say she has been refusing her salt pills: “They taste bad.”

Instantly, Teresa switches into doctor mode. No more “Mom”: She calls Berenice by her first name, asking her, imploring her, to give straight answers. Berenice has low blood sodium, which can lead to confusion and even seizures. The pills are there to help.

It was Berenice who instilled in Teresa a passion for medicine. A born storyteller from a big Italian family, Berenice came of age during World War II, serving in the United States Naval Reserve, a women’s-only branch of the military often called “WAVES” for short.

Berenice would go on to raise two children – Teresa and her twin brother – while pursuing a career as a licensed vocational nurse and community journalist. As a child, she had survived a diphtheria epidemic. She had seen the poliovirus come and go. Teresa was determined she would outlive COVID-19 too.

‘I was just so afraid my mother would die’

Back on her porch, Teresa tells her mother she will call her back. A second later, she is on the phone with the nursing home. No need to introduce herself beyond “Berenice’s daughter”: The woman who picks up instantly recognises her. They talk strategy. Mixing the salt pills in yoghurt has not worked. What about apple sauce?

Feeling reassured, Teresa rings her mother again. They talk at least once a day. “She, unlike others, is alert enough to call me when she has a complaint. And sometimes she calls me instead of the nurses,” Teresa explains. They chat about dinner plans. Teresa promises to order her mother a pizza.

Her mother has increasing difficulty dialling phone numbers, though. She relies on the operator to connect her instead. But even that is a blessing, Teresa says. “God help the people who can’t.”

[Jawahir Al-Naimi/Al Jazeera]

Since the start of the coronavirus pandemic, nursing homes and other communal living facilities have been particularly hard hit, with the virus spreading more easily in confined spaces. The elderly are especially vulnerable.

But for those living with dementia, the threat comes not only from COVID-19 itself but from the very same practices meant to stop it, like quarantining. The Alzheimer’s Society in the United Kingdom reports that 82 percent of dementia patients surveyed showed deterioration since lockdown measures were put in place. That includes memory loss, difficulty concentrating and increased agitation.

And in the US, between February 1 and October 9 of this year, the Centers for Disease Control and Prevention reported 30,248 more dementia-related deaths than average, compared to data from 2015 through 2019.

Experts fear that isolation and lack of supervision, plus an overburdened healthcare system, may be contributing to the excess deaths. “It’s such a mess that we have to rethink how we do this, completely,” Teresa says. “I was just so afraid my mother was going to die.”

The decision Teresa took to place her mother in a nursing home four years ago was not an easy one. Teresa was suffering from complications of rheumatoid arthritis. Her mother was living in her spare room, and she needed constant attention. Left alone, Berenice could wander out onto the street. She could not remember whether it was day or night.

“My husband and I were both exhausted and had no privacy,” Teresa explains. Hired caregivers would come in and out of the house, and Berenice, always the extrovert, loved to be the centre of attention. “If we would try to have a conversation about something else, she would interrupt us.”

As her medical needs grew too great to handle at home, Berenice went to live at the San Francisco Campus for Jewish Living. There, Teresa says, her mother had group activities and other outlets to share her outgoing personality. But much of that interaction stopped with the pandemic.

Teresa first found out that visitors were barred when a friend tried to stop by. “He came back on that Friday, on March 10, and said, ‘They won’t let me in. They shut down’. And that was the first I’d heard of it,” she says.

Suddenly, she no longer had a means to check her mother’s condition. And as a doctor-turned-activist, Teresa knew the risks that came with long-term living facilities. Individualised care is key, especially for patients with later-stage dementia. “They never look or act normal. So, you have to know them pretty well to know when they are worse than normal.”

Even before the pandemic, Teresa says it was crucial for families to be as involved as possible in a loved one’s care. “We have a joke in medicine. You write on the physical exam ‘WNL’: within normal limits. But the other abbreviation is: ‘We never looked.’”

Isolation, depression and weight loss

Lawyer Anthony Chicotel is a colleague of Teresa’s at the California Advocates for Nursing Home Reform. He says the top priority now is increasing visitation rights, for the benefit of both long-term care residents and their families.

“People are dying from COVID-19 who didn’t have the virus. They’re dying because of the response that we had related to COVID-19. It might be the isolation, depression, the weight loss, the lack of supervision and observation that normally these people would have,” Chicotel says. “The lack of family involvement that they would normally have is hurting people and killing some of them, particularly those with dementia.”

Chicotel admits to feeling a certain “impotence” since the pandemic began. He says it has become increasingly difficult to influence healthcare policy.

