Month: July 2017

“That’s one small step for man, one giant leap for mankind.”

The immortal words of American astronaut Neil Armstrong, uttered on July 20, 1969, when he became the first man to set foot on the moon.

Along with astronauts Buzz Aldrin and Mike Collins aboard Apollo 11, NASA made history this day 48 years ago, inspired by a 1961 speech by then President John F. Kennedy Jr., who made the challenge during an address to Congress at the height of the Cold War:

“I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to Earth.” 

Armstrong changed the world that day, and himself, according to a BBC documentary.  

In it, friends and family describe how the fame of that moment was overwhelming.  

Shy by nature, Armstrong would rarely would speak of his achievement over the years, adding mystery and a certain enigmatic quality to his public personality.  Armstrong didn’t like being singled out, noting the Moon mission was a team effort.

“He really didn’t know what he wanted to do,” Neil’s sister, June Armstrong says in the BBC piece. “‘What am I going to do now? What can I do?’”

He became reclusive. But in 2005, Armstrong appeared in an interview with CBS’s Ed Bradley on 60 Minutes, where he described the feeling of that famed moon walk.

“It’s a brilliant surface in that sunlight. The horizon seems quite close to you because the curvature is so much more pronounced than here on Earth. It’s an interesting place to be. I recommend it.”

Armstrong died August 25, 2012, at the age of 82.
…

There are no proven ways to stave off Alzheimer’s, but a new report raises the prospect that avoiding nine key risks starting in childhood just might delay or even prevent about a third of dementia cases around the world.

How? It has to do with lifestyle factors that may make the brain more vulnerable to problems with memory and thinking as we get older. They’re such risks as not getting enough education early in life, high blood pressure and obesity in middle age, and being sedentary and socially isolated in the senior years.

Thursday’s report in the British journal Lancet is provocative – its authors acknowledge their estimate is theoretical, based on statistical modeling. A recent U.S. report was much more cautious, saying there are encouraging hints that a few lifestyle changes can bolster brain health but little if any proof.

Still, it’s never too early to try, said Lancet lead author Gill Livingston, a psychiatry professor at University College London.

“Although dementia is diagnosed in later life, the brain changes usually begin to develop years before,” she noted.

Early next year, a $20 million U.S. study will begin rigorously testing if some simple day-to-day activities truly help older adults stay sharp. In the meantime, Alzheimer’s specialists say there’s little down side to certain common-sense recommendations.

“Increased health of the body supports increased health of the brain,” said cognitive neuroscientist Laura Baker of Wake Forest School of Medicine in North Carolina, who will lead the upcoming U.S. study.

Consider physical activity, crucial for heart health. “If in fact it should also improve the prospects for cognitive function and dementia, all the better,” said Dr. Richard Hodes, director of the U.S. National Institute on Aging and an avid exerciser.

Here’s the latest from this week’s Alzheimer’s Association International Conference on possible ways to guard your brain:

Key risks

A Lancet-appointed panel created a model of dementia risks throughout life that estimates about 35 percent of all cases of dementia are attributable to nine risk factors – risks that people potentially could change.

Their resulting recommendations: Ensure good childhood education; avoid high blood pressure, obesity and smoking; manage diabetes, depression and age-related hearing loss; be physically active; stay socially engaged in old age.

The theory: These factors together play a role in whether your brain is resilient enough to withstand years of silent damage that eventually leads to Alzheimer’s.

Does changing these or other lifestyle factors really help?

Last month, the U.S. National Academies of Sciences, Engineering and Medicine reported there’s little rigorous proof. That report found some evidence that controlling blood pressure, exercise and some forms of brain training – keeping intellectually stimulated – might work and couldn’t hurt.

Why? What’s good for the heart is generally good for the brain. In fact, high blood pressure that can trigger heart attacks and strokes also increase risk for what’s called “vascular dementia.”

And exercising your gray matter may bulk up the brain, whether it’s from childhood education or learning a new language as an adult. The more you learn, the more connections your brain forms, what scientists call cognitive reserve. Some U.S. studies have suggested that generations better educated than their grandparents have somewhat less risk of dementia.

