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Hospital Research Home Lottery funds lifesaving research at the Royal Adelaide Hospital

BY keeping the human face of medicine in the forefront of its thinking, The Hospital Research Foundation is raising millions for lifesaving research and patient care at the new Royal Adelaide Hospital and public hospitals across Adelaide, supported by the Hospital Research Home Lottery.

F ew people know this better than the researchers and the people seeking life altering treatments from their work.

Professor Jane Andrews and her patient, Rhianna Mummery, 20, are among the many who continue to benefit from THRF’s $1.6 million in funding to set up the new purpose-built Clinical Trials Centre at the RAH.

 Research into ulcerative colitis (UC) at the RAH

“This place is essential,” says Prof Andrews, who is acting director and head of the RAH Inflammatory Bowel Disease Service, Gastroenterology and Hepatology.

“If we hadn’t had this centre made available on transition to the new RAH, there would have been a catastrophe, really, for several reasons. Clinical research is and should be an integral part of teaching hospital medicine otherwise ... we’re not serving the teaching hospital role or advancing medicine and we’re not helping patients’ outcomes.

“I think it’s absolutely essential and fantastic that THRF found the financial resources to facilitate that. It’s really not an add-on it’s an essential part of teaching hospital medicine.”

One of many trials Prof Andrews is involved with at the centre is for a new formulation of a drug that treats ulcerative colitis (UC), an inflammatory bowel disease that causes bleeding, abdominal pain and diarrhoea in sufferers. More than 80,000 Australians live with either UC or Crohn’s disease. There is no cure and, if left untreated with drug therapies or surgery, a severe case of the disease can be fatal.

SUCCESS: Patient Rhianna Mummery is part of a clinical trial for a drug therapy for ulcerative colitis. Picture: Calum Robertson

The drug, which has previously been available to the public as an intravenous injection, is being trialled for use as a simpler injection just under the skin — one that patients can safely administer themselves. Prof Andrews says the trial is being conducted simultaneously in medical centres around the world.

Her patient, Rhianna Mummery, is part of the trial, which is going well for her so far.

“I was diagnosed (with UC) in 2007, and I was about 10 years old. I was really skinny and pale and losing a lot of blood in the toilet, so my dad rushed me to the hospital,” Ms Mummery says.

“Then, 18 months later, I finally got diagnosed with UC. I was in hospital for almost three weeks and I got all the treatment I needed and I was pretty much good then. Then about three years later I got inflamed again. Every time I’d get inflamed I’d have steroids, which make me really big (through weight gain).

It wasn’t the best thing as a little kid, especially at school being bullied for the side effects of some medication.

“And you’re always looking out for a toilet or something just in case an accident happens.”

Prof Andrews invited her to join the trial and she jumped at the chance of a more effective treatment with fewer side effects. Now in its third phase after placebo trials last year, the trial is in what’s called the “open-label” phase. “I must have been getting the real drug because it worked and then towards the end of the year I went on the open label, so now I just inject myself every two weeks,” Ms Mummery says.

She urges South Australians to support THRF through donations or buying tickets in the Hospital Research Home Lottery so that lifesaving trials like hers can continue in the RAH’s Clinical Trials Centre. “Do it because it’s a really good cause,” she smiles.

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PROFESSOR JOHN BELTRAME

As the Director of Research for the Central Adelaide Local Health Network, leading cardiologist and academic researcher Professor Beltrame gets to keep an eye on all of the research projects at the RAH and The Queen Elizabeth Hospital.

But he also gets to care for patients like Tim Lamming, who is one of about 6000 Australians who suffer from Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA), also known as an “unexplained heart attack” because there are no significant cholesterol blockages in patients’ coronary arteries.

Prof Beltrame hopes to put an end to the suffering of people like Mr Lamming after receiving the inaugural Basil Hetzel Translational Grant through THRF in 2017. With his team, he is doing pioneering research into the causes and treatment of MINOCA.

Research into treatments for MINOCA at the RAH

“This has given us a tremendous opportunity to advance (treatment of) this condition,” he says. “Most patients who have a heart attack have significant cholesterol blockages and that enable us to do (standard) treatments. In about 5 to 10 per cent of patients, they don’t have these blockages so we can’t do these kind of treatments.