First, there has been what he calls a “balkanisation” of public health. Normally, Chicotel would concentrate on lobbying state and federal officials. But these days, cities, counties and even individual facilities have their own COVID-19 rules. “It’s been really hard to get a grasp on everything as efficiently as we could in the past.”

Then, there is the idea that governments should stop the virus at any cost – even if it means suspending the rights of individuals in long-term care, Chicotel says.

“I think it is, to some extent, ageism rearing its head,” he explains. “We’re just, as a society, used to telling older people what’s best for them and forcing them to accept it. We just haven’t seen the same kinds of restrictions on childcare, for example, that we’ve seen with elder care.”

Chicotel considers the restrictions “the biggest civil rights tragedy” in the history of long-term care in the US. And he fears it may only get worse, as facilities relax staffing requirements and residents remain cut off from their loved ones.

“Are these policies actually benefitting as much as we thought they would? Probably not. Are they costing more than we thought they would? As time goes along, absolutely they are,” he says.

One outcome Chicotel predicts will be a rise in prescriptions for so-called “chemical restraints” – drugs used to control the behaviour of patients.

With healthcare staff stretched thin during the pandemic, it may be increasingly tempting to use behaviour-altering drugs for convenience rather than necessity – especially, Chicotel says, “with fewer people to notice that mom or dad is constantly sleeping all of a sudden”.

A ‘perfect storm’ of healthcare shortcomings

Ann Kolanowski, a retired professor of nursing and psychiatry at Penn State University, calls what is happening a “perfect storm” of healthcare shortcomings. Many of the issues facing dementia patients have been long-standing, she explains, but the pandemic has brought them into sharp relief.

Nursing homes in particular – where a majority of dementia-related deaths in the US took place even before the pandemic – were shown to have a “terrific lack of sufficient staff, particularly those with infection control expertise,” Kolanowski says.

They also lacked basic personal protective equipment (PPE) like masks and their infrastructure proved largely outdated.

Then, there was the rift in priorities. “What COVID brought to light is this tension that we have between infection control using social isolation – because that’s really our major treatment right now – and quality of life. And this tension is huge. It affects the nursing home residents. It affects staff as well as families,” Kolanowski says.

But Kolanowski argues that preventing infection and providing individualised care do not have to be mutually exclusive. It all comes down to educating family members to be part of the care system – and providing adequate resources for staff.

Nursing home workers often contend with low wages that force them to work in multiple long-term care facilities. Staff turnover is high. Add to that meagre, if any, sick leave, and Kolanowski sees a recipe for carrying the virus from facility to facility, “exponentially causing more transmission”.

[Jawahir Al Naimi/Al Jazeera]

Many of these employees care deeply for the dementia patients they look after, Kolanowksi says. Their patients’ deaths can feel like a personal loss. “It’s not like a hospital where you have somebody come in and they’re there for a few days, maybe a week, and then they go home. These are people they’ve known for years. So they are like family.”

It is part of a shift in care practices that Kolanowski has seen since she first graduated from college in 1970. Back then, there was little understanding of neurodegenerative diseases like dementia. Nursing homes were modelled on hospitals. Patients were written off as confused or senile.

“We’re not a society that necessarily values older people, and people with dementia in particular,” she says. While Kolanowski admits our understanding of dementia has come a long way since then, she remains concerned that the need for individual care is still being neglected.

Nursing homes in the US, for instance, are not required to have a registered nurse on staff at all times – something Kolanowski believes is crucial “to take care of these complex people who have complex medical needs”.

‘Some people will only eat when a relative feeds them’

“You can’t think about dementia without thinking about caregivers,” says Marina Martin, chief of geriatrics at the Stanford School of Medicine. “Because dementia means you’re going to need caregivers.”

Martin, like many healthcare professionals, has found herself in a bind. There is no substitute for seeing a patient in person, she says. She can check for new wounds, observe how they move, gauge their reactions. But at the same time, going from room to room to see patients simply is not an option with a virus as contagious as COVID-19.

Even the most basic protective equipment has also proved to be a barrier. “When I go to see my patients with significant dementia, they may not understand why I’m wearing all this stuff on my face,” Martin says, referring to the face shield and N95 mask that now form part of her uniform. “So I try to explain it a little bit. But I get more blank looks or quizzical looks than I used to.”

Likewise, patients sometimes forget why they are wearing a mask too. “They might put it on their forehead. I’ve seen all kinds of things,” she says.