Other factors have less scientific support. Studies show people with hearing loss are more likely to experience memory problems, and have speculated that it’s because hearing loss leads to depression and social isolation – or even makes the brain work harder to deal with garbled sound, at the expense of other thinking skills. But so far there aren’t studies proving hearing aids reverse that risk.

In fact, the strongest evidence that lifestyle changes help comes from Finland, where a large, randomized study found older adults at high risk of dementia scored better on brain tests after two years of exercise, diet, cognitive stimulation and social activities.

Hunting proof

Would those strategies help Americans, who tend to be sicker, fatter and more sedentary than Scandinavians? The Alzheimer’s Association is funding a study to find out, with enrollment of 2,500 cognitively healthy but high-risk older adults to begin next year.

Want to try on your own? They’ll test:

-Walking – supervised, so no cheating. Wake Forest’s Baker puts seniors on treadmills at the local YMCA to avoid bumpy sidewalks. She starts exercise-newbies at 10 minutes a day for two days a week and works up to longer walks on more days.

-A diet that includes more leafy greens, vegetables, whole grains, fish and poultry than the typical American menu.

-Certain brain games and what Baker called an “intellectual stimulation barrage,” outings and other steps that keep people social, not sitting home on a computer, while they exercise their brains.

-Improving control of medical conditions like high blood pressure and diabetes that are toxic to the brain.

 
…

For the first time in the global AIDS epidemic that has spanned four decades and killed 35 million people, more than half of all those infected with HIV are on drugs to treat the virus, the United Nations said in a report released Thursday.

AIDS deaths are also now close to half of what they were in 2005, according to the U.N. AIDS agency, although those figures are based on estimates and not actual counts from countries.

Experts applauded the progress, but questioned if the billions spent in the past two decades should have brought more impressive results. The U.N. report was released in Paris where an AIDS meeting begins this weekend.

“When you think about the money that’s been spent on AIDS, it could have been better,” said Sophie Harman, a senior lecturer in global health politics at Queen Mary University in London. 

She said more resources might have gone to strengthening health systems in poor countries.

“The real test will come in five to 10 years once the funding goes down,” Harman said, warning that countries might not be able to sustain the U.N.-funded AIDS programs on their own.

The Trump administration has proposed a 31 percent cut in contributions to the U.N. starting in October.

According to the report, about 19.5 million people with HIV were taking AIDS drugs in 2016, compared to 17.1 million the previous year.

UNAIDS also said there were about 36.7 million people with HIV in 2016, up slightly from 36.1 million the year before.

In the report’s introduction, Michel Sidibe, UNAIDS’ executive director, said more and more countries are starting treatment as early as possible, in line with scientific findings that the approach keeps people healthy and helps prevent new infections. Studies show that people whose virus is under control are far less likely to pass it on to an uninfected sex partner.

“Our quest to end AIDS has only just begun,” he wrote.

The report notes that about three-quarters of pregnant women with HIV, the virus that causes AIDS, now have access to medicines to prevent them from passing it to their babies. It also said five hard-hit African countries now provide lifelong AIDS drugs to 95 percent of pregnant and breast-feeding women with the virus.

“For more than 35 years, the world has grappled with an AIDS epidemic that has claimed an estimated 35 million lives,” the report said. “Today, the United Nations General Assembly has a shared vision to consign AIDS to the history books.” The death toll from AIDS has dropped dramatically in recent years as the wide availability of affordable, life-saving drugs has made the illness a manageable disease.

But Harman said that “Ending AIDS” — the report’s title — was unrealistic.

“I can see why they do it, because it’s bold and no one would ever disagree with the idea of ending AIDS, but I think we should be pragmatic,” she said. “I don’t think we will ever eliminate AIDS so it’s possible this will give people the wrong idea.”
…

More than nine billion tons of plastic has been produced since 1950 with most of it discarded in landfills or the environment, hurting ecosystems and human health, according to the first major global analysis of mass-produced plastics.

Nearly 80 percent of this plastic ended up in landfills or the environment and production in increasing quickly, researchers from the University of California, Santa Barbara, said in the study published on Wednesday.