“MINOCA was first detailed here in Adelaide and we are known for this research around the world. We now have the opportunity to continue to lead, internationally, this research because this ... will be a full study about (whether) the course of these standard treatments for heart attacks are actually of benefit to people who have MINOCA.”

Prof Beltrame was able to diagnose Mr Lamming: “Tim’s case provides inspiration to find more treatments for people like him.”

DIAGNOSED: Research at the RAH has led to a diagnosis for heart patient Tim Lamming.

Mr Lamming, 48, says his first heart attack came out of the blue in December 2012 and was seriously scary. “I was working for Bunnings and doing some heavy lifting ... and it was a hot day,” Mr Lamming says. “I just started to feel off and after probably 10 or 15 minutes I was an absolute sea of perspiration. I went upstairs to sit down ... and that’s when the chest pain started to come on. My boss walked past he took one look at me and said ‘I think you need to go to hospital’.

On the way down North Tce, I arrested in the back of an ambulance and they had to give me a thump on the chest to get me going again.

Over the next two years, Mr Lamming suffered severe unexplained chest pain on average every 12 weeks, forcing him to quit work and become almost housebound. The medications he was prescribed also gave him severe headaches and even migraines. Finally, in 2015 he was put in touch with Prof Beltrame who diagnosed him with MINOCA. Mr Lamming did not qualify for Prof Beltrame’s research work but is desperately hoping it yields a better treatment.

“It’s really important for me that he succeeds and that he’s able to do the research into this condition. It’s not a common condition and, while Prof Beltrame ... has been able to find a combination of medication that’s at least stopped me from having heart attacks, it hasn’t been able to stop me from having chest pain and that’s the biggest impact on my life,” he says.

“It’s really important that funding for research continues so that it can help people like me try and return to some sense of normality. Just to be able to do the daily things that a lot of people take for granted.”

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PROFESSOR GUY MADDERN

Prof Maddern, a liver surgeon and Director of Surgery for the Central Adelaide Local Health Network, has spent much of his life working to repair people’s livers — often from the ravages of cancer — and finding better ways to help treat his patients. About 28,000 Australians are diagnosed with metastatic liver cancer each year.

“THRF has been fantastic for supporting research generally but certainly in surgery we’ve been beneficiaries of their initiatives,” he says.

RESEARCHER: Professor Guy Maddern.

“The sorts of projects that we’ve been involved with have been around particularly detecting cancers, so we are trying to detect in patients whether the cancer is likely to have spread at a very early stage long before scans or normal blood tests would pick this up. That’s been an area we’re working on and quite successfully.”

Research into treatments for liver cancer at the RAH

The work has looked at finding new ways of destroying tumours instead of surgically removing them. “We actually put probes in to destroy them by all sorts of means — some of them are thermal, where you heat them, some of them are electric, where you create an electrical imbalance which destroys them, and others are a combination,” he says.

“We are now able to operate on patients, for example with liver cancers, that would’ve been considered inoperable before.”

Prof Maddern says THRF supports research efforts by funding staff time but also with new equipment used to evaluate and analyse samples from patients.

The research is crucial, he says, because even if new technologies or treatments do not work out, the results go to inform the next round of experimentation that may lead to a break through: “In the long run (it) is helping our community.”

RESEARCH: The new Royal Adelaide Hospital in Adelaide.

THE HOSPITAL RESEARCH HOME LOTTERY

To date, THRF, especially through its highly-popular Home Lottery, has provided more than $5.5 million to fund research and patient care at the RAH, including the Clinical Trials Centre. In 2017, it provided more than $12 million in funding to South Australia’s hospitals for lifesaving medical research and patient care.

The latest Home Lottery offers the biggest Grand Prize to date, valued at more than $2.8 million. The fully-furnished Scott Salisbury Home at Henley Beach is just minutes from the foreshore. This home has boutique resort stylings AND comes with $1 million in cash. At least 13,705 prizes will be given away, including luxury vehicles, worldwide holidays, electrical goods and more.

GRAND PRIZE: The Hospital Research Home Lottery home at Henley Beach.