Still, for all the difficulties, Martin is confident that healthcare professionals and families can collaborate to keep coronavirus transmission low, while still providing in-person support for dementia.

These patients cannot wait two years for isolation practices to end, Martin says. They need visitation, however limited, now. “Some people really will only eat when their family member feeds them. I have had two patients with that situation in one of the buildings where I work.”

Digital divide another barrier

Esther Oh, co-director of the Johns Hopkins Memory and Alzheimer’s Treatment Center in Baltimore, Maryland, has found telemedicine – remote care through digital services like Zoom – to be promising though, for certain individuals living with dementia.

Ordinarily, she estimates her centre receives 2,500 visits each year. Many of her patients are not in nursing homes but rather in independent living communities or family homes.

“Of course, I used to be a firm believer in in-person visits only,” she says. But when the pandemic started to spread, her methods had to adapt. “We went from 100 percent in-person visits only – we didn’t do any telemedicine – to 100 percent telemedicine from the third week of March.”

The first week, Oh recalls that none of her patients chose to use video conferencing software. They preferred the telephone. Oh suspects the technology was unfamiliar and therefore, scary.

But as time went on, she saw some caregivers and patients embracing video calls. It was more convenient for patients who otherwise had to travel long distances and caregivers who could sometimes spend hours helping a loved one out of bed.

Since the initial stay-at-home orders relaxed, Oh says she is now back to seeing approximately 80 percent of her patients in-person again. But she also continues to offer telemedicine to those who prefer it.

Video conferencing online allows Oh’s patients to see her full face, without a mask, which helps especially when a patient has hearing problems. Plus, they can invite their loved ones to attend their appointments too, as opposed to in-person visits, where only one individual can enter the exam room at a time.

“All their children from out of state can actually Zoom in. So they really like that,” Oh says. “It’s literally a Zoom click away. So sometimes we have four or five faces on the screen.”

[Jawahir Al-Naimi]

Still, it is no silver bullet. Some people living with dementia find video conferencing acutely distressing. And for a certain segment of the population – one that includes both patients and caregivers alike – a digital divide exists: They lack the access to technology that would make video conferencing even possible.

“We just assume everybody has an iPhone or an Android,” Oh says. “Even if you provide somebody with a mobile device, they would have to have a data plan or Wi-Fi and know-how, in terms of how to download Zoom. So it’s actually a really complicated process. When I do webinars now for caregivers, I do wonder who is not there.”

‘This is new. And I’m blaming it on COVID’

Pamela Montana and her husband, Bob Linscheid, of Danville, California, work to represent the voices of those living with dementia and their caregivers. They serve on the Governor’s Task Force on Alzheimer’s Prevention and Preparedness in California.

Their expertise comes from first-hand experience. Montana, 65, was diagnosed with younger-onset Alzheimer’s disease in 2016. Her dementia changed both of their lives.

She first noticed something was wrong while she was at work. Montana had a high-pressure job at Intel, the US technology company, that often required her to multitask. “At Intel, you had to or you wouldn’t make it,” she explains.

But she started to notice at staff meetings that she wasn’t able to absorb what was going on any more. “I had to write down almost every word they said, to let it sink into my brain,” she says. “I cognitively wasn’t grabbing it.”

Linscheid started to observe changes, too. He had known Montana since the 1970s when she was an undergraduate at California’s Chico State University, balancing school with a job manning the copy machine at the student union.

“We hit it off,” Montana recalls, but it was only decades later, when Montana pulled an alumni magazine out of the mailbox with Linscheid’s face on it, that they reconnected. They got married in 2012.

Since then, they have made annual trips to Hawaii in December. But one year, as they drove back to their getaway home to take a conference call, Linscheid noticed Montana seemed disoriented. She kept asking what was happening.

“I pulled over the car, and I said, ‘Do you realise this is the third time you’ve asked me this question?’ And with a straight, solemn face, she said ‘No’,” Linscheid says.

Back in California, it was a struggle to get Montana diagnosed. She would pass the cognitive assessments doctors gave her, but then forget, for example, where she went to school for her master’s degree.

“If I hadn’t forgotten that, I don’t know if I would have been diagnosed even now,” she says. Linscheid, meanwhile, had grown frustrated that Montana’s doctor was not taking her condition seriously. “It didn’t seem to be that urgent to her.”

Those kinds of experiences fuelled their work as advocates. Nowadays, they sometimes find themselves on panels with scientists and politicians, representing the relationship between patients and caregivers.

