Day: March 6, 2019

A hospital in Jordan has given a victim of Yemen’s war new hope for the future, thanks to the cutting edge technology of 3D printed prosthetics.

Abdullah Ayed, 21, lost one arm and badly damaged the other when his home in Aden was hit by an explosive in 2017.

He spent weeks in a coma in a local hospital. When he woke, he learned one of his arms had to be amputated while the other was almost beyond repair.

“I wished for death, that would have been better than being like this,” said Ayed.  “It was embarrassing to go out with my hand amputated, especially still being young, I wanted to get married, I wanted a job. But I did not lose my faith in God.”

In August 2018, the international medical charity, Medecins Sans Frontieres (MSF), sent Ayed to Amman for treatment and rehabilitation.

The MSF reconstructive surgery program was set up in 2006, and aims to help patients regain independence. Ayed was chosen to receive a 3D-printed prosthetic.

Project supervisor, Samar Ismail, said 3D-printed prosthetics are faster to produce and much cheaper. The price for a 3D limb is around 30$, while the more conventional limbs start at 200$ and can go up to thousands of dollars.

The lightweight is also a huge advantage, Ismail added, which enables patients to use them for longer.

So far, more than 20 limbs have been fitted to patients, from Gaza, Iraq, Syria and Yemen.

Ayed said his prosthetic is life-changing. Though difficult to use at first, therapy helped him regain skills such as tying his shoes or putting on a shirt.

“I had lost hope in life, but now after training my mental state is much better,” he said.

He is practicing motor-skills that would enable him to work at a laundromat. But his biggest dream is to be able to go back to Yemen, get married and start a family.

“That’s all I want, to go back home and for things to get better there.”
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The Trump administration’s plans to roll back climate change regulations could boost U.S. carbon emissions by over 200 million tons a year by 2025, according to a report on Tuesday prepared for state attorneys general.

The increase from the world’s second-biggest greenhouse gas emitter behind China would hobble global efforts to avoid the worst impacts of climate change, which scientists say is caused by burning fossil fuels and will lead to devastating sea-level rise, droughts and more frequent powerful storms.

“The Trump administration’s actions amount to a virtual surrender to climate change,” said the report by the State Energy & Environmental Impact Center, released at a gathering of the National Association for Attorneys General in Washington.

The report from the research group, based out of New York University’s law school, analyzed the impact of rolling back six major regulations related to climate change that President Donald Trump is seeking to rework to unfetter business.

They include national vehicle tailpipe standards and the Obama-era Clean Power Plan to limit emissions from power plants, among others focused on major polluter industries.

More than a dozen state attorneys general, including those from Maryland, New York and Massachusetts, are challenging the administration on their rollbacks in court.

California, for example, is leading a coalition of 21 states in challenging the administration’s rollback of tailpipe standards. Weakening those standards will lead to an additional 16 million to 34 million tons of carbon dioxide emissions annually by 2025, according to the report.

It also estimated that American drivers would pay between $193 billion and $236 billion dollars in added fuel costs by 2035 without the national clean car standard.

The Trump administration has said it wants to reduce the emissions standard targets for vehicles because sticking to them would make automobiles too expensive.

The Trump administration’s Affordable Clean Energy rule (ACE), which replaced the Clean Power Plan, would also result in a big jump in emissions along with a higher number of premature deaths from poor air quality, the report said.

The administration has countered that its revised rule would reduce emissions in much the same way as the Clean Power Plan, but in a way that strictly adheres to the federal Clean Air Act.

The six regulations the center examined provided the “most important near-term opportunity to reduce greenhouse gas emissions and fight against climate change,” the report said.
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A mind-altering medication related to the club drug Special K won U.S. approval Tuesday for patients with hard-to-treat depression, the first in a series of long-overlooked substances being reconsidered for severe forms of mental illness.

