Russia’s lunar spacecraft entered the moon’s orbit on Wednesday, a major step toward the country’s ambition of being the first to land on the moon’s south pole in the search for frozen water. 

The Luna-25 entered the moon’s orbit at 11:57 a.m. local time (0857 GMT), Russia’s space corporate Roskosmos said. 

Luna-25 will circle the moon, the Earth’s only natural satellite, for about five days, then change course for a soft landing on the lunar south pole planned for August 21. 

India’s Chandrayaan-3 entered the moon’s orbit earlier this month ahead of a planned touchdown on the south pole of the moon later this month. 

The Luna-25, which is roughly the size of a small car, will aim to operate for a year on the south pole, where scientists at NASA and other space agencies in recent years have detected traces of frozen water in the craters. 

The presence of water on the moon has implications for major space powers, potentially allowing longer human sojourns on the planet that would enable the mining of lunar resources.  

No Russian spacecraft has entered lunar orbit since Luna-24, the Soviet Union’s 1976 moon mission, according to Anatoly Zak, the creator and publisher of www.RussianSpaceWeb.com which tracks Russian space programs. 

“Entering lunar orbit is absolutely critical for the success of this project,” Zak told Reuters. “This is a first for the post-Soviet period.” 

“Some are calling this the second lunar race so it is very important for Russia to resume this program. Luna-25 is not just one mission — it is part of a much broader Russian strategy that stretches 10 years into the future.” 
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New restrictions on access to a drug used in the most common form of abortion would be imposed under a federal appeals court ruling issued Wednesday, but the Supreme Court will have the final say.

The ruling by three judges on the 5th U.S. Circuit Court of Appeals in New Orleans overturned part of a lower court ruling that revoked the Food and Drug Administration’s approval — more than two decades ago — of mifepristone. But it left intact part of the ruling that would end the availability of the drug by mail and require that the drug be administered in the presence of a physician.

Those restrictions won’t take effect, at least right away, because the Supreme Court previously intervened to keep the drug available during the legal fight.

At issue is a Texas-based federal judge’s April ruling revoking the drug’s approval, which was granted more than 20 years ago by the Food and Drug Administration.

There is no precedent for a U.S. court overturning the approval of a drug that the FDA has deemed safe and effective. While new drug safety issues often emerge after FDA approval, the agency is required to monitor medicines on the market, evaluate emerging issues and take action to protect U.S. patients. Congress delegated that responsibility to the FDA — not the courts — more than a century ago.

But during a May 17 hearing, the 5th Circuit panel — Judges Jennifer Walker Elrod, James Ho and Cory Wilson — pushed back frequently against assertions that U.S. District Judge Matthew Kacsmaryk’s April 7 ruling was unprecedented and unwarranted.

Kacsmaryk, Ho and Wilson are all appointees of former President Donald Trump. Elrod was appointed to the 5th Circuit by former President George W. Bush. All of the judges have a history of supporting abortion restrictions.

The Texas lawsuit was filed by the Alliance Defending Freedom, a conservative Christian legal group that was also involved in the Mississippi case that led to the June 2022 Supreme Court ruling overturning Roe v. Wade and the nationwide right to abortion.

Mifepristone is one of two pills used in medication abortions. The other drug, misoprostol, is also used to treat other medical conditions. Health care providers have said they could switch to misoprostol if mifepristone is no longer available or is too hard to obtain. Misoprostol is somewhat less effective in ending pregnancies.
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Surgeons transplanted a pig’s kidney into a brain-dead man and for over a month it’s worked normally — a critical step toward an operation the New York team hopes to eventually try in living patients.

Scientists around the country are racing to learn how to use animal organs to save human lives, and bodies donated for research offer a remarkable rehearsal.

The latest experiment announced Wednesday by NYU Langone Health marks the longest a pig kidney has functioned in a person, albeit a deceased one — and it’s not over. Researchers are set to track the kidney’s performance for a second month.

“Is this organ really going to work like a human organ? So far it’s looking like it is,” Dr. Robert Montgomery, director of NYU Langone’s transplant institute, told The Associated Press.

“It looks even better than a human kidney,” Montgomery said on July 14 as he replaced a deceased man’s own kidneys with a single kidney from a genetically modified pig — and watched it immediately start producing urine.

The possibility that pig kidneys might one day help ease a dire shortage of transplantable organs persuaded the family of the 57-year-old Maurice “Mo” Miller from upstate New York to donate his body for the experiment.

“I struggled with it,” his sister, Mary Miller-Duffy, told the AP. But he liked helping others and “I think this is what my brother would want. So I offered my brother to them.”

“He’s going to be in the medical books, and he will live on forever,” she added.