Even for those with relatively mild cognitive impairment, like Montana, the COVID-19 pandemic has had serious consequences. “Bob could probably do a much better job explaining how my short-term memory is, but it is pretty much almost non-existent,” she says. “This is new. And I’m blaming this on COVID.”

She used to organise her calendar around lunch dates, dinner plans and coffee. “I am – as you already know – super chatty,” she laughs. All the interaction she had built her life around ground to a halt in March. And phone calls, for her, can be exhausting. “I feel like I lost my freedom in some ways.”

These days, Montana finds herself picking up her phone to text someone, only to forget who and what she was texting. Every day, she will walk into a room and wonder what she is doing there. “Six months ago, I wasn’t doing that,” she says. “It just hit me hard.”

Linscheid, too, has remarked that her energy waned as social distancing has dragged on. There was one occasion when Montana did not get out of bed all day.

He says he checks in on her constantly, at least 10 times a day – something that is possible because the former president and CEO of the San Francisco Chamber of Commerce left his job there after her diagnosis. Unlike many families, they say they had the financial wherewithal to cover medical costs, while Linscheid pursued a more flexible career. He estimates he lost $60,000 to $70,000 of earned income before he was able to settle into his new work.

These days, Montana fills her time knitting and watching TV shows like Grey’s Anatomy – even though she has seen it four or five times, she laughs. And then every Friday, she logs onto a virtual Alzheimer’s support group to meet with others isolated during the pandemic.

Some of her friends there are older than her and doing fine. Others are younger and suffering more. The lesson, she says, is that “everybody’s Alzheimer’s is different”.

“The words I get sometimes are, ‘Well, you look great.’ I just want to punch them. Because yeah, I do look great. I moisturise and I dye my hair, otherwise it’d be grey. I take good care of myself the best that I can.”

This, she likes to say, is what Alzheimer’s looks like too. And even though you may not see it, the pandemic is exacting its toll.

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World

All the products we found to be the best during our testing this year

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(CNN) —  

Throughout the year, CNN Underscored is constantly testing products — be it coffee makers or headphones — to find the absolute best in each respective category.

Our testing process is rigorous, consisting of hours of research (consulting experts, reading editorial reviews and perusing user ratings) to find the top products in each category. Once we settle on a testing pool, we spend weeks — if not months — testing and retesting each product multiple times in real-world settings. All this in an effort to settle on the absolute best products.

So, as we enter peak gifting season, if you’re on the hunt for the perfect gift, we know you’ll find something on this list that they (or you!) will absolutely love.

Coffee

Best burr coffee grinder: Baratza Virtuoso+ Conical Burr Grinder With Digital Timer Display ($249; amazon.com or walmart.com)

Baratza Virtuoso+ Conical Burr Grinder
Baratza Virtuoso+ Conical Burr Grinder

Beginner baristas and coffee connoisseurs alike will be pleased with the Baratza Virtuoso+, a conical burr grinder with 40 settings for grind size, from super fine (espresso) to super coarse (French press). The best coffee grinder we tested, this sleek look and simple, intuitive controls, including a digital timer, allow for a consistent grind every time — as well as optimal convenience.

Read more from our testing of coffee grinders here.

Best drip coffee maker: Braun KF6050WH BrewSense Drip Coffee Maker ($79.95; amazon.com)

Braun KF6050WH BrewSense Drip Coffee Maker
Braun KF6050WH BrewSense Drip Coffee Maker

During our testing of drip coffee makers, we found the Braun KF6050WH BrewSense Drip Coffee Maker made a consistently delicious, hot cup of coffee, brewed efficiently and cleanly, from sleek, relatively compact hardware that is turnkey to operate, and all for a reasonable price.

Read more from our testing of drip coffee makers here.

Best single-serve coffee maker: Breville-Nespresso VertuoPlus ($165; originally $179.95; amazon.com)

Breville-Nespresso VertuoPlus
Breville-Nespresso VertuoPlus

Among all single-serve coffee makers we tested, the Breville-Nespresso VertuoPlus, which uses pods that deliver both espresso and “regular” coffee, could simply not be beat for its convenience. Intuitive and a snap to use right out of the box, it looks sleek on the counter, contains a detached 60-ounce water reservoir so you don’t have to refill it with each use and delivers perfectly hot, delicious coffee with a simple tap of a lever and press of a button.

Read more from our testing of single-serve coffee makers here.

