Delegates from 137 countries are attending a week-long anti-tobacco conference to exchange ideas and propose policies for tackling the worldwide tobacco pandemic. Organizers say progress has been made since the World Health Organization’s Framework Convention on Tobacco Control came into force in 2005, but more needs to be done.

Organizers of the 8th Conference of the Parties to the WHO Convention, known as COP8, credit high taxes on cigarette packages for discouraging sales, as well as the designation of smoke-free environments, improved packaging and labeling, and bans on tobacco advertising, promotion and sponsorship. 

But Head of Convention Secretariat Vera da Costa e Silva says cross-border advertising remains less regulated and difficult to enforce. She tells VOA the tobacco industry has circumvented the bans by using Instagram, Facebook and other social media.

“By using social media, not only they capture the attention of young people who are the biggest users of social media, but they also keep tobacco as socially acceptable,” she said.

WHO reports there are more than one billion smokers in the world, with around 80 percent living in low- and middle-income countries. More than seven million people die prematurely from tobacco-related causes every year, according to WHO. 

Da Silva says the emergence of new and novel tobacco products is one of the biggest barriers to the work of the COP. She says the group is calling on governments to regulate and forbid practices such as e-cigarette use and vaping until more evidence of their effects is available.   
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The 2018 Nobel Prize for Physiology or Medicine has been awarded to James Allison of the University of Texas and Tasuku Honjo of Japan’s Kyoto University for their discoveries in cancer therapy.

“Allison and Honjo showed how different strategies for inhibiting the brakes on the immune system can be used in the treatment of cancer,” the Nobel Assembly at Sweden’s Karolinska Institute said in a statement on awarding the prize.

The prize for physiology or medicine is first Nobel Prize awarded each year.

The prizes for physics, chemistry, and peace will also be announced this week. The literature prize will not be given this year because of a sexual misconduct scandal at the body that decides the award. The Nobel Memorial Prize for Economic Sciences will be announced on Monday, October 8.

The prize comes with an award of $1.1 million.

Who are they?

James P. Allison was born 1948 in Alice, Texas, USA. He received his PhD in 1973 at the University of Texas, Austin. From 1974-1977 he was a postdoctoral fellow at the Scripps Clinic and Research Foundation, La Jolla, California. From 1977-1984 he was a faculty member at University of Texas System Cancer Center, Smithville, Texas; from 1985-2004 at University of California, Berkeley and from 2004-2012 at Memorial Sloan-Kettering Cancer Center, New York. From 1997-2012 he was an investigator at the Howard Hughes Medical Institute. Since 2012 he has been professor at University of Texas MD Anderson Cancer Center, Houston, Texas and is affiliated with the Parker Institute for Cancer Immunotherapy.

Tasuku Honjo was born in 1942 in Kyoto, Japan. In 1966 he became an MD, and from 1971-1974 he was a research fellow in the USA at Carnegie Institution of Washington, Baltimore and at the National Institutes of Health, Bethesda, Maryland. He received his PhD in 1975 at Kyoto University. From 1974-1979 he was a faculty member at Tokyo University and from 1979-1984 at Osaka University. Since 1984 he has been professor at Kyoto University. He was a faculty dean from 1996-2000 and from 2002-2004 at Kyoto University.
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Scientists have managed to wipe out a population of mosquitoes in a laboratory using a type of genetic engineering known as a gene drive. The intervention prevented the females from reproducing and caused the entire population to die off. Scientists hope the method can be transferred from the lab to the real world to tackle mosquito populations that spread diseases like malaria, as Henry Ridgwell reports.
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Scientists have managed to wipe out a population of mosquitoes in a laboratory using a type of genetic engineering known as a gene drive. The intervention prevented the females from reproducing and caused the entire population to die off. Scientists hope the method can be transferred from the lab to the real world to tackle mosquito populations that spread diseases like malaria, as Henry Ridgwell reports.
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Seven in 10 people worldwide die from cardiovascular diseases, cancer, diabetes and chronic lung diseases, according to a study published in The Lancet earlier this month.

These diseases not only rob people prematurely of their lives, they cost enormous amounts of money. The Lancet report estimated that over the next 15 years, the costs to developing countries alone is projected to total more than $7 trillion.

Three years ago, world leaders pledged to reduce premature deaths from these non-communicable diseases by one-third by the year 2030.

At Thursday’s U.N. General Assembly meeting in New York, WHO Director-General Tedros Adhanom Ghebreyesus said less than half of the world’s countries will meet that target, urging world leaders to recommit to these goals.

Tedros called for more political commitment and domestic investment. He said he knew from his own experience that “with political commitment, anything is possible. Without it, progress is slow.”

Tedros mentioned a list of what he called “best buys,” policy changes that cost little but produce huge rewards. “WHO’s best buys are cost-effective and affordable for all countries. Spending to build a healthier population is not a cost. It’s an investment in human capital that pays a rich reward.”

Tedros urged countries to increase tobacco taxes, restrict advertising for alcohol, and lower the amount of salt, sugar and fat in food products. Doing this will lower the risks for diabetes, cancer, heart disease and stroke. He advised countries to vaccinate girls against cervical cancer.   