Attempts at animal-to-human transplants have failed for decades as people’s immune systems attacked the foreign tissue. Now researchers are using pigs genetically modified so their organs better match human bodies.

Last year with special permission from regulators, University of Maryland surgeons transplanted a gene-edited pig heart as a last-ditch attempt to save a dying man. He survived only two months before the organ failed for reasons that aren’t fully understood but that offer lessons for future attempts.

Now, the Food and Drug Administration is considering whether to allow some small but rigorous studies of pig heart or kidney transplants in volunteer patients.

The NYU experiment is one of a string of developments aimed at speeding the start of such clinical trials. Also Wednesday, The University of Alabama at Birmingham reported another important success — a pair of pig kidneys worked normally inside another donated body for seven days.

Kidneys don’t just make urine — they provide a wide range of jobs in the body. In the journal JAMA Surgery, UAB transplant surgeon Dr. Jayme Locke reported lab tests documenting the gene-modified pig organs’ performance. She said the weeklong experiment demonstrates they can “provide life-sustaining kidney function.”

These experiments are critical to answer more remaining questions “in a setting where we’re not putting someone’s life in jeopardy,” said Montgomery, the NYU kidney transplant surgeon who also received his own heart transplant — and is acutely aware of the need for a new source of organs.

More than 100,000 patients are on the nation’s transplant list and thousands die each year waiting.

Previously, NYU and a team at The University of Alabama at Birmingham had tested pig kidney transplants in deceased recipients for just two or three days. An NYU team also had transplanted pig hearts into donated bodies for three days of intense testing.

But how do pig organs react to a more common human immune attack that takes about a month to form? Only longer testing might tell.

The surgery itself isn’t that different from thousands he’s performed “but somewhere in the back of your mind is the enormity of what you’re doing … recognizing that this could have a huge impact on the future of transplantation,” Montgomery said.

The operation took careful timing. Early that morning Drs. Adam Griesemer and Jeffrey Stern flew hundreds of miles to a facility where Virginia-based Revivicor Inc. houses genetically modified pigs — and retrieved kidneys lacking a gene that would trigger immediate destruction by the human immune system.

As they raced back to NYU, Montgomery was removing both kidneys from the donated body so there’d be no doubt if the soon-to-arrive pig version was working. One pig kidney was transplanted, the other stored for comparison when the experiment ends.

“You’re always nervous,” Griesemer said. To see it so rapidly kickstart, “there was a lot of thrill and lot of sense of relief.”

How long should these experiments last? Alabama’s Locke said that’s not clear — and among the ethical questions are how long a family is comfortable or whether it’s adding to their grief. Because maintaining a brain-dead person on a ventilator is difficult, it’s also dependent on how stable the donated body is.

In her own experiment, the donated body was stable enough that if the study wasn’t required to end after a week, “I think we could have gone much longer, which I think offers great hope,” she said.

The University of Maryland’s Dr. Muhammad Mohiuddin cautions that it’s not clear how closely a deceased body will mimic a live patient’s reactions to a pig organ — but that this research educates the public about xenotransplantation so “people will not be shocked” when it’s time to try again in the living.
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Germany’s Cabinet on Wednesday approved a plan to liberalize rules on cannabis, setting the scene for the European Union’s most populous member to decriminalize possession of limited amounts and allow members of “cannabis clubs” to buy the substance for recreational purposes.

The legislation is billed as the first step in a two-part plan and still needs approval by parliament. But the government’s approval is a stride forward for a prominent reform project of Chancellor Olaf Scholz’s socially liberal coalition, although significantly short of its original ambitions.

The bill, which the government hopes will take effect at the end of this year, foresees legalizing possession of up to 25 grams (nearly 1 ounce) of cannabis for recreational purposes and allowing individuals to grow up to three plants on their own.

German residents who are 18 and older would be allowed to join nonprofit “cannabis clubs” with a maximum of 500 members each. The clubs would be allowed to grow cannabis for members’ personal consumption.

Individuals would be allowed to buy up to 25 grams per day, or a maximum 50 grams per month — a figure limited to 30 grams for people under 21. Membership in multiple clubs would not be allowed. The clubs’ costs would be covered by membership fees, which would be staggered according to how much cannabis members use.

The government plans a ban on advertising or sponsoring cannabis and the clubs, and consumption won’t be allowed within 200 meters (656 feet) of schools, playgrounds and sports facilities, or near cannabis club premises.

Officials hope their plan will help protect consumers against contaminated products and reduce drug-related crime. Health Minister Karl Lauterbach said he expects the system to produce “very competitive” prices, “so we think that we can push back the black market well with these rules.”

At present, “we have rising consumption, problematic consumption,” Lauterbach told reporters. “It simply couldn’t have carried on like this.”