Whether you win or lose, the money raised will continue to support lifesaving medical research and patient care through THRF, which also opened its own office at the RAH in October 2017. The hub will allow the public easy access to information on the work of THRF and a place to make donations and buy tickets in each new lottery.

Funds totalling $750,000 have also recently been announced for another three RAH research projects, with more funding rounds soon to be announced.

Prof Beltrame explains the new research grants at the RAH: “The first is to embark on a (team) study of whether artificial sweeteners can perhaps cause diabetes rather than preventing diabetes led by Professor Chris Rayner. Professor Marianne Chapman, a specialist from the ICU, will investigate how much protein we have to give patients who are on a long-stay in intensive care. This will have an important impact on their outcomes. The third grant has been awarded to Professor Prashanthan Sanders, one of my cardiology colleagues, who continues his internationally renowned research into atrial fibrillation (an irregular, often rapid heart rate that causes poor blood flow). He’s now looking at how best to implement this in the hospital system.

“This is very exciting because the outstanding research that’s been done at the RAH for many years can now be further advanced with these additional funds.”

THRF chief executive Paul Flynn says: “We exist to save lives. Our work is only possible thanks to the support of our donors and ticket buyers in the Hospital Research Home Lottery. Thank you to the South Australian community for their ongoing support.”

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Join the fight of our lives

Superbugs are set to be the No.1 global killer within the next three decades ... and every one of us could be affected.

Step by step into the heart of paradise

Step by step into the heart of paradise

Resilient and resourceful: it’s what defines south australians and their businesses.

Road trip of rediscovery

Road trip of rediscovery

We’re in the fight of – and for – our lives. For the past 20 years, a global war has been waged against a medical threat to all mankind. It may not be a war you have heard about but it’s one that is likely to affect every single one of us in some shape or form – and, until now, it’s a war we haven’t been winning.

It’s the battle of the bugs: more specifically, superbugs – bacteria that have adapted to become resistant to attacks from antibiotics and the immune system. MRSA, Streptococcus pneumoniae, E. coli and salmonella are just some of these bacterial infections. Currently, 700,000 people die every year across the globe as a result of antibiotic resistance, and the World Health Organisation predicts this will rise to 10 million deaths by the year 2050 – that’s more than the number of people who will die from cancer and diabetes combined.

Scientists both around the world and in Australia have joined the fight against superbugs, looking for new solutions to conquer this deadly issue. And one possible new solution has been discovered here in Adelaide by Dr Katharina Richter, a CJ Martin Biomedical Research Fellow at the Basil Hetzel Institute for Transitional Health Research (BHI), based at The Queen Elizabeth Hospital and supported by The Hospital Research Foundation (THRF).

Dr Richter, who has worked at the Ear, Nose and Throat Surgery department at TQEH for the past three years, has been battling superbugs since she first encountered the deadly bacteria while working in an emergency pharmacy in Zurich, Switzerland.

“I worked with patients on a daily basis who had chronic infectious diseases and came with prescriptions for steroids, antibiotics and painkillers – and that’s all,” says the German-born researcher. “They came back every couple of weeks or months with a new prescription for the same drugs. It was so frustrating to see the patients suffering.”

Her experience sparked in Dr Richter a passion to research ways to combat superbugs. After a brief stint at the University of Copenhagen, she was awarded a PhD scholarship at The University of Adelaide, co-founded by THRF, where she researched new ways to destroy antibiotic-resistant bacteria. Now a post-doctoral researcher, Dr Richter continues to receive vital funding from THRF for her battle with the bugs.

The biggest challenge, she says, is the sheer tenacity of superbugs.

“Bacteria are actually very similar to us humans – they don’t want to live alone,” Dr Richter says. “Who wants to live alone, right? You find your mate, you multiply, you found a family, a home. Bacteria do the same: they multiply and form clusters, or families. These produce a slimy matrix – a biofilm – that covers the entire cluster. This biofilm makes them much more resistant to environmental changes so they can stand attacks from the immune system, from antibiotics. They can also survive UV light, humidity or any kind of hot or low temperatures.”

What makes superbugs even more formidable is their remarkable ability to exchange knowledge within these slimy matrix.