Less than 10 percent was recycled and about 12 percent was incinerated.

“If you spread all of this plastic equally, ankle-deep, it would cover an area the size of Argentina,” Roland Geyer, a professor of industrial ecology and the study’s lead author, told the Thomson Reuters Foundation. “It is an enormous amount of material that does not biodegrade … I am very worried.”

Burning plastics contributes to climate change and adversely impacts human health, while build-ups of the material can hurt the broader environment, Geyer said.

Packaging is the largest market for plastic and the petroleum-based product accelerated a global shift from reusable to single-use containers, researchers said.

As a result, the share of plastics in city dumps in high and middle income countries rose to more than 10 percent by 2005 from less than 1 percent in 1960.

Unlike other materials, plastic can stay in the environment for thousands of years, Geyer said.

There are more than 5 trillion pieces of plastic floating in the world’s oceans, according to a 2014 study published in a Public Library of Science journal.

This build-up harms marine life and ecosystems on sea and land, Geyer said.

If current trends continue more than 13 billion tons of plastic waste will end up in the environment or landfills by 2050, researchers said.
…

SpaceX’s chief said Wednesday that the first launch of its big new rocket is risky and stands “a real good chance” of failure.

Founder Elon Musk told a space station research conference Wednesday that he wants to set realistic expectations for the flight later this year from Cape Canaveral. The Falcon Heavy will have three boosters instead of one, and 27 engines instead of nine, all of which must ignite simultaneously. No one will be aboard the initial flights. When it comes time to add people, Musk said, “no question, whoever’s on the first flight, brave.”

SpaceX plans to fly two paying customers to the moon late next year, using a Falcon Heavy.

While the moon may not be in Musk’s personal travel plans, he said in response to a question that he’d like to ride one of his smaller Falcon rockets to the International Space Station in maybe three or four years. SpaceX plans to start ferrying NASA astronauts to the orbiting outpost, using Falcon 9 rockets and enhanced Dragon capsules, by the middle of next year. SpaceX now uses the Dragon capsule to deliver supplies to the space station.

“All right, we’ll put you on the manifest,” said NASA’s space station program manager Kirk Shireman.

​’Major pucker factor’

​Speaking for over an hour at the Washington conference, Musk encouraged people to go to Cape Canaveral for the Falcon Heavy launch. “It’s guaranteed to be exciting,” he promised, getting a big laugh.

“There’s a lot of risk associated with Falcon Heavy, real good chance that that vehicle does not make it to orbit,” he said. “Major pucker factor, really, is like the only way to describe it.”

Building the Falcon Heavy has proven harder than SpaceX envisioned, according to Musk. But it will be capable of lifting more than double the amount of payload into orbit than the current Falcon 9, and also hoisting a SpaceX Dragon capsule into a loop around the moon.

As for Mars, Musk said he favored friendly competition for getting astronauts to the red planet. NASA for years has supported an international effort. Musk said it would be better to have at least two or three-country coalitions striving to get there first and making the most progress.

Praise for NASA

He praised the model used by NASA in the commercial crew program, in which both SpaceX and Boeing are developing capsules for flying space station astronauts. Americans have not launched from home soil since the last shuttle flight in 2011, instead forced to use Russian rockets. The crew Dragons will parachute into the ocean just like the cargo Dragons; land landings were scrapped because of the work needed to make everything safe.

Musk said he’s updated his long-term plan for colonizing Mars to make it more economically feasible. The vehicles will be smaller, although still big. He promised to share his evolving ideas at a September conference in Australia.

“Going to Mars is not for the faint of heart,” Musk stressed. “It’s risky, dangerous, uncomfortable and you might die. Now do you want to go? For a lot of people, the answer is going to be hell no, and for some, it’s going to be hell yes.”

 
…

Congressional Republicans are moving forward with legislation to roll back the Endangered Species Act, amid complaints that the landmark 44-year-old law hinders drilling, logging and other activities.

At simultaneous hearings Wednesday, House and Senate committees considered bills to revise the law and limit lengthy and costly litigation associated with it.