The center-right opposition argues that the government is pressing ahead with legalizing a risky drug despite European legal obstacles and expert opinion. An organization representing German judges says the plan is likely to increase rather than decrease the burden on the judicial system and could even increase demand for black-market cannabis.

Some advocates of legalization aren’t happy either.

“What we’re getting from the health minister is overregulation, a continued stigmatization of cannabis users and a much too tight regulatory corset, which simply makes it impossible for many, many [cannabis clubs] to work,” said Oliver Waack-Jürgensen, who heads the Berlin-based High Ground “cannabis social club” founded last year. He is also on the board of a national association representing such clubs.

Lauterbach rejected the objections.

“The fact that it’s being attacked from both sides is a good sign,” the minister said. He added that “approval with much more liberalization, like for example in Holland or some American states, would have led to consumption expanding,” and that those who oppose any legalization “have no answer” to rising consumption, crime and a burgeoning black market.

The legislation is to be accompanied by a campaign meant to sensitize young people to the risks of consuming cannabis.

The government says it plans to follow the new legislation by mapping out a second step — five-year tests of regulated commercial supply chains in select regions, which would then be scientifically evaluated.

That’s far short of its original plan last year, which foresaw allowing the sale of cannabis to adults across the country at licensed outlets. It was scaled back following talks with the EU’s executive commission.

Approaches elsewhere in Europe vary. The Netherlands combines decriminalization with little market regulation.

Dutch authorities tolerate the sale and consumption of small amounts of the substance at so-called coffeeshops, but producing and selling large amounts of it, necessary to keep the coffeeshops supplied, remains illegal. Amsterdam, long a magnet for tourists wanting to smoke weed, has been cracking down on coffeeshops.

The Dutch government, meanwhile, has launched an experiment it says aims to “determine whether and how controlled cannabis can be legally supplied to coffeeshops and what the effects of this would be.”

In Switzerland, authorities last year cleared the way for a pilot project allowing a few hundred people in Basel to buy cannabis from pharmacies for recreational purposes. The Czech government has been working on a plan similar to Germany’s to allow sales and recreational use of cannabis, which isn’t finalized.

Denmark’s capital, Copenhagen, has proposed legalizing weed, but parliament turned down the idea. France has no plans to liberalize its strict cannabis rules.
…

Researchers in heavily drilled Pennsylvania were preparing Tuesday to release findings from taxpayer-financed studies on possible links between the natural gas industry and pediatric cancer, asthma and poor birth outcomes.

The four-year, $2.5 million project is wrapping up after the state’s former governor, Democrat Tom Wolf, in 2019 agreed to commission it under pressure from the families of pediatric cancer patients who live amid the nation’s most prolific natural gas reservoir in western Pennsylvania.

A number of states have strengthened their laws around fracking and waste disposal over the past decade. However, researchers have repeatedly said that regulatory shortcomings leave an incomplete picture of the amount of toxic substances the industry emits into the air, injects into the ground or produces as waste.

The Pennsylvania-funded study involves University of Pittsburgh researchers and comes on the heels of other major studies that are finding higher rates of cancer, asthma, low birth weights and other afflictions among people who live near drilling fields around the country.

Tuesday evening’s public meeting to discuss the findings will be hosted by the University of Pittsburgh School of Public Health and the state Department of Health, on the campus of state-owned Pennsylvania Western University.

Edward Ketyer, a retired pediatrician who is president of the Physicians for Social Responsibility Pennsylvania and who sat on an advisory board for the study, said he expects that the studies will be consistent with previous research showing that the “closer you live to fracking activity, the increased risk you have at being sick with a variety of illnesses.”

“We’ve got enough evidence that associates, that links, that correlates fracking activity to poor health. And the biggest question is, why is anybody surprised about that?” Ketyer said.

The gas industry has maintained that fracking is safe, and industry groups in Pennsylvania supported Wolf’s initiative to get to the bottom of the pediatric cancer cases.

The study’s findings are emerging under new Governor Josh Shapiro, also a Democrat, whose administration has yet to publish or otherwise release the researchers’ reports since taking office earlier this year.

The advent of high-volume hydraulic fracturing, combined with horizontal drilling miles deep in the ground over the past two decades, transformed the United States into a worldwide oil and gas superpower.

But it also brought a torrent of complaints about water and air pollution, and diseases and ailments, as it encroached on exurbs and suburbs in states like Texas, Colorado and Pennsylvania.

One of the most enduring images of gas drilling pollution was residents in a northern Pennsylvania community lighting their tap water on fire.

A state grand jury investigation later found that a company had failed to fix its faulty gas wells, which leaked flammable methane into residential water supplies in surrounding communities.