Tedros also recommended that countries provide universal health coverage as the best way to prevent and treat non-communicable diseases.

He said if these policies were implemented globally, they would save 10 million lives by 2025 and prevent 17 million strokes and heart attacks by 2030. And, again, focusing on economic benefits, Tedros said implementing “best buys” would generate $350 billion in economic growth in the poorest countries between now and 2030.

 

 
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A rise in violence in the eastern Democratic Republic of Congo is displacing more people and hampering humanitarian efforts, including operations to stop the spread of Ebola, the United Nations refugee agency warns.

More than 20 people have been killed in recent attacks in the Beni area of Congo’s North Kivu province and farther north in Ituri province, both near the border with Uganda. 

The UNHCR estimates more than a million people are displaced in North Kivu. And, it notes, more people are fleeing their homes in the face of increasing attacks. 

The main rebel groups — the Allied Democratic Forces and National Army for the Liberation of Uganda — have been active in the Beni area for some time. However, UNHCR spokesman Babar Baloch tells VOA fighting has reached the city itself for the first time, making it risky for staff to move around.

“Many humanitarians have had to stop their activities. But, UNHCR, we are trying to send colleagues into Beni town as soon as we can to provide humanitarian assistance to those who have been affected by the recent rounds of violence,” Baloch said.

Beni is the epicenter of an Ebola outbreak in eastern DRC, and is the base for anti-Ebola operations by the World Health Organization. These operations were shut down temporarily following recent rebel attacks. 

WHO reports 154 confirmed and probable cases of Ebola in the area, including 101 deaths. The agency resumed its activities in Beni on Wednesday, despite security concerns. 

WHO officials say they cannot afford to halt operations and allow the deadly Ebola virus to spread. 
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Tuberculosis is a vicious epidemic that is drastically underfunded. That was the takeaway message from the first high-level meeting focused on the infectious disease at the U.N. General Assembly in New York.

Amina Mohammad, U.N. deputy secretary-general, said the disease is fueled by poverty, inequality, migration and conflict, and that an additional $13 billion per year is needed to get the disease under control.  

Last year, tuberculosis killed more people than any other communicable disease — more than 1.3 million men, women and children.

The World Health Organization estimates that the 10 million people who become newly infected each year live mostly in poor countries with limited access to health care.

Dr. Tedros Adhanom Ghebreyesus, head of the WHO, told the assembly that partnership is vital to end the disease. He said the WHO is committed to working with every country, partner and community to get the job done.

The WHO plans to lead U.N. efforts to support governments and other partners in order to drive a faster response to TB.

Most people can be cured with a six-month treatment program. But as world leaders told the assembly, medication is expensive, and the stigma associated with TB interferes with getting people screened and treated.

Nandita Venkatesan, a young woman from India, told the assembly about the toll the disease has taken on her life. She got TB more than once, including a drug-resistant variety. She said it robbed her of eight years of her life while she was being treated. One of the medications she took to help cure TB robbed her of her hearing.

Venkatesan said getting cured involved hospital stays, six surgeries and negative reactions to at least one drug used to cure her.

Just days before the high-level meeting, the WHO released its annual TB report. It found cases in all countries and among all age groups. It also found that two-thirds of the cases were in eight countries — India, Pakistan, Bangladesh, China, Indonesia, the Philippines, South Africa and Nigeria.

The meeting ended with the adoption of a declaration intended to strengthen action and investments for ending TB and saving millions of lives.
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A new report warns that wetlands are disappearing three times faster than the world’s forests, with serious consequences for all life on earth. 

The Ramsar Convention on Wetlands is a global treaty ratified in 1971 by 170 countries to protect wetlands, which are ecosystems inundated by water, such as swamps, bogs and floodplains. 

Unfortunately, the goal of this treaty is under threat. Ramsar Convention officials report about 35 percent of the world’s wetlands have been lost between 1970 and 2015.

State of crisis

Unless this situation is urgently reversed, Ramsar Convention Secretary-General Martha Roja Urrego warns the world will be in a state of crisis because wetlands are critical for all aspects of life.

“All the water that we use for consumption, irrigation and for hydro-electricity comes directly or indirectly from wetlands,” Urrego said. “Secondly, wetlands also have a main function in filtering waste and pollutants, so they act as the kidneys of the world. They filter the waste.”

Urrego says wetlands also are essential in regulating the global climate as peatlands store twice as much carbon as the world’s forests. 

Several factors

The report finds wetland loss is driven mainly by such factors as climate change, population increase, changing consumption patterns and urbanization, particularly in coastal zones and river deltas.

Authors of the report say biodiversity also is in a state of crisis. They say more than 25 percent of all wetlands plants and animals are at risk of extinction.

Scientists say without biodiversity, there is no future for humanity, because the air people breathe, the water they drink and the food they eat ultimately rely on biodiversity in its many forms.
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An estimated 80,000 Americans died of flu and its complications last winter, the disease’s highest death toll in at least four decades.