Best coffee subscription: Blue Bottle (starting at $11 per shipment; bluebottlecoffee.com)

Blue Bottle coffee subscription
Blue Bottle coffee subscription

Blue Bottle’s coffee subscription won us over with its balance of variety, customizability and, most importantly, taste. We sampled both the single-origin and blend assortments and loved the flavor of nearly every single cup we made. The flavors are complex and bold but unmistakably delicious. Beyond its coffee, Blue Bottle’s subscription is simple and easy to use, with tons of options to tailor to your caffeine needs.

Read more from our testing of coffee subscriptions here.

Best cold brewer coffee maker: Hario Mizudashi Cold Brew Coffeepot ($25; amazon.com)

Hario Mizudashi Cold Brew Coffeepot
Hario Mizudashi Cold Brew Coffeepot

This sleek, sophisticated and streamlined carafe produces 1 liter (about 4 1/4 cups) of rich, robust brew in just eight hours. It was among the simplest to assemble, it executed an exemplary brew in about the shortest time span, and it looked snazzy doing it. Plus, it rang up as the second-most affordable of our inventory.

Read more from our testing of cold brew makers here.

Kitchen essentials

Best nonstick pan: T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid ($39.97; amazon.com)

T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid
T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid

If you’re a minimalist and prefer to have just a single pan in your kitchen, you’d be set with the T-fal E76597. This pan’s depth gives it multipurpose functionality: It cooks standard frying-pan foods like eggs and meats, and its 2 1/2-inch sides are tall enough to prepare recipes you’d usually reserve for pots, like rices and stews. It’s a high-quality and affordable pan that outperformed some of the more expensive ones in our testing field.

Read more from our testing of nonstick pans here.

Best blender: Breville Super Q ($499.95; breville.com)

Breville Super Q
Breville Super Q

With 1,800 watts of motor power, the Breville Super Q features a slew of preset buttons, comes in multiple colors, includes key accessories and is touted for being quieter than other models. At $500, it does carry a steep price tag, but for those who can’t imagine a smoothie-less morning, what breaks down to about $1.30 a day over a year seems like a bargain.

Read more from our testing of blenders here.

Best knife set: Chicago Cutlery Fusion 17-Piece Knife Block Set ($119.74; amazon.com)

Chicago Cutlery Fusion 17-Piece Knife Block Set
Chicago Cutlery Fusion 17-Piece Knife Block Set

The Chicago Cutlery Fusion 17-Piece Knife Block Set sets you up to easily take on almost any cutting job and is a heck of a steal at just $119.97. Not only did the core knives included (chef’s, paring, utility and serrated) perform admirably, but the set included a bevy of extras, including a full set of steak knives. We were blown away by their solid construction and reliable execution for such an incredible value. The knives stayed sharp through our multitude of tests, and we were big fans of the cushion-grip handles that kept them from slipping, as well as the classic look of the chestnut-stained wood block. If you’re looking for a complete knife set you’ll be proud of at a price that won’t put a dent in your savings account, this is the clear winner.

Read more from our testing of knife sets here.

Audio

Best true wireless earbuds: AirPods Pro ($199, originally $249; amazon.com)

Apple AirPods Pro
Apple AirPods Pro

Apple’s AirPods Pro hit all the marks. They deliver a wide soundstage, thanks to on-the-fly equalizing tech that produces playback that seemingly brings you inside the studio with the artist. They have the best noise-canceling ability of all the earbuds we tested, which, aside from stiff-arming distractions, creates a truly immersive experience. To sum it up, you’re getting a comfortable design, a wide soundstage, easy connectivity and long battery life.

Read more from our testing of true wireless earbuds here.

Best noise-canceling headphones: Sony WH-1000XM4 ($278, originally $349.99; amazon.com)

Sony WH-1000XM4
Sony WH-1000XM4

Not only do the WH-1000XM4s boast class-leading sound, but phenomenal noise-canceling ability. So much so that they ousted our former top overall pick, the Beats Solo Pros, in terms of ANC quality, as the over-ear XM4s better seal the ear from outside noise. Whether it was a noise from a dryer, loud neighbors down the hall or high-pitched sirens, the XM4s proved impenetrable. This is a feat that other headphones, notably the Solo Pros, could not compete with — which is to be expected considering their $348 price tag.

Read more from our testing of noise-canceling headphones here.

Best on-ear headphones: Beats Solo 3 ($119.95, originally $199.95; amazon.com)

Beats Solo 3
Beats Solo 3

The Beats Solo 3s are a phenomenal pair of on-ear headphones. Their sound quality was among the top of those we tested, pumping out particularly clear vocals and instrumentals alike. We enjoyed the control scheme too, taking the form of buttons in a circular configuration that blend seamlessly into the left ear cup design. They are also light, comfortable and are no slouch in the looks department — more than you’d expect given their reasonable $199.95 price tag.