The Pennsylvania-funded study comes on the heels of other major studies, such as one published last year by Harvard University researchers, who said they found evidence of higher death rates in more than 15 million Medicare beneficiaries who lived downwind of oil and gas wells in major exploration regions around the U.S.

Yale University researchers last year said they found that children in Pennsylvania living near an oil or gas wellsite had up to two to three times the odds of developing acute lymphocytic leukemia, a common type of cancer in children.

Establishing the cause of health problems is challenging, however. It can be difficult or impossible for researchers to determine exactly how much exposure people had to pollutants in air or water, and scientists often cannot rule out other contributing factors.

Because of that, environmental health researchers try to gather enough data to gauge risk and draw conclusions.

“The idea is we’re collecting evidence in some kind of a systematic way, and we’re looking at that evidence and judging whether causation is a reasonable interpretation to make,” said David Ozonoff, a retired environmental health professor who chaired the Department of Environmental Health at Boston University.

Another key piece of evidence is to identify an activity that exposes people to a chemical as part of assembling evidence that fits together in narrative, Ozonoff said.
…

A clinical trial in Australia is developing a treatment for sleep disturbances caused by wildfires. The study, which is supported by Natural Hazards Research Australia, a research organization, and Federation University Australia, is now seeking participants in Australia, the United States and Canada.

The trial is aimed at people who have disturbed sleep, including nightmares, insomnia or symptoms of trauma after surviving a wildfire.

Participants will be asked about their experiences with wildfires and asked to rate the severity of their sleep and trauma symptoms.

Those who take part complete short assessments and provide feedback through online activities. The testing is at home using sleep-specific technology and apps that track sleep.

Clinical psychologist Fadia Isaac is conducting the trial with other researchers at Federation University Australia, with funding from Natural Hazards Research Australia’s Postgraduate Research Scholarship program.

She tells VOA that people confronted by trauma experience a so-called “fight or flight” response, when the brain reacts to shock.

“If we are not getting sleep because of the fight or flight response then there is no room for these emotions to get processed during that time and therefore the trauma can be ongoing, sleep can also continue to be a problem for those people and unfortunately it becomes a vicious cycle for many people,” she said.

This is an international study that is seeking participants in Australia, the United States and Canada.

Their experiences of a wildfire do not need to be recent; the event could be several years or even decades ago.

Isaac says the early signs from the clinical trial are encouraging.

“If they are waking up too early or they cannot initiate sleep, or they are having regular nightmares, these modules are dedicated to actually psycho-educate the public about sleep, insomnia, nightmares and trauma symptoms. It is very easy to use and we have had some great feedback from our current participants,” she said.

Prolific vegetation growth has led to warnings that Australia could face serious wildfires later this year.

A royal commission inquiry into Australia’s Black Summer bushfires of 2019-20 — which destroyed vast parts of the country — along with other disasters, said in October 2020 that climate change had exacerbated the extreme conditions which caused the fires.

2023 has already been a savage year for wildfires. The fires in Hawaii are the deadliest in the United States in more than 100-years.

Canadian wildfire officials said earlier this month that the 2023 wildfire season is the worst ever recorded, with millions of hectares of land already scorched.

Fires have also caused widespread devastation in Spain and Portugal.

And recent fires on the Greek island of Rhodes forced the evacuation of thousands of people as the flames reached resorts on the island’s south-eastern coast.
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New Zealand on Monday removed the last of its remaining COVID-19 restrictions, marking the end of a government response to the pandemic that was watched closely around the world. 

Prime Minister Chris Hipkins said the requirement to wear masks in hospitals and other health care facilities would end at midnight, as would a requirement for people who caught the virus to isolate themselves for seven days. 

New Zealand was initially praised internationally for eliminating the virus entirely after imposing nationwide lockdowns and strict border controls. 

But as the pandemic wore on and more infectious variants took hold, the nation’s zero-tolerance approach became untenable. It eventually abandoned its elimination strategy. 

Reflecting on the government’s response to the virus over more than three years, Hipkins said that during the height of the pandemic he had longed for the day he could end all restrictions, but now it felt anticlimactic. 

He said about 3,250 New Zealanders from a population of 5 million had died with COVID-19 as a primary or secondary cause — about one-fifth of the mortality rate in the United States. 

“While there were no doubt fractures in our collective sense of unity, I believe that New Zealanders can be enormously proud of what we achieved together,” Hipkins said. “We stayed home, we made sacrifices, we got vaccinated, and there is absolutely no question, we saved lives.” 

Health Minister Ayesha Verrall said coronavirus case numbers and hospitalizations were low and had been trending down since June, and the publicly funded health system had faced less disruption from the virus this southern winter. 