The director of the U.S. Centers for Disease Control and Prevention, Dr. Robert Redfield, revealed the total in an interview Tuesday with The Associated Press.

Flu experts knew it was a very bad season, but at least one found the size of the estimate surprising.

“That’s huge,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. The tally was nearly twice the figure previously seen by health officials as representing a bad year, he said.

In recent years, flu-related deaths have ranged from about 12,000 to 56,000, according to the CDC. 

Last fall and winter, the U.S. went through one of the most severe flu seasons in recent memory. It was driven by a kind of flu that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly.

The season peaked in early February and it was mostly over by the end of March.

Making a bad year worse, the flu vaccine didn’t work very well. Experts nevertheless say vaccination is still worth it because it makes illnesses less severe and saves lives.

CDC officials do not have exact counts of how many people die from flu each year. Flu is so common that not all flu cases are reported, and flu is not always listed on death certificates. So the CDC uses statistical models, which are periodically revised, to make estimates.

Fatal complications from the flu can include pneumonia, stroke and heart attack.

CDC officials called the 80,000 figure preliminary, and it may be revised. But they said it was not expected to go down.

The 80,000 figure eclipsed estimates for every flu season going back to the winter of 1976-77. Estimates for many earlier seasons were not readily available.

Last winter was not the worst flu season on record, however. The 1918 flu pandemic, which lasted nearly two years, killed more than 500,000 Americans, historians estimate.

It’s not easy to compare flu seasons through history, partly because the nation’s population is changing. There are more Americans — and more elderly Americans — today than in decades past, noted Dr. Daniel Jernigan, a CDC flu expert.

How bad will the coming flu season be? So far, the flu that’s been detected is a milder strain, and early signs are that the vaccine is shaping up to be a good match, Jernigan said.

The makeup of the vaccine has been changed this year to try to better protect against expected strains.

“We don’t know what’s going to happen, but we’re seeing more encouraging signs than we were early last year,” Jernigan said. 
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After decades of disappointment in efforts to develop a malaria vaccine, researchers are starting to see promise in a new approach.

While most vaccines trigger the body’s defenses to produce antibodies against a disease-causing germ, the new approach recruits an entirely different branch of the immune system.

If it works, it could open up a new route to attack other diseases, including hepatitis and possibly HIV, the virus that causes AIDS.

Nearly 450,000 people die of malaria each year, according to the World Health Organization. The parasites that cause the disease are increasingly becoming drug-resistant. 

One successful vaccine has been developed so far, but it prevented only about a third of cases in a clinical study.

Experts have decided that’s better than nothing. The vaccine is being piloted in Ghana, Kenya and Malawi.

New angle

Other scientists are trying a different angle of attack.

There are basically two ways to prevent germs from causing infections. “You either prevent them from getting into cells with antibodies, or you kill them inside the cells with T-cells,” said Stephen Hoffman, chief executive officer of Sanaria, a company working on one vaccine.

Most vaccines target the infection by building up antibodies. “If you need to kill them inside the cells with T-cells, we haven’t been overwhelmingly successful,” Hoffman said.

But Sanaria is one group seeing success by targeting malaria parasites inside infected liver cells, the first stop in the complex life cycle of the disease.

One key difference is how the vaccine is delivered. Hoffman’s group tried a typical route: injecting radiation-weakened parasites into patients’ skin or muscle. That didn’t work.

But it did work when injected directly into veins.

The weakened parasites traveled to the liver, where they set off an immune reaction. Defensive cells killed liver cells that were infected with malaria parasites.

And the liver’s defenses were ready when faced with the real thing months later.

Most of that early work has been done in mice and macaques. When Hoffman and colleagues did something similar with a handful of human patients, most were protected against infection.

No waiting

Recruiting immune cells in the liver is especially effective because “we don’t need to wait until the immune system figures out that the parasite is in the liver and starts mounting an immune response, which can take days and sometimes weeks,” said Adrian Hill, director of the Jenner Institute at Oxford University. 

“By then, the malaria’s gone. It only spends a week in the liver, and then it’s out in your blood causing disease.”

Hill’s group just published a study in the journal Science Translational Medicine in which immune cells in the liver were triggered by using a protein from the parasite, rather than the entire organism.

Scientists hope to get a better grasp on the system these vaccines employ, known as cellular immunity. Harnessing this system could help tackle hepatitis and HIV infection.

Drugs can control HIV infection but can’t eliminate it from the body.

“If somebody could get cellular immunity to work really well for vaccination, that would be transformative for a whole range of diseases,” Hill said. “Not just for infectious diseases that we want to prevent, but ones that we want to treat and we can’t treat today.”
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The Trojan Horse allowed the ancient Greek army to enter the city of Troy and defeat it. A similar strategy could help doctors destroy superbugs that are resistant to current antibiotics.

The decreasing effectiveness of antibiotics is among the most critical challenges facing medicine today, as drug-resistant bacteria resist almost every therapy thrown at them. But researchers at the University of Washington School of Medicine wondered if superbugs could be tricked into taking in a molecule that looks like food but wreaks havoc once inside.