Read more from our testing of on-ear headphones here.

Beauty

Best matte lipstick: Stila Stay All Day Liquid Lipstick ($11, originally $22; amazon.com or $22; nordstrom.com and stilacosmetics.com)

Stila Stay All Day Liquid Lipstick
Stila Stay All Day Liquid Lipstick

The Stila Stay All Day Liquid Lipstick has thousands of 5-star ratings across the internet, and it’s easy to see why. True to its name, this product clings to your lips for hours upon hours, burritos and messy breakfast sandwiches be damned. It’s also surprisingly moisturizing for such a superior stay-put formula, a combo that’s rare to come by.

Read more from our testing of matte lipsticks here.

Best everyday liquid liner: Stila Stay All Day Waterproof Liquid Eyeliner ($22; stilacosmetics.com or macys.com)

Stila Stay All Day Waterproof Liquid Eyeliner
Stila Stay All Day Waterproof Liquid Eyeliner

The Stila Stay All Day Waterproof Liquid Eyeliner is a longtime customer favorite — hence its nearly 7,500 5-star reviews on Sephora — and for good reason. We found it requires little to no effort to create a precise wing, the liner has superior staying power and it didn’t irritate those of us with sensitive skin after full days of wear. As an added bonus, it’s available in a whopping 12 shades.

Read more from our testing of liquid eyeliners here.

Work-from-home essentials

Best office chair: Steelcase Series 1 (starting at $381.60; amazon.com or $415, wayfair.com)

Steelcase Series 1
Steelcase Series 1

The Steelcase Series 1 scored among the highest overall, standing out as one of the most customizable, high-quality, comfortable office chairs on the market. At $415, the Steelcase Series 1 beat out most of its pricier competitors across testing categories, scoring less than a single point lower than our highest-rated chair, the $1,036 Steelcase Leap, easily making it the best bang for the buck and a clear winner for our best office chair overall.

Read more from our testing of office chairs here.

Best ergonomic keyboard: Logitech Ergo K860 ($129.99; logitech.com)

Logitech Ergo K860
Logitech Ergo K860

We found the Logitech Ergo K860 to be a phenomenally comfortable keyboard. Its build, featuring a split keyboard (meaning there’s a triangular gap down the middle) coupled with a wave-like curvature across the body, allows both your shoulders and hands to rest in a more natural position that eases the tension that can often accompany hours spent in front of a regular keyboard. Add the cozy palm rest along the bottom edge and you’ll find yourself sitting pretty comfortably.

Read more from our testing of ergonomic keyboards here.

Best ergonomic mouse: Logitech MX Master 3 ($99.99; logitech.com)

Logitech MX Master 3
Logitech MX Master 3

The Logitech MX Master 3 is an unequivocally comfortable mouse. It’s shaped to perfection, with special attention to the fingers that do the clicking. Using it felt like our fingers were lounging — with a sculpted ergonomic groove for nearly every finger.

Read more from our testing of ergonomic mice here.

Best ring light: Emart 10-Inch Selfie Ring Light ($25.99; amazon.com)

Emart 10-Inch Selfie Ring Light
Emart 10-Inch Selfie Ring Light

The Emart 10-Inch Standing Ring Light comes with a tripod that’s fully adjustable — from 19 inches to 50 inches — making it a great option whether you’re setting it atop your desk for video calls or need some overhead lighting so no weird shadows creep into your photos. Its three light modes (warm, cool and a nice mix of the two), along with 11 brightness levels (among the most settings on any of the lights we tested), ensure you’re always framed in the right light. And at a relatively cheap $35.40, this light combines usability and affordability better than any of the other options we tested.

Read more from our testing of ring lights here.

Home

Best linen sheets: Parachute Linen Sheet Set (starting at $149; parachute.com)

Parachute Linen Sheets
Parachute Linen Sheets

Well made, luxurious to the touch and with the most versatile shopping options (six sizes, nine colors and the ability to order individual sheets), the linen sheets from Parachute were, by a narrow margin, our favorite set. From the satisfying unboxing to a sumptuous sleep, with a la carte availability, Parachute set the gold standard in linen luxury.

Read more from our testing of linen sheets here.