“We have been able to complete 16,000 more operations than we did last year, and so that is a very good indication our health system is on a much more even keel than it was,” she said. 

The announcement comes two months before a general election. 

David Seymour, the leader of the opposition ACT Party, said the government had been treating people like children for too long. 

“They have been happy to impose high costs with little benefit and have taken their sweet time getting around to fixing it,” Seymour said in a statement. 
…

For the team aboard the Okeanos Explorer off the coast of Alaska, exploring the mounds and craters of the sea floor along the Aleutian Islands is a chance to surface new knowledge about life in some of the world’s deepest and most remote waters.

The National Oceanic and Atmospheric Administration research vessel is on a five-month mission aboard a reconfigured former Navy vessel run by civilians and members of the NOAA Corps. The ship, with a 48-member crew, is outfitted with technology and tools to peer deep into the ocean to gather data to share with onshore researchers in real time. The hope is that this data will then be used to drive future research.

“It’s so exciting to go down there and see that it’s actually teeming with life,” said expedition coordinator Shannon Hoy. “You would never know that unless we were able to go down there and explore.”

Using a variety of sonars and two remotely operated vehicles — Deep Discoverer and Serios — researchers aboard the ship are mapping and collecting samples from areas along the Aleutian Trench and the Gulf of Alaska. High-resolution cameras that can operate at depths of up to 6,000 meters (19,685 feet) allow researchers to document and immediately share their findings. The ship can also livestream dives to the public.

Many factors, such as depth, speed and sonar capability, influence how much sea floor can be mapped. In 2 to 4 weeks, the Okeanos Explorer can map as much as 50,000 square kilometers (31,069 square miles), Hoy said.

During these dives, Hoy said the team plans to investigate some of the area’s cold seep communities — places where gases from under the sea floor rise through cracks and where plants don’t rely on photosynthesis for food production. 

“We’re also going to be looking through the water column to see what interesting animals and fauna that we can see there,” she said. 

Kasey Cantwell, the ship’s operations chief, said the data will help researchers and the public better understand these remote stretches of ocean, including marine life and habitats in the area. That could inform management decisions in fisheries. Data could also help detect hazards and improve nautical charts.

“It’s really hard to care for things you don’t understand, to love things you don’t understand,” Cantwell said.

The deep ocean off Alaska’s Aleutian Islands is one of the least mapped places in the U.S., partly due to its remoteness. Modern mapping standards have covered just 34% of the sea floor around Alaska, which has one of the nation’s largest coastal ecosystems, and only a fraction of that has been seen, according to the expedition’s website.

Closing these gaps is a mission priority and will help meet a goal of mapping all the United States’ deep waters by 2030 and near-shore waters by 2040, according to Emily Crum, a communications specialist with the National Oceanic and Atmospheric Administration.

But the data collection process is laborious.

Thomas Morrow, a physical scientist on the ship, likened the effort to “walking the length of several city blocks in complete darkness with a tiny flashlight.”

Nevertheless, all these small looks add up to a better understanding of what lies in the deepest parts of the sea.

In the expedition’s first two months, researchers recorded methane seeps and saw a Brisingid sea star at a depth of 2,803 meters (9,200 feet) that had not been documented in the Aleutians before. At least two potential new species have also been discovered.

Earlier this year while on an expedition off the coast of Washington state, researchers aboard the ship documented a jellyfish floating in the deep, and soon had a call from an excited scientist who told them the jellyfish was behaving in ways not seen before.

“The feeling of wonder that sometimes happens in that control room is so palpable,” he said.  
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Patients who take blockbuster drugs like Wegovy or Ozempic for weight loss may face life-threatening complications if they need surgery or other procedures that require empty stomachs for anesthesia. This summer’s guidance to halt the medication for up to a week may not go far enough, either. 

Some anesthesiologists in the U.S. and Canada say they’ve seen growing numbers of patients on the weight-loss drugs who inhaled food and liquid into their lungs while sedated because their stomachs were still full — even after following standard instructions to stop eating for six to eight hours in advance. 

The drugs can slow digestion so much that it puts patients at increased risk for the problem, called pulmonary aspiration, which can cause dangerous lung damage, infections and even death, said Dr. Ion Hobai, an anesthesiologist at Massachusetts General Hospital in Boston. 

“This is such a serious sort of potential complication that everybody who takes this drug should know about it,” said Hobai, who was among the first to flag the issue. 

Nearly 6 million prescriptions for the class of drugs that include Wegovy and Ozempic were written between January and May in the U.S. for people who don’t have diabetes, according to Komodo Health, a health care technology company. The drugs induce weight loss by mimicking the actions of hormones, found primarily in the gut, that kick in after people eat. They also target signals between the gut and the brain that control appetite and feelings of fullness, and by slowing how fast the stomach empties. 