“Biofilms can talk to each other,” Dr Richter says. “Once a certain threshold of bacteria is reached, they start to communicate with each other, to streamline their defence and therefore to survive better. If one bacterium becomes resistant to an antibiotic, it can exchange this knowledge to all the other bacteria in the community; within a very short period of time, the entire biofilm becomes resistant. That’s why biofilms are so difficult to kill.”

Professor Guy Maddern, surgeon and Director of Research at BHI, says the situation has been exacerbated in recent years with our increasing reliance on, and the overprescription of, antibiotics, giving superbugs ample opportunity to strengthen their defence.

“People have been warning us about this for at least 20 years and it has become a commonplace problem over the last 10-15 years,” he says. “If the we don’t win the war against superbugs, we’ll be driving ourselves back to the pre-penicillin days. The things we take for granted now, where a course of antibiotics will lead to a likely resolution for the problem, will disappear.

“We are going to have a whole lot of our options taken away from us over the next decade and we have to find either other ways of managing it or completely different treatments.”

In her lab at the BHI, Dr Richter is doing just this, developing two new antibiotic-free treatments to stop superbugs in their tracks. One treatment, used as a nasal rinse “to flush out all the bad bugs” after sinus surgery, utilises minuscule silver particles (about 1/1000th the width of a human hair); the other, a wound-healing gel implemented in the sinuses after sinus surgery, contains two compounds that delete nutrients and act as a poisonous food, delivering a “double whammy” against superbugs.

The treatments, both currently part of a clinical trial at TQEH, are both delivered topically, giving them more power to combat biofilms.

“If you have a product that delivers your antibiotics or compounds directly to the spot where they are needed without going through the entire body, it’s much more effective,” Dr Richter says. “The drug does not have to travel through the gut, so you can increase the concentration of your drug and deliver it directly where it is needed without having side effects.”

At present, Dr Richter’s treatment is mainly active against Golden Staff but she foresees it becoming a weapon against other superbugs in the future. But, while one battle looks to be almost won, the war against superbugs is far from over.

“Bacteria are smart and they will always adapt and try to survive; therefore it is essential for us to never stop doing research and coming up with new weapons to kill bacteria,” Dr Richter says. “This is why medical research is so much needed and also funding for medical research is needed.”

Much of the funding for Dr Richter’s important research has come from THRF and its popular Hospital Research Home Lottery.

“THRF funding is absolutely crucial for me,” she says. “The Foundation is one of the major funding bodies in South Australia – without them, many people would die. Without research there’s no innovation and no health benefit for the entire population.”

It’s a sentiment echoed by Prof Maddern.

“The support the Foundation has provided has been fantastic,” he says. “This is an endless fight but I do think this particular problem, given enough time and resources can be fixed.

“It’s likely to be a problem that’s going to affect someone in your family over the next decade. You hope it doesn’t but it’s almost a certainty someone in your immediate circle will be affected.”

FIGHTING FOR THE FUTURE

For younger researchers like Dr Richter, support from THRF is key not just to funding but also to furthering scientific investigations.

“The Foundation is always there for us researchers,” she says. “They help us get the message out if we have a new superbug or cancer treatment or whatever researchers are doing. They are interested in the outcome and they want to see we bring innovations directly to patients in clinical practice. This is what they’re passionate about and it’s what I’m passionate about as well – that’s why it’s a dream team.”

Paul Flynn, CEO of The Hospital Research Foundation, says funding supported by the Hospital Research Home Lottery provides an essential platform which allows inexperienced researchers to progress their studies.

“Younger, less experienced researchers who are only five or so years out of finishing their PhD, and many students and researchers applying to do their PhDs, would struggle without the funding we provide,” Flynn says. “These are the sort of people we have to nurture otherwise the future of Australian medical research won’t be as rosy.”

THRF provides vital medical funding to help save the lives of thousands of South Australians through its donors and annual Hospital Research Home Lottery, which offers a first prize of a luxurious new home plus $1 million in cash, and hundreds of other fantastic prizes.

“It’s a bit of a win-win for the community,” Flynn says. “The community sees the benefit, they feel the benefit because they experience the benefit.”