Microbiology professor Pradeep Singh said they focused on iron, which is a critical nutrient for bacteria to multiply and spread. He told VOA that natural binders in the body take up iron, which is also important for our health, and try to keep it from bacteria. But the invaders have mechanisms to get to the bound iron.

“So, we were thinking about an alternative way that didn’t involve iron binding,” he explained. “How could we exploit the really high requirement for iron for infecting bacteria? And that’s how we came up with the idea of using a chemical mimic to exploit the bacteria’s own uptake system to get an antimicrobial drug inside.”

An iron Trojan Horse

The mimic they chose was gallium, a metal similar to iron. And like many successful antibiotics, Singh notes that gallium targets a number of vital functions in the bacteria.

“We know that one of the things it does is it inhibits an enzyme that is involved in producing copies of bacterial cell DNA — that’s really important for making daughter cells. If you can’t replicate your DNA, you can’t multiply. We’ve also shown that gallium can inhibit an enzyme that protects (bacteria) from oxidative stress like hydrogen peroxide. It probably does a bunch of other things, too, so it kind of just causes this kind of haywire in the cell for a bunch of those biological functions of iron.”

In lab studies, bacteria developed resistance to gallium at low rates, and its potency was increased when it was administered with some existing antibiotics. These factors led Singh and his colleague Chris Goss, a professor of medicine and pediatrics, to do preliminary tests of gallium in mice and humans, with exciting results detailed in the current issue of Science Translational Medicine.

A promising strategy against bad bacteria

 

In mice, they found that a single dose of gallum cured lethal lung infections.

The human trial — involving 20 patients with the lung disease cystic fibrosis — provided some tantalizing findings. Goss told VOA the gallium was given by infusion over five days. And while it rapidly cleared from the blood, it moved to the lungs, positively impacting patients’ breathing for up to a month.

“The key measure in cystic fibrosis and many lung diseases is forced expiratory volume, which is, you blow in a tube, and we see how much you can blow. And what we found is actually (forced expiratory volume) increased significantly from baseline in the realm of what we would normally see in an antibiotic-treated population. So, a similar effect as giving inhaled antibiotics or some oral antibiotics. And that was what I think made this an unusual finding, that the proof seemed to be there that you can give this drug intravenously, and it would actually impact lung function.”

More research is needed to confirm gallium’s safety and effectiveness as a treatment, but preliminary results suggest that the strategy that ended the Trojan War might be a winning approach to today’s battle against superbugs.
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An experimental GlaxoSmithKline vaccine could prevent tuberculosis developing in half of those who receive it, making it potentially the first new shot against the global killer in a century, researchers said on Tuesday.

Given the failure of other candidates in recent years, it marks a milestone in the fight against TB, although the 54 percent efficacy rate achieved in adults in a mid-stage clinical trial is low compared to immunizations for other diseases.

The current vaccine called Bacille Calmette-Guérin (BCG) was developed in 1921 and is given routinely to babies in countries with high rates of TB to prevent severe disease.

However, BCG protection wears off in just a few years and it does nothing to protect against the most common form of TB that invades the lungs of adults and adolescents, and can be transmitted through coughing and sneezing.

A more effective vaccine is viewed by experts as key to controlling TB and fighting the growing scourge of drug-resistant infection. With TB a major focus for global health, the United Nations is holding its first ever high-level meeting on the disease in New York on Wednesday.

GSK’s vaccine is designed to stop latent TB from becoming active and causing sickness. An estimated 1.7 billion people – one quarter of the global population – have latent TB infection, putting them at risk of a disease that killed 1.6 million people last year.

Results of an ongoing Phase IIb trial of the vaccine – known as M72/AS01 and developed by GSK in conjunction with Aeras, a nonprofit TB group backed by the Bill & Melinda Gates Foundation – were published online by the New England Journal of Medicine.

After a mean follow-up of 2.3 years, 10 of the 1,786 adults vaccinated twice developed active pulmonary TB compared with 22 of the 1,787 given two placebo injections. The study was conducted in Kenya, Zambia and South Africa.

The vaccine did produce more side effects than placebo, with two-thirds of participants reporting at least one adverse event, typically injection-site reactions or flu-like symptoms.

Most of the volunteers had received the BCG vaccine and all were HIV negative. People with HIV are more vulnerable to TB because their immune systems are weakened.

Areas Chief Executive Jacqui Shea said the results were “ground-breaking” and showed that more effective TB vaccines were achievable.

GSK is confident it can do better in future, with larger trials set to refine the vaccine’s dosing schedule and potentially target specific groups of patients who are most likely to benefit.

“It’s the first time we really tested the biological potential of our vaccine and we think that there is a lot of additional improvement now that we can bring,” the company’s head of vaccines research, Emmanuel Hanon, told Reuters.

TB is a particularly tricky disease to vaccinate against because the bacteria that cause it can hide from the body’s immune system and scientists lack protective markers in the blood to predict whether a vaccine will work.