The bills come as a federal court lifted federal protections for gray wolves in Wyoming and the Trump administration moved to lift protections for grizzly bears in and near Yellowstone National Park. Interior Secretary Ryan Zinke also is reviewing federal efforts to conserve the imperiled sage grouse in 11 Western states.

House Natural Resources Committee Chairman Rob Bishop said the bills would curb excessive litigation and allow officials to focus on actual species conservation.

All too often, the endangered species law “has been misused to control land, block a host of economic activities important for jobs … [and] proliferate costly litigation that drains taxpayer resources away from actual conservation efforts,” said Bishop, a Utah Republican.

‘Meddling’ opposed

Arizona Representative Raul Grijalva, the panel’s senior Democrat, said the law “does not need congressional meddling to work better. What it needs is congressional support.”

Despite years of Republican efforts to pass bills weakening the species law and cut funding for agencies responsible for protecting and recovering imperiled American wildlife, “99 percent of listed species have continued to survive, and 90 percent are on schedule to meet their recovery goals,” Grijalva said.

Environmental groups called the simultaneous hearings a “one-two punch” on threatened wildlife.

“While nine out of ten Americans want to protect endangered species and their habitat, congressional leaders are spending their time dismantling the ESA in favor of special interests,” said Jamie Rappaport Clark, president and CEO of Defenders of Wildlife. “Enactment of any of these bills will only hasten the disappearance of endangered and threatened species from our planet.”

Five bills were being considered by the House panel, and a sixth bill was being heard in the Senate Environment and Public Works Committee. One of the bills would allow economic factors to be considered in species-listing decisions, while another would cap attorneys’ fees in endangered species cases.

Gray wolves

Both the House and Senate would “delist” the gray wolf as a protected species in the western Great Lakes and Wyoming, with management turned over to state officials in Wyoming, Minnesota, Wisconsin and Michigan. The bills also would block further judicial review of a 2011 decision by the Fish and Wildlife Service to remove federal protections for the wolves.

Gray wolves were once hunted to the brink of extinction in most of the country, but now number over 5,500 in the lower 48 states, including nearly 3,800 in Minnesota, Wisconsin and Michigan and nearly 400 in Wyoming.

Representative Collin Peterson, a Minnesota Democrat, said the current law prevents Midwest farmers from killing wolves even if they attack cattle or pets.

“The states, not the federal government, are best equipped to manage their gray wolf populations by balancing safety, economic and species-management issues,” he said.

Senator John Barrasso, a Wyoming Republican who is chairman of the Senate environment panel, said the bipartisan Senate bill would enhance recreational hunting and sport fishing, ensure common-sense environmental regulation, and protect wildlife and wildlife habitat. The bill would reauthorize several environmental programs, promote construction and expansion of public target ranges for recreational shooting, and allow fishermen to continue using lead tackle, among other provisions.

“This bill is another example of how we can all work together, both Democrat and Republican, to help protect the environment and grow our economy,” Barrasso said.

Gregory Sheehan, acting director of the Fish and Wildlife Service, said the Trump administration generally supports the House bills, with “some technical modifications.”

His agency plays a key role in preventing extinctions and aiding recovery, Sheehan said, “but states and the people on the ground who have long been stewards of the land are in the best position to be the primary caretakers of species over the long-term.”
…

Kathy Holbrook was at home one night last year when she started having chest pains, so the 63-year-old former office manager drove to a hospital near her home in the eastern Kentucky mountains.

“I am a Christian lady, so I believe in the power of prayer and I was just praying to God to give me the strength to get there,” she said.

She made it, and doctors treated her for a small blockage in her heart. Because Holbrook has Medicaid, the hospital got paid for its services, helping it keep its doors open and preventing Holbrook from a more perilous drive to the next nearest hospital more than 30 miles away.

Millions of Americans got health insurance through the expansion of Medicaid programs in 31 states under the Affordable Care Act. Though efforts in Congress to overhaul the law collapsed, many remain nervous as some Republicans, including President Donald Trump, say they haven’t given up on repealing the law.

People who work at hundreds of rural hospitals are also watching closely. Those hospitals have struggling budgets that were propped up by the massive influx of poor people who gained taxpayer-funded health insurance.