DREAM COME TRUE

Thanks to the Hospital Research Home Lottery, Gavin Reichelt is now living the dream, with a luxury new home in Brighton and $1 million in the bank.

Reichelt, 57, bought his tickets in the third and final 2018 Home Lottery on the spur of the moment.

“I was sitting watching TV one night and saw the ad for the Home Lottery. I thought I’d just ring up and buy three tickets. The lady on the phone said it was cheaper to buy five so I decided to buy 10,” he says.

Incredibly, the winning ticket was in the second batch of five Reichelt bought.

“I’m never usually stuck for words but I was just flabbergasted – I couldn’t believe it,” says Reichelt, formally from Mount Barker. “It’s life-changing. The first afternoon I moved into the house, I sat on the balcony watching the ocean for three hours – it was just amazing.”

The highlight of winning for Reichelt is the security the money brings to help him support his three grown-up children and two grandchildren.

“My main aim is to look after the kids because things are pretty tough for them,” he says. “To be able to help them is the biggest thing – to know they’ll be looked after.”

Reichelt is deeply grateful to the Hospital Research Home Lottery for giving him this new start in life.

“They’re fantastic people,” he says. “And the lottery helps THRF too, so the money is going to a good cause.”

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Thanks to some resourceful minds, there are many businesses in this great state that have pivoted and are now guiding our state back from hibernation to a bustling economy and a state of wellbeing, for employers and employees alike.

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Immigrants don’t crowd out u.s.-born professionals, new study finds.

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New research finds that admitting more foreign-born physicians helps Americans live longer and does ... [+] not crowd out U.S. doctors.

New research finds that admitting more foreign-born physicians helps Americans live longer and does not crowd out U.S. doctors. The study, published by the National Bureau of Economic Research, is relevant to the debate over H-1B visas and concludes that blocking the admission of high-skilled professionals lacks sound economic reasoning. The results are similar to other research that finds foreign-born scientists and engineers aid the economy and do not harm the prospects of U.S. professionals.

H-1B Lottery Results

Because lawmakers believed high-skilled foreign nationals could harm the employment of U.S.-born workers, Congress limited the annual admission of new H-1B visa holders for companies to 85,000. That includes a 65,000 annual cap and a 20,000 exemption to the yearly limit for individuals with an advanced degree from a U.S. university.

U.S. Citizenship and Immigration Services changed the H-1B registration selection process for FY 2025 to eliminate possible gaming by some employers. The new system is beneficiary-centric, meaning USCIS selects unique beneficiaries to eliminate the issue of employers filing multiple registrations for the same individuals (except for those with legitimate job offers). That change seems to have succeeded and will likely make additional selection rounds unnecessary. (USCIS added selection rounds for FY 2024 to approve a sufficient number of qualified beneficiaries.)

“The new system will change the process but is unlikely to solve a fundamental shortcoming in U.S. immigration law—the H-1B annual limit is too low for America’s size and an economy that relies on technical talent to grow and innovate,” I wrote in March . That proved to be the case.

According to an agency statement , USCIS selected only approximately 25% of eligible beneficiaries in FY 2025. It was about the same proportion as in FY 2024 after accounting for the additional rounds due to multiple registrations. USCIS stated it selected 120,603 registrations out of 470,342 eligible registrations in FY 2025. (USCIS selects more than 85,000 H-1B registrations to accommodate denials and withdrawals.) USCIS selected 114,017 beneficiaries out of approximately 442,000 unique beneficiaries for FY 2025, meaning the agency did not select nearly 328,000 high-skilled foreign nationals in the FY 2025 H-1B registration process due to the low annual limit.

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The inadequate annual limit for H-1B visas affects high-tech employers, hospitals, and rural health clinics. Many states need help attracting physicians to practice in rural areas, and limited access to medical care affects residents’ health outcomes.

In 1994, Congress passed the Conrad Visa Waiver Program to allow states to waive the requirement for a foreign physician in J-1 status to return home in two years if they worked in a medically underserved area for at least three years. The federal government must designate the location as a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Medically Underserved Population.