As a result, TB vaccines must be tested in big clinical trials, a large and costly gamble.

Mike Turner, head of infection and immunobiology at the Wellcome Trust medial charity, said the encouraging results represented a “landmark moment” and M72/AS01 now needed to be tested in much larger numbers of people.
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The number of babies born infected with syphilis in the United States has more than doubled since 2013, according to the U.S. Centers for Disease Control and Prevention.

In a report released Tuesday, the CDC said the number of cases of congenital syphilis, in which the disease is passed from the mother to the baby, increased 153 percent — from 362 in 2013 to 918 in 2017.

“When a baby gets syphilis, it means the system has failed that mother repeatedly, both before and during her pregnancy,” said David Harvey, executive director of the National Coalition of STD Directors.

“If STD prevention programs had anywhere near the support they need, no new mom would ever have to cope with this devastating diagnosis,” he said.

Syphilis is easily treatable with antibiotics. But when untreated in the mother, it increases the risk of miscarriage and newborn death. Children born with the disease can suffer severe health consequences, including deformed bones, blindness or deafness.

About 70 percent of the cases of congenital syphilis in the U.S. over the span studied were found in California, Florida, Louisiana, New Mexico and Texas. 

Harvey said women should be tested before becoming pregnant, soon after becoming pregnant, and throughout the pregnancy. 

One-third of the mothers who gave birth to babies with congenital syphilis had been tested. But the tests were performed too late in their pregnancies to prevent the infection of the fetuses, or the women became infected after being tested. 

“That we have any cases of syphilis among newborns, let alone an increasing number, is a failure of the health care system,” Harvey said. 

Congenital syphilis is only a part of the nation’s growing STD crisis. According to the CDC, the three most easily treatable sexually transmitted diseases — chlamydia, gonorrhea and syphilis — rose nearly 10 percent in 2017 to an all-time high of nearly 2.3 million cases. That eclipsed the previous record total from 2016 by more than 200,000 cases.
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More than 11,000 people in Sudan’s eastern state of Kassala have been infected over the past month by Chikungunya, a debilitating mosquito-borne viral disease, but no deaths have been reported, a Sudanese official said Tuesday.

Chikungunya is spread by two mosquito species and can cause severe symptoms, which develop three to seven days after a person is bitten by an infected mosquito. They include high fever, headache, muscle pain, back pain and rash. In rare cases, it is fatal. There are no dedicated treatments or vaccines for Chikungunya.

“So far official statistics say that about 11,000 people were infected, and there haven’t been any documented cases of death because of the Chikungunya fever,” said Magzoub Abou Moussa, a spokesman for the Kassala state administration.

Heavy rains

The outbreak began in recent weeks when heavy rains pummeled the area, which led to the flooding of a major river in Kassala.

Abou Moussa said his state had received health and technical aid from Sudan’s health ministry, but expressed concern over the spread of the virus and called for further help.

Eyewitnesses said they had seen planes on Monday sweeping over the state, spraying mosquito pesticides.

Sudanese opposition parties have accused the government of failing to deal with the situation in Kassala and called for international organizations’ help.

“We hold the government fully responsible for the spread of the epidemic,” said a statement from the National Umma Party, the largest opposition party. “We call on civil society organizations and the World Health Organization to help the people of Kassala.”

Activists on social media said the number of people infected by the disease was much higher than the government’s figure and that there had been deaths not documented by the government.
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When emergency tests showed the telltale right-sided pain in Heather VanDusen’s abdomen was appendicitis, she figured she’d be quickly wheeled into surgery. But doctors offered her the option of antibiotics instead.

A new study from Finland shows her choice is a reasonable alternative for most patients with appendicitis. Five years after treatment with antibiotics, almost two-thirds of patients hadn’t had another attack.

It’s a substantial change in thinking about how to treat an inflamed appendix. For decades, appendicitis has been considered a medical emergency requiring immediate surgery to remove the appendix because of fears it could burst, which can be life-threatening.

But advances in imaging tests, mainly CT scans, have made it easier to determine if an appendix might burst, or if patients could be safely treated without surgery.

The results suggest that nearly two-thirds of appendicitis patients don’t face that risk and may be good candidates for antibiotics instead.

“It’s a feasible, viable and a safe option,” said Dr. Paulina Salminen, the study’s lead author and a surgeon at Turku University Hospital in Finland.

Her study in adults is the longest follow-up to date of patients treated with drugs instead of surgery for appendicitis, and the results confirm one-year findings reported three years ago.

‘A new era’

Research has also shown antibiotics may work for some children with appendicitis.

The Finnish results were published Tuesday in the Journal of the American Medical Association.

A journal editorial said “it’s a new era of appendicitis treatment.”

Appendix removal is the most common emergency surgery worldwide, with about 300,000 performed each year in the United States alone, said Salminen. She said the results from her study suggest many of those surgeries could be avoided.

U.S. doctors have started offering antibiotics instead of surgery and Salminen said she occasionally does, too. The journal editorial said appropriate patients should be given that option.