The nasal spray from Johnson & Johnson is a chemical cousin of ketamine, which has been used for decades as a powerful anesthetic to prepare patients for surgery. In the 1990s, the medication was adopted as a party drug by the underground rave culture due to its ability to produce psychedelic, out-of-body experiences. More recently, some doctors have given ketamine to people with depression without formal FDA approval.

The Food and Drug Administration approved Spravato as a fast-acting treatment for patients who have failed to find relief with at least two antidepressants. Up to 7.4 million American adults suffer from so-called treatment-resistant depression, which heightens the risk of suicide, hospitalization and other serious harm, according to the FDA.

The drug will cost between $590 and $885 depending on the dosage and before various insurance discounts and rebates.

There have been no major pharmaceutical innovations for depression since the launch of Prozac and related antidepressants in the late 1980s. Those drugs target the feel-good brain chemical serotonin, and can take weeks or months to kick in.

Ketamine and J&J’s version work differently than those drugs, targeting a chemical called glutamate that is thought to restore brain connections that help relieve depression. 

When the drug works, its effect is almost immediate. That speed “is a huge thing because depressed patients are very disabled and suffer enormously,” said Dr. John Mann, a psychiatrist and researcher at Columbia University. If the drug doesn’t work, physicians can quickly switch to other options, he noted.

The FDA approved Spravato, known chemically as esketamine, based on study results that showed patients taking the drug experienced a bigger improvement in their depression levels than patients taking a sham treatment, when measured with a psychiatric questionnaire.

The drug is designed to be lower-dose and easier to use than ketamine, which is normally given as an intravenous infusion. 

Robin Prothro, 60, began taking antidepressants more than 20 years ago. But she says none of the five medications she tried relieved the depression that has stymied her personal and professional life.

Since enrolling in a Spravato trial two years ago, Prothro says her depression has lifted and she’s returned to hobbies she abandoned years ago, like gardening.

She takes the drug every two weeks at her psychiatrist’s office while reclining in a comfortable chair.

“You can feel it coming on, it’s a strong drug,” she said, describing colors and shapes that drift before her eyes. “I just let the drug work. I close my eyes and my mind is amazingly quiet.” 

Psychedelics reconsidered 

The ketamine-like drug is the first of several psychoactive substances making their way through the U.S. regulatory process as physicians search further afield for new therapies. Researchers are conducting late-stage trials of psilocybin, the active ingredient in magic mushrooms, and MDMA, a euphoria-inducing club drug, as potential treatments for depression and post-traumatic stress disorder.

“Substantially different agents are only rarely appearing from pharmaceutical companies or other laboratories,” said Dr. Paul Summergrad, a psychiatrist at Tufts University. “That’s prompting people to investigate other compounds.”

Unlike ketamine, psilocybin and MDMA have no legal medical use. Classified in the same category as heroin and LSD, they are tightly restricted by the federal government. But the FDA’s approval of esketamine could smooth their path.

Burden of depression

Depression is among the leading causes of disability in the U.S. and is being closely monitored by health authorities amid rising suicides nationwide. In 2017, the U.S. suicide rate rose to 14 deaths per 100,000 people, the highest rate in at least 50 years, according to federal records. 

Government officials haven’t suggested an explanation for the trend, though academic researchers point to the nation’s widening income gap, financial struggles and divisive politics.

J&J’s drug will be subject to a number of restrictions due to its abuse potential, side effects and lingering safety questions.

The drug will only be given by accredited specialists who must monitor patients for at least two hours after administration, due to its trippy, disorienting effects. Additionally, all patients will be tracked in a registry to monitor long-term safety and effectiveness.

The immediate impact of ketamine is thought to last just four to seven days and there’s no consensus yet on how long patients can benefit from ongoing treatment.

Still, there are few other options for patients who fail to respond to antidepressants. The most effective treatment in such cases, electroshock therapy, requires patients to be fully sedated and can cause persistent memory loss.

Wall Street has high expectations for J&J’s medication, with analysts predicting more than $600 million in annual sales by 2022. But J&J will face competition in the marketplace.