The 1994 law limited the number of waivers for foreign physicians on J-1 visas to 20 per state. In 2002, Congress expanded the program to 30 for each state. That expansion made it easier for economists to research the program’s impact on patients and other physicians.

“Our analysis uses available data on physicians, utilization of J-1 visa waivers and associated state policies to assess the impact of the Conrad 30 program on the supply of physicians,” according to the study by Breno Braga of the Urban Institute, Gaurav Khanna of the University of California at San Diego and Sarah Turner of the University of Virginia.

“We find that relaxing the baseline cap on J-1 visa waivers generated a sustained increase in IMG [international medical graduates] physicians, without reducing the supply of U.S.-trained physicians, with these effects particularly large in states with the fewest restrictions on the nature of employment for waiver recipients.

“In precise terms, we find that states that took advantage of the cap expansion of the program have 0.04 more IMGs per thousand habitants than states that did not take advantage of the cap expansion in 2001. Using simple calculations based on Basu et al. (2019), we estimate that this increase in supply of doctors was associated with a 20.6-day increase in life expectancy in states taking advantage of the cap increase in 2001.”

No Evidence Of A Negative Impact On U.S.-Born Physicians

Braga, Khanna and Turner examined the impact of the Conrad 30 program expanding the number of foreign physicians per state on U.S.-born doctors and found no negative effect. “Our results are also consistent with evidence that an increasing supply of high-skilled immigrants might have null to positive effects on labor market outcomes of natives when their labor supply is constrained (Kerr and Lincoln 2010 and Peri, Shih, and Sparber 2015).”

As the economists noted, the findings on the Conrad 30 program’s expansion align with other research results. A May 2020 NFAP study by University of North Florida economics professor Madeline Zavodny found, “[T]he evidence points to the presence of H-1B visa holders being associated with lower unemployment rates and faster earnings growth among college graduates, including recent college graduates.”

Economists Giovanni Peri, Kevin Shih and Chad Sparber examined the impact of H-1B visa holders on U.S. professionals. They concluded , “A rise in foreign STEM growth by 1 percentage point of total employment increases wage growth of college-educated natives by 7–8 percentage points. The same change had a smaller but usually significant effect on non-college-educated native wage growth equal to 3–4 percentage points.”

William R. Kerr (Harvard Business School) and William F. Lincoln (University of Michigan) analyzed Current Population Survey employment records from 1995 to 2008. They found a rise in H-1B visas increased innovation (patents) and had no negative impact on U.S. professionals. “A 10% growth in the national H-1B population corresponded with a 2%-4% higher growth in immigrant SE employment for each standard deviation increase in state dependency,” according to Kerr and Lincoln. “We do not find any substantive effect on native [U.S.-born] scientists and engineers across a range of labor market outcomes like employment levels, mean wages, and unemployment rates.”

The research on the Conrad 30 program and other recent studies indicate that allowing more foreign-born physicians, scientists and engineers to work in the United States would help the U.S. economy and not harm the employment of U.S.-born professionals.

Stuart Anderson

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Soldiers stand outside in the snow. Tanks and other military equipment are in the background.

Putin Is Selling Victory, and Many Russians Are Buying It

Vladimir Putin’s message to his country appears to be taking hold: that Russia is fighting against the whole Western world — and winning.

Military cadets at an exhibition of equipment captured from NATO countries in front of the Victory Museum in Moscow. Credit...

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By Valerie Hopkins

Photographs by Nanna Heitmann

Reporting from Moscow

  • May 15, 2024

The word “victory” is everywhere in Moscow these days.

It is being projected from gargantuan LED screens alongside major intersections and highways and written on red flags whipping in the wind. It’s prominent at an exhibit of Western weapons destroyed on Ukrainian battlefields and lugged back to Moscow as war trophies on display in — where else? — Victory Park.

Victory is precisely the message that President Vladimir V. Putin, 71, has sought to project as he has been feted with pomp and pageantry after another electoral success, while his army sweeps through Ukrainian villages in a stunning new offensive in the northeast.

“Together, we will be victorious!” Mr. Putin said at his inauguration last week after securing a fifth term as president. Two days later, the country celebrated Victory Day, Russia’s most important public holiday, which commemorates the Soviet contribution to the defeat of Nazi Germany in World War II.