In June, the American Society of Anesthesiologists issued guidance advising patients to skip daily weight-loss medications on the day of surgery and hold off on weekly injections for a week before any sedation procedures. Dr. Michael Champeau, the group’s president, said the action was based on anecdotal reports of problems — including aspiration — from around the country. 

It’s not clear how many patients taking the anti-obesity drugs may be affected by the issue. But because the consequences can be so dire, Hobai and a group of colleagues decided to speak out. Writing in the Canadian Journal of Anesthesia, they called for the drug to be stopped for even longer — about three weeks before sedation. 

That accounts for how long semaglutide, the active medication in Wegovy, remains in the body, said Dr. Philip Jones, a Mayo Clinic anesthesiologist who is also deputy editor-in-chief of the journal. 

“When 90% of it is gone, which is after three weeks, hopefully everything should go back to normal,” Jones said. 

Champeau and Jones both acknowledged there’s not enough evidence to say for certain how long semaglutide should be held to make anesthesia safe. Many patients won’t see providers far enough in advance to stop the drug three weeks before procedures, Champeau noted. 

Aspiration occurs in one of every 2,000 to 3,000 operations that require sedation, and almost half of patients who aspirate during surgery develop a related lung injury. But case reports show recent patients on semaglutide had problems even when they stopped food as long as 20 hours before their procedures. 

“There’s nothing that says if you fast twice as long, it will be OK,” Champeau said. 

Among the several reports detailing potentially serious problems was one of Hobai’s patients, a 42-year-old man in Boston who recently began taking Wegovy, had to be intubated and suffered respiratory failure that put him in intensive care. He aspirated food that remained in his stomach despite fasting for 18 hours. 

In Chapel Hill, North Carolina, a 31-year-old-woman on a low dose of Ozempic had fasted for 10 hours before a routine endoscopy prior to bariatric surgery last fall. The procedure had to be stopped because solid food remained in her stomach and she was at high risk for aspiration, the report said. 

Since then, doctors have seen dozens of similar cases as use of the weight-loss medication has grown, said Dr. Elisa Lund, an anesthesiologist at the University of North Carolina at Chapel Hill School of Medicine. “It has exponentially increased,” she said. 

Hobai is completing a retrospective study of almost 200 patients taking semaglutide. While it’ll be published later this year, the work so far appears to confirm a small study from Brazil, he said. In that study, about a quarter of patients taking semaglutide had residual food in their stomachs during procedures requiring sedation — even after stopping the drug for 10 days. 

The American Society of Anesthesiologists advises doctors who are in doubt to treat patients who haven’t paused the drug as if they have full stomachs, which can mean using different types of sedation protocols or delaying procedures, if possible. Jones added that research is urgently needed to update guidelines for doctors and patients. 

Novo Nordisk, which makes Ozempic, Wegovy and similar drugs, said the firm’s clinical trial and post-marketing safety data did not show that the medications led to aspiration. But the drugmaker noted that the medications are known to cause delayed emptying of the stomach and that the labels warn of possible gastrointestinal side effects. 

Stopping the medications for three weeks can cause problems, too. Patients with diabetes will need another way to control their blood sugar and those seeking to lose weight may regain some, Hobai said. 

Hobai suggests that people using Wegovy and similar drugs tell their doctors before sedation and discuss the risks and benefits. 

“If you’re taking this drug and you need an operation, you will need to have some extra precautions,” he said. 
…

Postal worker Eugene Gates Jr. was delivering mail in the suffocating Dallas heat this summer when he collapsed in a homeowner’s yard and was taken to a hospital, where he died.

Carla Gates said she’s sure heat was a factor in her 66-year-old husband’s death, even though she’s still waiting for the autopsy report. When Eugene Gates died on June 20, the temperature was 36.6 Celsius and the heat index, which also considers humidity, had soared over 43.3 Celsius.

“I will believe this until the day I die, that it was heat-related,” Carla Gates said.

Even when it seems obvious that extreme heat was a factor, death certificates don’t always reflect the role it played. Experts say a mishmash of ways more than 3,000 counties calculate heat deaths means we don’t really know how many people die in the U.S. each year because of high temperatures in an ever-warming world.

That imprecision harms efforts to better protect people from extreme heat because officials who set policies and fund programs can’t get the financial and other support needed to make a difference.

“Essentially, all heat related deaths are preventable. People don’t need to die from the heat,” said epidemiologist Kristie L. Ebi, who focuses on global warming’s impact on human health as a professor at the University of Washington.