A decades-old drug, ketamine is already used off-label to treat depression by some doctors. At least 150 clinics around the U.S. provide treatment with various forms of the drug, which is available as a low-cost generic. Patients often pay hundreds or thousands of dollars for intravenous infusions of the drug over several weeks or months. Such therapies are generally not covered by insurance because they haven’t been approved as safe and effective by FDA regulators.

Some doctors plan to offer both ketamine and the new J&J drug.

Dr. Steve Levine says having FDA-approved standards for dosing and administering the new drug should raise standards in the field and drive out some of the bad actors who are not qualified to treat depression.

“This is going to bring in some standards, regulation and it’s going to make it safer and more accessible to patients,” said Levine, who serves as vice president of the American Society of Ketamine Physicians, a group representing doctors, nurses and others using ketamine for treating depression or other non-approved uses.
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Some of the world’s largest airlines have yet to set long-term targets to reduce their climate-changing emissions, climate and economic researchers warned Tuesday.

Top publicly listed airlines have cut their “emissions intensity” — how much pollution they produce for the same amount of activity — significantly in recent years, said researchers from the London School of Economics’ Grantham Research Institute.

But they are not making clear plans for the much larger emissions reductions needed to meet internationally agreed climate goals, the researchers said.

Beyond 2020 and particularly in the long-term “the targets these airlines have set to reduce their emissions are not clearly consistent with the Paris Agreement goals,” said Simon Dietz, co-author of a study released Tuesday.

The Paris goals, agreed by world governments in 2015, call for keeping global temperature rise to “well below” 2 degrees Celsius and ideally to 1.5C above pre-industrial times.

The study, which looked at 20 of the world’s largest publicly listed airlines, noted that air travel currently accounts for about 2 percent of global carbon dioxide emissions, and 12 percent of transport-related emissions.

Cutting those emissions — and emissions from shipping — is particularly challenging because their mobile nature makes it harder for companies to use clean energy sources such as solar or wind power.

Alternative fuels, such as hydrogen, may offer long-term solutions but are still being developed.

The study, backed by investor groups, analyzed the public disclosures of airlines as a way of assessing their performance on combatting climate change, Dietz said.

The airlines were evaluated based on their carbon management practices and emissions performance. Airlines with lower emissions often had younger fleets, more passengers per flight and a focus on longer versus shorter flights, Dietz said.

Helen Vines Fiestas, the deputy global head of sustainability at BNP Paribas Asset Management, said the report raises key questions about what the aviation industry is prepared to do to contribute to climate change action in the long run.

Airlines, she said, should join forces and look at airline-related emissions as a joint problem, “asking how are we going to go about it” in making emissions reductions, she said.

But “this is just not what we are seeing, and this is what really worries us,” she said.

Carbon offsets

Many airlines have adopted industry targets to reduce net emissions, usually through “carbon offsetting,” which can include things like paying to plant carbon-absorbing forests or build clean energy systems elsewhere to compensate for airline emissions, Dietz said.

Delta Airlines, for instance — rated in the study as one of the most active airlines on addressing climate issues — has committed to capping carbon emissions at 2012 levels, in part by purchasing offsets, according to Catherine Simmons, a spokeswoman for Delta.

Its website lets customers estimate their emissions and contribute to a range of carbon offset programs to compensate for them.

The airline between 2016 and 2020 also is replacing 30 percent of its main fleet with aircraft 15 to 25 percent more fuel-efficient, Simmons said, and its fleet has seen a 9 percent increase in fuel efficiency since 2009.

The airline industry more broadly has set goals that include capping aviation’s net emissions at 2020 levels, and halving net emissions by 2050 from 2005 levels, Dietz said.

But that approach is not necessarily the most effective, he said, because reducing “net emissions” can be done through offsets rather than actual aviation emissions reductions.

“If you look at modeling by organizations like the International Energy Agency, it clearly shows that in the long run, the airline sector needs to reduce its own emissions,” he said. “We’re calling on airlines to make commitments that clearly show what they are going to achieve.”
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