Best shower head: Kohler Forte Shower Head (starting at $74.44; amazon.com)

Kohler Forte Shower Head
Kohler Forte Shower Head

Hands down, the Kohler Forte Shower Head provides the best overall shower experience, offering three distinct settings. Backstory: Lots of shower heads out there feature myriad “settings” that, when tested, are pretty much indecipherable. The Forte’s three sprays, however, are each incredibly different and equally successful. There’s the drenching, full-coverage rain shower, the pulsating massage and the “silk spray” setting that is basically a super-dense mist. The Forte manages to achieve all of this while using only 1.75 gallons per minute (GPM), making it a great option for those looking to conserve water.

Read more from our testing of shower heads here.

Best humidifier: TaoTronics Cool Mist Humidifier (starting at $49.99; amazon.com)

TaoTronics Cool Mist Humidifier
TaoTronics Cool Mist Humidifier

The TaoTronics Cool Mist Humidifier ramped up the humidity in a room in about an hour, which was quicker than most of the options we tested. More importantly, though, it sustained those humidity levels over the longest period of time — 24 hours, to be exact. The levels were easy to check with the built-in reader (and we cross-checked that reading with an external reader to confirm accuracy). We also loved how easy this humidifier was to clean, and the nighttime mode for the LED reader eliminated any bright lights in the bedroom.

Read more from our testing of humidifiers here.

Video

Best TV: TCL 6-Series (starting at $579.99; bestbuy.com)

TCL 6-Series
TCL 6-Series

With models starting at $599.99 for a 55-inch, the TCL 6-Series might give you reverse sticker shock considering everything you get for that relatively small price tag. But can a 4K smart TV with so many specification standards really deliver a good picture for $500? The short answer: a resounding yes. The TCL 6-Series produces a vibrant picture with flexible customization options and handles both HDR and Dolby Vision, optimization standards that improve the content you’re watching by adding depth to details and expanding the color spectrum.

Read more from our testing of TVs here.

Best streaming device: Roku Ultra ($99.99; amazon.com)

Roku Ultra
Roku Ultra

Roku recently updated its Ultra streaming box and the 2020 version is faster, thanks to a new quad-core processor. The newest Ultra retains all of the features we loved and enjoyed about the 2019 model, like almost zero lag time between waking it up and streaming content, leading to a hiccup-free streaming experience. On top of that, the Roku Ultra can upscale content to deliver the best picture possible on your TV — even on older-model TVs that don’t offer the latest and greatest picture quality — and supports everything from HD to 4K.

Read more from our testing of streaming devices here.

Travel

Best carry-on luggage: Away Carry-On ($225; away.com)

Away Carry-On
Away Carry-On

The Away Carry-On scored high marks across all our tests and has the best combination of features for the average traveler. Compared with higher-end brands like Rimowa, which retail for hundreds more, you’re getting the same durable materials, an excellent internal compression system and eye-catching style. Add in smart charging capabilities and a lifetime warranty, and this was the bag to beat.

Read more from our testing of carry-on luggage here.

Best portable charger: Anker PowerCore 13000 (starting at $31.99; amazon.com)

Anker PowerCore 13000
Anker PowerCore 13000

The Anker PowerCore 13000 shone most was in terms of charging capacity. It boasts 13,000 mAh (maH is a measure of how much power a device puts out over time), which is enough to fully charge an iPhone 11 two and a half times. Plus, it has two fast-charging USB Type-A ports so you can juice a pair of devices simultaneously. While not at the peak in terms of charging capacity, at just $31.99, it’s a serious bargain for so many mAhs.

Read more from our testing of portable chargers here.

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Trump’s misleading tweet about changing your vote, briefly explained

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Searches for changing one’s vote did not trend following the recent presidential debate, and just a few states appear to have processes for changing an early vote. But that didn’t stop President Trump from wrongly saying otherwise on Tuesday.

In early morning posts, the president falsely claimed on Twitter and Facebook that many people had Googled “Can I change my vote?” after the second presidential debate and said those searching wanted to change their vote over to him. Trump also wrongly claimed that most states have a mechanism for changing one’s vote. Actually, just a few states appear to have the ability, and it’s rarely used.

Twitter did not attach a label to Trump’s recent tweet.
Twitter

Trump’s claim about what was trending on Google after the debate doesn’t hold up. Searches for changing one’s vote were not among Google’s top trending searches for the day of the debate (October 22) or the day after. Searches for “Can I change my vote?” did increase slightly around the time of the debate, but there is no way to know whether the bump was related to the debate or whether the people searching were doing so in support of Trump.

It was only after Trump’s posts that searches about changing your vote spiked significantly. It’s worth noting that people were also searching for “Can I change my vote?” during a similar period before the 2016 presidential election.