With a better count, she said, “you can start developing much better heat wave early warning systems and target people who are at higher risk and make sure that they’re aware of these risks.”

Currently, about the only consistency in counting heat deaths in the U.S. is that officials and climate specialists acknowledge fatalities are grossly undercounted.

“Deaths are investigated in vastly different ways based on where a person died,” said Dr. Greg Hess, the medical examiner for Pima County, Arizona’s second most populous county and home to Tucson. “It should be no surprise that we don’t have good nationwide data on heat-related deaths.”

Many experts say a standard decades-old method known as counting excess deaths could better show how extreme heat harms people.

“You want to look at the number of people who would not have died during that time period and get a true sense of the magnitude of the impact,” Ebi said, including people who would not have suffered a fatal heart attack or renal failure without the heat.

The excess deaths calculation is often used to estimate the death toll in natural disasters, with researchers tallying fatalities that exceeded those that occurred at the same time the previous year when circumstances were average.

Counting excess deaths was used to calculate the human impact of a heat wave in Chicago that killed more than 700 people in July 1995, many elderly Black people who lived alone. Researchers also counted excess deaths during the COVID-19 pandemic to provide more complete information about deaths directly and indirectly related to the coronavirus.

But as things stand now, the Centers for Disease Control and Prevention reports just 600 to 700 heat deaths annually in the United States. A study published last month in the journal Nature Medicine estimated more than 61,000 heat-related deaths last summer across Europe, which has roughly double the U.S. population but more than 100 times as many heat deaths.

Dr. Sameed Khatana, a staff cardiologist at the Philadelphia VA Medical Center and assistant professor at the University of Pennsylvania’s Perelman School of Medicine, has said deaths in which heat contributed significantly to fatalities from causes like heart failure should also be considered.

Khatana participated in research published last year that counted excess deaths in all U.S. counties. The findings suggested that from 2008 to 2017 between 3,000 to 20,000 adult deaths from all causes listed on death certificates were linked to extreme heat. Heart disease was listed as the cause of about half of the deaths.

After the Pacific Northwest heat wave in summer of 2021, the Canadian province of British Columbia reported more than 600 deaths due to heat exposure while Oregon and Washington each initially reported a little more than 100 such fatalities.

“It’s frustrating that for 90 years public health officials in the United States have not had a good picture of heat-related mortality because we have such a bad data system,” said Dr. David Jones, a Harvard Medical School professor who also teaches in the epidemiology department at the Harvard T.H. Chan School of Public Health.

There is no uniformity among who does the counting across U.S. jurisdictions. Death investigations in some places might be carried out by a medical examiner, typically a physician trained in forensic pathology. In other locales, the coroner could be an elected sheriff, such as the one in Orange County, California. In some small counties in Texas, a justice of peace might determine cause of death.

Utah and Massachusetts are among states that do not track heat-related deaths where exposure to extreme heat was a secondary factor.

The CDC, which is often several years behind in reporting, draws information on heat deaths from death certificate information included in local, state, tribal and territorial databases.

The CDC said in a statement that coroners and others who fill out death certificates “are encouraged to report all causes of death,” but they may not always associate those contributing causes to an extreme heat exposure death and include the diagnostic codes for heat illnesses.

Hess, the Arizona coroner, said determining environmental heat was a factor in someone’s death is difficult and can take weeks or even months of investigation including toxicological tests.

“If someone was shot in the head, it’s pretty obvious what happened there,” Hess said. “But when you find a body in a hot apartment 48 hours after they died, there is a lot of ambiguity.”

Hess noted that Pima County this year began including heat-related deaths in its tally of environmental heat fatalities. Maricopa County, home to Phoenix, America’s hottest big city, for years has included heat-related deaths. Clark County, Nevada, home to Las Vegas, now also considers deaths in which heat was a contributing factor.

Maricopa’s Public Health Department counted 425 “heat associated” deaths last year, including those where heat was a secondary factor, such as a heart attack provoked by high temperatures.

It reports there were 59 heat-associated deaths confirmed this year through Aug. 5, with another 345 under investigation. The latest count follows the hottest month in Phoenix on record, and a record 31 consecutive days that hit 43.3 Celsius or higher.

Dallas, which regularly sees summer highs above 37.7 Celsius, sweltered through an excessive heat warning this month and also grapples with oppressive humidity.

Carla Gates, whose mail carrier husband died, noted cities worldwide now must learn to deal with extreme weather. She said her spouse, with 36 years on the job, tried to protect himself by taking a chest filled with ice and several bottles of cold water on his rounds.

“Our climate has changed,” she said. “And I don’t think it’s going back to how it was 20 years ago. So we’re going to have to get used to it and we’re going to have to make some adjustments.”