Honor guard members walk down a red carpet in the center of a large hallway as people look on from either side.

During the first year of the invasion, many Russians were shocked and ashamed by the war; hundreds of thousands left the country. During the second year, they were concerned about a potential second wave of mobilization.

But with the war now in its third year, many Russians seem to have learned to accept it, interviews over the last week and recent polling show. And “victory” is an easy sell in Mr. Putin’s Russia.

Western sanctions have inflicted few economic hardships. The military news from Ukraine is increasingly positive. Yes, soldiers are still returning in coffins, but mostly to families in the hinterlands , not among the Moscow elite. And for many, the deaths only reinforce the idea, pushed by state news media and driven home relentlessly by Mr. Putin, that Russia is facing an existential threat from the West.

“We can feel that victory is near,” said Andrei, 43, who said he traveled to Moscow for the May 9 holiday celebrations from the Chita region, almost 3,000 miles from the capital.

Like others interviewed for this story, he declined to provide his last name, indicating apparent mistrust of Western news media.

He was among those who braved the cold and even snow to visit the collection of recently captured Western military equipment. (Ukraine also displays destroyed Russian tanks in the center of Kyiv). But the brash exhibit in Moscow, with flags on the equipment showing which countries donated them to Ukraine, fits Russia’s narrative that it is fighting against the whole developed world — and winning.

“When you see all this, and all these flags, it is clear that the whole world is supplying weapons and you know that a world war is going on,” Andrei said. “It’s Russia against the whole world, as usual.”

Ivan, another visitor to Victory Park, waited his turn to pose in front of the rusted and charred hulk of the German Leopard tank, flashing a smile and giving a thumbs up as his friend photographed him. People jostled for a spot beside a similarly destroyed American-made M1 Abrams tank.

“There has been so much talk about these Abrams, about these Leopards, and what is the result?” said Ivan, 26.

“They are all standing here, we are looking at them, we see what condition they are in. This is great!” He smiled.

The bravado exhibited by Russians like Andrei and Ivan this month mirrors the confident posture of Mr. Putin as he steers Russia past economic challenges and to greater battlefield advantage in Ukraine.

His inauguration included a church service in which he was blessed by the leader of the Russian Orthodox Church, Patriarch Kirill I, who expressed hope that the president would remain in power until “the end of the century.”

According to the Levada Center, an independent polling institution, about 75 percent of Russians profess support for their army’s actions in Ukraine. (About a quarter of the population is against the war, the poll and other research shows, but protests are effectively banned, and repression is so intense that many people are afraid to acknowledge or share antiwar or anti-government content online).

Thousands who fled Russia have returned. Their lives have adapted to the new normal, and have actually changed less than those in the West might expect.

“It’s what, the 13th package of sanctions they’re making?” Ivan said, laughing. “So far, we don’t feel anything.”

Robots built by Yandex, Russia’s homegrown version of Google, can be seen traversing Moscow’s sidewalks making deliveries. Inflation is under control, at least for now. According to a report last month by Forbes, the number of billionaires in Moscow — measured in U.S. dollars — increased so much that the city moved up four spots in the global rankings, behind only New York City.

“Most of the brands that allegedly left Russia have not gone anywhere,” said Andrei, adding that he and his daughter planned to have lunch at a rebranded K.F.C. What had changed, he said, was that “the consolidation of society has taken place” over the rationale for the war, as well as the conservative social values Mr. Putin is pushing.

Mr. Putin and others trumpeted that apparent cohesion when the official results of his preordained election victory in March were announced, with a record 88 percent of the vote going to the incumbent, a figure that Western democracies decried as a sham.

“Russia is such a complicated, multiethnic country that to understand it and govern it, you need more than one term,” said Oleg V. Panchurin, 32, a veteran of the war in Ukraine.

“If it’s going to be President Putin, then I would be happy if he served 10 terms,” said Mr. Panchurin, who said had been recently wounded near Zaporizhzhia by a Ukrainian drone.

Some civilians who were interviewed said they were pleased the president had taken a hard-line conservative position promoting traditional family values.