Google declined to comment on the accuracy of Trump’s post.

Trump also claimed that these results indicate that most of the people who were searching for how to change their vote support him. But the Google Trends tool for the searches he mentioned does not provide that specific information.

Perhaps the most egregiously false claim in Trump’s recent posts is about “most states” having processes for changing your early vote. In fact, only a few states have such processes, and they can come with certain conditions. For instance, in Michigan, voters who vote absentee can ask for a new ballot by mail or in person until the day before the election.

The Center for Election Innovation’s David Becker told the Associated Press that changing one’s vote is “extremely rare.” Becker explained, “It’s hard enough to get people to vote once — it’s highly unlikely anybody will go through this process twice.”

Trump’s post on Facebook was accompanied by a link to Facebook’s Voting Information Center.
Facebook

At the time of publication, Trump’s false claims had drawn about 84,000 and 187,000 “Likes” on Twitter and Facebook, respectively. Trump’s posts accelerated searches about changing your vote in places like the swing state of Florida, where changing one’s vote after casting it is not possible. Those numbers are a reminder of the president’s capacity to spread misinformation quickly.

On Facebook, the president’s post came with a label directing people to Facebook’s Voting Information Center, but no fact-checking label. Twitter had no annotation on the president’s post. Neither company responded to a request for comment.

That Trump is willing to spread misinformation to benefit himself and his campaign isn’t a surprise. He does that a lot. Still, just days before a presidential election in which millions have already voted, this latest episode demonstrates that the president has no qualms about using false claims about voting to cause confusion and sow doubt in the electoral process.

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Nearly 6,000 civilian casualties in Afghanistan so far this year

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From January to September, 5,939 civilians – 2,117 people killed and 3,822 wounded – were casualties of the fighting, the UN says.

Nearly 6,000 Afghan civilians were killed or wounded in the first nine months of the year as heavy fighting between government forces and Taliban fighters rages on despite efforts to find peace, the United Nations has said.

From January to September, there were 5,939 civilian casualties in the fighting – 2,117 people killed and 3,822 wounded, the UN Assistance Mission in Afghanistan (UNAMA) said in a quarterly report on Tuesday.

“High levels of violence continue with a devastating impact on civilians, with Afghanistan remaining among the deadliest places in the world to be a civilian,” the report said.

Civilian casualties were 30 percent lower than in the same period last year but UNAMA said violence has failed to slow since the beginning of talks between government negotiators and the Taliban that began in Qatar’s capital, Doha, last month.

An injured girl receives treatment at a hospital after an attack in Khost province [Anwarullah/Reuters]

The Taliban was responsible for 45 percent of civilian casualties while government troops caused 23 percent, it said. United States-led international forces were responsible for two percent.

Most of the remainder occurred in crossfire, or were caused by ISIL (ISIS) or “undetermined” anti-government or pro-government elements, according to the report.

Ground fighting caused the most casualties followed by suicide and roadside bomb attacks, targeted killings by the Taliban and air raids by Afghan troops, the UN mission said.

Fighting has sharply increased in several parts of the country in recent weeks as government negotiators and the Taliban have failed to make progress in the peace talks.

At least 24 people , mostly teens, were killed in a suicide bomb attack at an education centre in Kabul [Mohammad Ismail/Reuters]

The Taliban has been fighting the Afghan government since it was toppled from power in a US-led invasion in 2001.

Washington blamed the then-Taliban rulers for harbouring al-Qaeda leaders, including Osama bin Laden. Al-Qaeda was accused of plotting the 9/11 attacks.

Calls for urgent reduction of violence

Meanwhile, the US envoy for Afghanistan, Zalmay Khalilzad, said on Tuesday that the level of violence in the country was still too high and the Kabul government and Taliban fighters must work harder towards forging a ceasefire at the Doha talks.

Khalilzad made the comments before heading to the Qatari capital to hold meetings with the two sides.

“I return to the region disappointed that despite commitments to lower violence, it has not happened. The window to achieve a political settlement will not stay open forever,” he said in a tweet.

There needs to be “an agreement on a reduction of violence leading to a permanent and comprehensive ceasefire”, added Khalilzad.

A deal in February between the US and the Taliban paved the way for foreign forces to leave Afghanistan by May 2021 in exchange for counterterrorism guarantees from the Taliban, which agreed to sit with the Afghan government to negotiate a permanent ceasefire and a power-sharing formula.

But progress at the intra-Afghan talks has been slow since their start in mid-September and diplomats and officials have warned that rising violence back home is sapping trust.

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