The study involved about 500 Finnish adults who had CT scans to rule out severe cases. Half were treated with antibiotics; the others had surgery.

Among the antibiotics patients, 100 ended up having surgery within five years of treatment — most for a suspected recurrence of appendicitis in the first year. Seven of them did not have appendicitis and likely could have avoided surgery. The results suggest the success rate for antibiotic treatment was almost 64 percent, the authors said.

About 1 in 4 surgery patients had complications, including infections around the incision, abdominal pain and hernias, compared with only 7 percent of antibiotics patients. Antibiotic patients had 11 fewer sick days on average than the surgery group. In the first year, their treatment costs were about 60 percent lower. A cost analysis for the full five years wasn’t included in the published results.

‘Keyhole’ surgery

Surgery patients in the Finnish study all had conventional incisions rather than the less invasive “keyhole” surgeries that are more common for appendix removal in the United States. The nonsurgery patients received three days of IV antibiotics in the hospital, followed by seven days of pills at home.

Dr. Giana Davidson, a University of Washington surgeon, is involved in a similarly designed multicenter U.S. study that may answer whether similar benefits would be seen for antibiotics versus “keyhole” surgery.

Davidson called the Finnish study “a critical piece to the puzzle, but I don’t think it answers all of the questions.”

VanDusen was treated at the University of Washington in 2016. She said she chose antibiotic treatment partly to avoid surgery scars, and now offers advice to patients for Davidson’s study.

“I knew the worst-case scenario was ending up back in the hospital, so why not try antibiotics first?” said VanDusen, who works in university communications.

She said she has done well since her treatment, but that the biggest drawback was “wondering, with every episode of stomach or bad gas, if it could happen again.”
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As the summer planting season approaches in eastern Zimbabwe, small-scale farmers struggle with familiar questions: When will the rains come, and when should I sow my crops?

This year something else is keeping them awake: In late August the government issued a warning about a potential El Niño weather pattern, associated with changes in weather patterns worldwide.

Should El Niño arrive, Zimbabwe might see normal or higher-than-average rains, said Washington Zhakata, director of the country’s Climate Change Department. More likely, though, there would not be enough rain.

“Looking at the past observations … once an El Niño sets in, depending on the strength and nature of the El Niño, the chances of bad rains or below-normal rainfall in Zimbabwe are between 50 and 65 percent,” he said.

In trying to figure out what to plant and when this year, farmers are also missing an old ally: Birds, whose movements traditionally have helped predict coming weather.

Delayed rainfall

In Zimbabwe’s Eastern Highlands the farming season typically starts in late October or early November. But in recent years the weather has become less predictable, and that is a growing problem for farmers.

“At times the rainy season is now starting well into December. The weather is now changing,” said Leonard Madanhire, a farmer in Zimunya, a village close to the Mozambique border.

Once, he said, farmers watched changes in the environment around them – particularly activity by birds – to work out whether or not they could expect a good season.

“We used to learn a lot from the birds about the seasons.

But these birds have long vanished,” he said.

When different species of birds arrived or left told villagers in his subsistence farming community what might be coming: a storm, a change of seasons, even flooding.

Some farmers held off planting until they saw certain species of migratory birds. The appearance of one particular type of stork – known as shuramurove – foretold a good rainy season, for instance.

But most of the birds once relied on – including the stork – have now vanished, he said.

“We last saw them here more than five years ago,” said Madanhire.

Absent friends

Togarasei Fakarayi, a programme manager at BirdLife Zimbabwe, a non-profit, said changing conditions in the country were having an impact on birds – and there was a clear link between climate change and the diversity and abundance of bird species.

“Birds are sensitive to environmental changes, in particular habitat changes. Climate change causes habitat changes over time – for instance, drying up of forests, grasslands and wetlands habitats as a result of global warming,” he said.

As those changes happen, species may shift or disappear from certain areas, Fakarayi said. More regular dry weather also has led to fires, which can destroy bird habitats.

“Climate change affects routes of migratory birds – in particular food abundance which is key, especially in stopover roosting areas,” he said.

Among the birds that have become far less common in Zimbabwe, Fakarayi said, were bateleur eagles and the southern ground hornbill.

Under the country’s Parks and Wildlife Act, storks and bateleur eagles are listed as specially protected animals, while the southern ground hornbill is considered as vulnerable, Fakarayi said.

The hornbill’s absence is something the farmers of Zimunya know well. In this region, characterized by mountains, forest and montane grasslands, the bird, known as the mariti or matendera, was once much easier to see – and to hear.

“If you hear the deep singing of the southern ground hornbill then you know it’s going to rain and you can plan your day. But these birds are now very rare,” said Madanhire.

That is also the case for the bateleur eagle, or chapungu, whose presence is synonymous with reliable rains, a bountiful harvest and good luck, said farmer Nicholas Kwadzanai Mukundidza.

“Chapungu is now rarely seen in the area, but this bird was sacred. And the honey bird (tsoro) which used to direct us to beehives in the forest has vanished too,” Mukundidza said.