‘Financial buoy’

The transformation has been especially dramatic in Kentucky, where rural hospitals are not just a lifeline for patients who may not have the means to travel far for the help they need. They also sustain local economies, providing jobs and services that people there have come to see as indispensable in some of the nation’s poorest and most isolated communities.

“It’s been a financial buoy for them to help keep them afloat,” said Steve Williams, the former CEO of Norton Healthcare who now is an adviser for the 22-bed Livingston Hospital in Salem, Kentucky. “The reality is there are 400,000 people on the rolls in Kentucky that weren’t there, and a lot of them [are] rural.”

Just two years ago, 15 of Kentucky’s 65 rural hospitals were in danger of closing. Since then, more than 440,000 Kentuckians — nearly 10 percent of the state’s population — got health coverage through Medicaid after the state chose to expand the program under the Affordable Care Act. In 2012, Kentucky hospitals provided $2.4 billion worth of “uncompensated care.” Three years later, it was $786 million, a 67 percent drop.

“It has helped them tremendously,” said Mike Rust, president and chief executive officer of the Kentucky Hospital Association.

Medicaid expansion at risk

But the Medicaid expansion could disappear under Republican proposals. The nonpartisan Congressional Budget Office estimates as many as 23 million Americans could lose their health insurance under a House-approved bill. Despite Republicans’ failure so far to repeal and replace the Affordable Care Act, Rust said hospitals are still “very nervous.”

“There is still a lot of uncertainty going on with what’s going to come out of Washington,” he said.

Rural hospitals in states that chose to expand Medicaid would be the most vulnerable. An analysis by The Commonwealth Fund, a health care advocacy group, showed the uncompensated care costs could rise 123 percent for those hospitals by 2026. In six states — California, Kentucky, Nevada, Oregon and Washington — the costs could rise more than 200 percent. Of the top 10 counties in the country with the highest percentage of adults relying on Medicaid, six are in Kentucky.

“An increase of uncompensated care of this level may not be sustainable for these vulnerable hospitals,” according to the report.

Nationwide, 81 of the more than 1,800 rural hospitals in America have closed since 2010, according to research from the North Carolina Rural Health Research Program. They include 12 closures in Texas, the most of any state.

‘Devastating effect’ on community

While a closed hospital would be bad for doctors and patients, it would also do disproportionate damage to delicate rural economies where the local hospital is often one of the largest employers along with the public school system.

When Parkway Regional Medical Center in Fulton, Kentucky, closed in 2015, the city lost $200,000 in tax revenue, or about 8 percent of its annual budget. City leaders responded by raising a tax on alcoholic beverages so they could continue to fund their police department.

“It had a devastating effect on our community,” Fulton City Manager Cubb Stokes said.

Senate Majority Leader Mitch McConnell, a Kentucky Republican, noted that rural hospitals “are in trouble already,” adding to the challenges of crafting a health care bill. He said his “principle concern is the collapsing private health insurance market.” Last month, insurance regulators in Kentucky announced individual rates could increase by as much as 34 percent next year.

“That’s the immediate emergency,” McConnell said.

Costs are rising for taxpayers, too. The Medicaid expansion is expected to cost Kentucky nearly $300 million by 2020, adding pressure to a state budget already stressed by a multibillion public pension debt. That’s why Ralph Alvarado, a Republican state senator and an emergency room doctor, supports the GOP health care bill. He said if states have more authority over Medicaid spending, they can design a program to protect rural hospitals.

“Give us the power to do what we think is best,” Alvarado said. “The one size fits all from the feds doesn’t work.”

Some Kentuckians say the stakes are too high to take a chance on anything that could hurt local hospitals. Jonathan Nickell, a 29-year-old machinist from Mount Sterling, recently stood outside the St. Joseph Mount Sterling hospital while his wife was having surgery. He voted for Donald Trump in the presidential election, but said he would not support him anymore if the Medicaid expansion were to disappear.

“Most people live off Medicaid. If they don’t have that, they don’t have nothing,” he said. “You will be sending them to their deathbeds.”
…