Now she wants to honor her husband by pushing legislation to ensure people working outside are better protected from the heat. Gates noted that the day her husband died he was in an old mail truck without working air conditioning.

“I don’t wish this on anyone, anyone to get a phone call that their loved one died working, doing something that they love in the heat,” she said.
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With field temperatures soaring above 150 degrees at times, 10-year-old baseball player Emmitt Anderson and his teammates from Alabama thought better of kneeling when they gathered near the mound for pregame prayers at a recent regional youth baseball tournament here.

“It was too hot on our knees,” Anderson said of the artificial surface. “We just stood up.”

High heat proved considerably harder to handle than fastballs up in the strike zone at the DYB World Series this week. Temperatures reached 105 degrees, with the heat index peaking at 117.

Some spectators and umpires required treatment for heat-related symptoms. A few passed out and were briefly hospitalized.

“The heat was so extreme, I just knew it was a matter of time before something happened,” said Dr. Kelsey Steensland, an anesthesiologist from Dothan, Alabama, who was there to watch her 10-year-old son, Finn, play for a team representing their state.

During opening ceremonies, she rushed to help an elderly woman who’d collapsed and didn’t regain consciousness for several minutes.

“This was a medical emergency,” Steensland said. “It was more than just giving someone a glass of water.”

With climate change driving average global temperatures higher, organizers, players and spectators taking part in quintessentially American traditions such as midsummer youth baseball championships are having to pay closer attention to the heat — and become more resourceful about mitigating its effects.

A case in point is the DYB World Series, which features teams from 11 Southern states competing in multiple age groups up to 12 years old. Formerly known as Dixie Youth Baseball, DYB was established in 1955.

“The number one priority to any event that anybody puts on outdoors is the safety and health of the participants,” DYB Commissioner William Wade said. “We’ve got to do the best we can to preach whatever safety we can.”

Large evaporative coolers — which pull air over water to cool it before blowing it back out — were placed in dugouts. It was the first time B.J. Branigan, who coached a team from the New Orleans area, had ever seen that.

During the first four days of the six-day tournament, when temperatures were hottest, games were halted every two innings for five-minute “heat breaks.” Cases of water were supplied to coaches, players and umpires.

Many also wore wet cooling towels on the back of their necks.

Sail shades over the stands helped keep fans out of direct sunlight at the Ruston Sports Complex — a newly built facility that drew widespread praise from tournament participants and attendees. But some expressed concern over the way the artificial turf fields, “infilled” with black rubber pellets for cushioning, became so hot at times that one could easily see air rippling from convection just above the surface.

“One day they advised us that the temp was 167 on the field — and it felt like it,” umpire Tim Ward said, noting that he’d never been so hot in 25 years of calling balls and strikes. “You couldn’t stand still. You had to keep moving or your shoes would start getting soft on the bottom, and the heat was radiating up into you.”

Ward was behind home plate that day, wearing a mask and chest protector, and passed out between innings.

When he regained consciousness, he was being treated in the dugout, and was taken soon after by ambulance to a hospital. He missed one day of games and returned to umpire again before the tournament ended.

Any proposal to cancel or postpone the tournament would have been met with considerable opposition. It was getting close to the start of the school year for some players, and these were their highest-stakes games of the season. Parents and grandparents had booked hotels and traveled from as far as Virginia.

Spectators tried to adapt on the fly.

Many showed up with hand-pulled wagons to move newly purchased, lithium-ion battery powered misting fans to seating areas, where they were rigged to buckets of water.

“I’ve never experienced any kind of heat like this before. You can feel your eyes drying out,” said Steensland, who watched games with a misting fan pointed at her and her 7-month-old daughter.

“You’re either prepared or you’re not,” she said. “And the people that come prepared have a wagon full of hundreds of dollars of equipment — chairs, fans, tents. You have to have industrial grade fans to get through temperatures like this.”

Experts say heat exhaustion and heat stroke are likely to become more common in the coming decades. Signs of heat illness include heavy sweating, dizziness, muscle spasms, nausea and loss of consciousness. One of the more common ways people die from extreme heat is cardiovascular collapse because of the extra energy the heart expends to help the body respond.

During opening ceremonies, the featured guest speaker was Louisiana Tech baseball coach Lane Burroughs. He tried to mentally prepare players and their families by noting, “It’s August in Louisiana. … We’re going to have to dominate those elements, won’t we?”

Casey Anderson, Emmitt’s father, smiled as he recalled that pep talk.

“I don’t know about dominating,” he said. “More like enduring and surviving.”

But parents and coaches said they heard virtually no complaints from the kids, who seemed thrilled to have a chance to end their season at the marquee event of every DYB season.
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