Zhenya, 36, and his girlfriend, Masha, expressed gratitude that the government had “finally handled the L.G.B.T.Q. issue” — by banning what it called the “L.G.B.T.Q. movement.” The pair were attending a 1940s-themed Victory Day celebration in a park in central Moscow where participants fox-trotted and waltzed as a live military band played.

With no one who could credibly replace him, the prospect that Mr. Putin will stay in power as long as he is alive feels increasingly possible to ordinary Russians, said Andrei Kolesnikov, a Moscow-based senior fellow at the Carnegie Russia Eurasia Center.

“Everyone understands that this is for a long time,” he said. “The longer he is in power, the more apprehension there is about who will be next, who will be worse.”

“We are moving closer to a scenario where we could see the effect of Stalin, when, after his death, people were crying, because people didn’t know how to live,” Mr. Kolesnikov added.

Russians who oppose the government say they increasingly fear that they will have to wait for Mr. Putin’s death for anything to change.

“I feel a very strong sense of hopelessness,” said Yulia, 48, a teacher who was visiting the grave of Aleksei A. Navalny, the opposition politician, in southeast Moscow. Mr. Navalny, who died in prison in an Arctic penal colony in February, had long been considered the only possible challenger to Mr. Putin. Yulia declined to use her last name out of fear of possible repercussions.

“I don’t see a way out of this,” she said.

Yulia’s son, Pavel, said, “We are sure that everything depends on the death of person in a certain place.” His mother shushed him, noticing the uniformed Russian National Guard forces that stood nearby; even in death, Mr. Navalny is still monitored closely by the government. Still, there was a steady stream of visitors to the grave.

On the other side of Moscow, mourners were still coming to show their respects to the 145 victims of the March 22 terrorist attack at Crocus City Hall, one of the deadliest in Europe in the past decade. Floral wreaths, plush toys and photos of the victims were placed near the destroyed concert hall.

The Islamic State claimed responsibility for the attack, and American officials have blamed Islamic State Khorasan Province, or ISIS-K , a branch of the group. Even so, the Kremlin has sought to cast blame on Ukraine and the West.

One woman who declined to give her name said she was sure the West was behind it — despite the fact that the United States had warned Moscow of an imminent attack . According to the Levada Center, half of those polled believe Ukraine was behind the attack, with almost 40 percent saying Western intelligence services were involved.

Vladimir, 26, who was visiting the improvised memorial for the first time, said he didn’t blame the Kremlin for failing to heed the warnings.

“I want the terrorists to be destroyed,” said Vladimir, a supermarket employee. But the president, he said, was doing a great job. “He works so hard.”

“ May God keep him alive and healthy,” he said. “If, God forbid, Putin dies, what will happen to our country?”

Anastasia Kharchenko contributed reporting from Moscow and Alina Lobzina from London.

Valerie Hopkins covers the war in Ukraine and how the conflict is changing Russia, Ukraine, Europe and the United States. She is based in Moscow. More about Valerie Hopkins

Our Coverage of the War in Ukraine

News and Analysis

The United States and Europe are coalescing around a plan to use interest earned on frozen Russian central bank assets to provide Ukraine with a loan to be used for military and economic assistance .

The Chinese leader Xi Jinping’s talks with President Vladimir Putin of Russia were a show of solidarity  between two autocrats battling Western pressure.

Ukraine asked the Biden administration to provide more intelligence  on the position of Russian forces and military targets inside Russia.

Europe’s Defense Industry: Russia’s invasion of Ukraine jolted Europe out of complacency about military spending. But the challenges are about more than just money .

Putin’s Victory Narrative: The Russian leader’s message to his country appears to be taking hold : that Russia is fighting against the whole Western world — and winning.

A Boxing Win Offers Hope: The Ukrainian boxer Oleksandr Usyk became the world’s undisputed heavyweight champion, a victory that has lifted morale  in a country struggling to contain Russian advances.

How We Verify Our Reporting

Our team of visual journalists analyzes satellite images, photographs , videos and radio transmissions  to independently confirm troop movements and other details.

We monitor and authenticate reports on social media, corroborating these with eyewitness accounts and interviews. Read more about our reporting efforts .

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