The lack of these birds means that farmers – who until recently combined traditional knowledge with forecasts from the meteorological department in deciding when to sow their crops – find it is harder to plan for changing conditions.

These days, Madanhire said, they do listen to the weather forecasts when they can get them. But, he added with a chuckle, “they are not reliable.”

Climate link

Linia Mashawi Gopo, the principal meteorologist at Zimbabwe’s Meteorological Services Department, said the department’s research indicated some – but not all – farmers use indigenous knowledge to forecast the weather.

“The younger generation prefers scientific forecasts while the older generation use both the (indigenous knowledge) and scientific forecasts,” she said.

But older people have found their traditional forecasting methods becoming less predictable over time, she said – in some cases because the indicators they once relied on had disappeared, while in others the behavior of animals and birds had changed.

“This is mostly attributed to climate change,” she said.

She said more work was needed to correlate indigenous knowledge of forecasting with scientific methods, and to set up a way to use both sets of information.

 
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The Marshall Islands, an atoll-nation vulnerable to sea level rise from climate change, announced steps Monday toward an ambitious plan to cut its greenhouse emissions to zero by 2050.

The Pacific country became the first small island nation to present such a strategy to the United Nations amid increasing interest from governments worldwide toward eliminating planet-warming emissions in a bid to curb man-made climate change.

“If we can do it so can you,” Hilda Heine, Marshall Islands president, said at an event on the sidelines of the annual U.N. summit that featured a handful of heads of small island nations.

The announcement came as more than 150 heads of state and government gathered on Monday for the annual United Nations General Assembly.

Heine upped the pressure on world leaders to go beyond current pledges to reduce their heat-trapping greenhouse gas emissions as agreed in the 2015 Paris climate agreement.

“I challenge you all to develop your own vision to fully decarbonize by 2050,” she told an audience of climate policymakers and advocates brought together by U.S. nonprofit The Climate Group.

Worldwide, nine other countries have so far unveiled long-term plans to completely eradicate carbon emissions at home, from Britain to France and the United States under the administration of former U.S. president Barack Obama.

Since then, the United States has become the only country to announce its intention to withdraw from the Paris pact, following a decision by President Donald Trump last year.

The Paris accord aims to limit the rise in global temperatures to well below 2 degrees Celsius (3.6 Fahrenheit), and ideally to 1.5 degrees Celsius, with a sweeping goal of ending the fossil fuel era this century.

Aseem Prakash, founding director of the University of Washington’s Center for Environmental Politics, said the Marshall Islands’ move spoke to a growing trend around carbon neutrality by cities, companies, and now countries.

Cities, regions and companies, including Indian conglomerate Mahindra and the state of California, made similar carbon-zero commitments in the run-up and at a global climate summit held in San Francisco earlier this month.

The announcement was charged with symbolism, said Prakash, with the Marshall Islands contributing less than 0.00001 percent of the global total of emissions.

The Marshall Islands’ net-zero strategy, in addition to seeking to slow climate change in the transport, electricity and waste sector, stresses the need to invest into adapting to freak weather events linked to global warming, from hurricanes to floods, said Heine.

At the event, New Zealand’s Prime Minister Jacinda Ardern pledged $300 million over four years to help Pacific countries set up defenses to ward off the impact of climate change.

“The challenge of climate change requires us to look beyond our domestic borders,” she said in a news release.
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Thousands of scientists joined on Monday to accuse the Trump administration of trying to erode the Endangered Species Act in favor of commercial interests with a plan to revamp regulations that have formed a bedrock of U.S. wildlife protection for over 40 years.

The extraordinary critique of the administration’s proposal, which was unveiled in July, came in an open letter addressed to Interior Secretary Ryan Zinke and Commerce Secretary Wilbur Ross from three associations representing 9,000 professional biologists.

A separate letter similarly condemning revisions proposed to endangered species policies was signed by 273 leading university scientists from around the country.

Both came as the 60-day public comment period drew to a close for what would be the most sweeping overhaul in decades of the rules implementing the landmark environmental law.

The 1973 Endangered Species Act (ESA) currently protects more than 1,600 species of U.S. animals and plants listed as either endangered — on the brink of extinction — or threatened — deemed likely to become extinct in the foreseeable future.

The ESA is credited with a number of high-profile success stories, including the comeback of the American bald eagle, the California condor and the grizzly bear.

But the act has long been controversial for requiring the government to designate “critical habitat” deemed essential to a listed species’ survival and limiting commercial activities there, such as construction, mining, energy development or logging.

Developers and other critics argue that such restrictions pose an unfair and overly burdensome intrusion on property rights and economic activity.

Under the administration’s proposal, the government would end the practice of automatically treating endangered species and threatened species essentially the same.

The plan also calls for initially evaluating a species’ critical habitat on the basis of its current range, rather than according to the larger area it could be expected to occupy once recovered.

The administration has argued its proposal would enhance wildlife protection by building greater support for a statute that has become outdated and by streamlining the regulatory process.

Scientists, however, said the planned revisions would undermine the ESA and drive some wildlife closer to extinction.

One proposed change, they said, to allow consideration of economic factors when assessing a species’ status, would violate the law’s requirement that safeguards hinge solely on science.

“This is completely disastrous for efforts to save species from extinction,” said Stuart Pimm, a conservation ecology professor at Duke University.

A spokesman for the U.S. Fish and Wildlife Service, Brian Hires, said the agency encourages “input on our proposed ESA regulatory changes from all stakeholders as part of a robust and transparent public process.”
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Archaeologists searching Portugal’s coast have found a 400-year-old shipwreck believed to have sunk near Lisbon after returning from India laden with spices, specialists said on Monday.

“From a heritage perspective, this is the discovery of the decade,” project director Jorge Freire said. “In Portugal, this is the most important find of all time.”

In and around the shipwreck, 40 feet (12 meters) below the surface, divers found spices, nine bronze cannons engraved with the Portuguese coat of arms, Chinese ceramics and cowry shells, a type of currency used to trade slaves during the colonial era.

Found on Sept. 3 off the coast of Cascais, a resort town on the outskirts of Lisbon, the shipwreck and its objects were “very well-preserved,” said Freire.

Freire and his team believe the ship was wrecked between 1575 and 1625, when Portugal’s spice trade with India was at its peak.

In 1994, Portuguese ship Our Lady of the Martyrs was discovered near Fort of Sao Juliao da Barra, a military defense complex near Cascais.

“For a long time, specialists have considered the mouth of the Tagus river a hotspot for shipwrecks,” said Minister of Culture Luis Mendes. “This discovery came to prove it.”

The wreck was found as part of a 10-year-old archaeological project backed by the municipal council of Cascais, the navy, the Portuguese government and Nova University of Lisbon.
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U.S. researchers are reporting progress in helping those paralyzed by spinal cord injuries to stand, and even to take steps.

Two teams of medical researchers working separately say an electrical implant that stimulates the spinal cord allowed three paralyzed patients to stand and move forward while they held on to a walker or were supported from the back.

One patient was able to walk the length of a football field.

“Recovery can happen if you have the right circumstances,” University of Louisville professor Susan Harkema said, adding that the spinal cord can “relearn to do things.”

Experts say that a damaged spinal cord leaves the brain unable to send messages to the nerves that activate the muscles.

The researchers believe those nerves are still alive, but are asleep.

Stimulating them with electricity, along with intense rehabilitation, can wake up those sleeping nerves and enable them to receive commands again.

Other earlier treatments using electricity allowed patients to stand and move their toes, but not walk.

But the researchers say this is not a cure for paralysis, and caution that it may not work on every patient. They say more study is needed.

Reports on the new therapy appear in the New England Journal of Medicine and the journal Nature Medicine.
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Scientists have succeeded in wiping out a population of caged mosquitoes in laboratory experiments using a type of genetic engineering known as a gene drive, which spread a modification blocking female reproduction.

The researchers, whose work was published Monday in the journal Nature Biotechnology, managed to eliminate the population in less than 11 generations, suggesting the technique could be used to control the spread of malaria, a parasitic disease carried by Anopheles gambiae mosquitoes.

“It will still be at least five to 10 years before we consider testing any mosquitoes with gene drive in the wild, but now we have some encouraging proof that we’re on the right path,” said Andrea Crisanti, a professor at Imperial College London who co-led the work.

The results mark the first time this technology has been able to completely suppress a population. The hope is that in future, mosquitoes carrying a gene drive could be released, spreading female infertility within local malaria-carrying mosquito populations and causing them to collapse.

Gene drive technologies alter DNA and drive self-sustaining genetic changes through multiple generations by overriding normal biological processes.

The technique used in this study was designed to target the specific mosquito species Anopheles gambiae that is responsible for malaria transmission in sub-Saharan Africa.

The World Health Organization has warned that global progress against malaria is stalling and could be reversed if momentum in the fight to wipe it out was lost.

The disease infected around 216 million people worldwide in 2016 and killed 445,000 of them. The vast majority of malaria deaths are in babies and young children in sub-Saharan Africa.

Crisanti’s team designed their gene drive to selectively alter a region of a so-called “doublesex gene” in the mosquitoes, which is responsible for female development.

Males who carried this modified gene showed no changes, and neither did females with only one copy of it, he explained in the study. But females with two copies of the modified gene showed both male and female characteristics — they failed to bite and did not lay eggs.

The experiments found the gene drive transmitted the genetic modification nearly 100 percent of the time, and after 7 to 11 generations the populations collapsed due to lack of offspring.

Crisanti said the results showed that gene drive solutions can work, offering “hope in the fight against a disease that has plagued mankind for centuries.”

He added, however, that “there is still more work to be done, both in terms of testing the technology in larger lab-based studies and working with affected countries to assess the feasibility of such an intervention.”
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Researchers at the European Space Agency are preparing for a historic trip. They say their Solar Orbiter, a modified spacecraft built to withstand the heat, will travel closer to the sun than ever before, which may help scientists study the buildup of solar storms. Arash Arabasadi reports.
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