There are fears that 20,000 people have died in Libya in devastating floods that began on 11 September. The official death toll of more than 5,000 is likely to increase: at least another 10,000 people are missing.

Two dams collapsed, releasing an estimated 30 million cubic metres of water into the city of Derna. Other towns and cities were also affected.

The immediate cause was extreme rain: the equivalent of a year’s rainfall in 24 hours. The World Meteorological Organization (WMO), based in Geneva, Switzerland, recorded many areas in Libya receiving 150–240 millimetres of precipitation. The town of Al-Bayda reported 414.1 millimetres in 24 hours, a record. In an average year, Derna gets 274 millimetres of rain, according to the German Weather Service.

Researchers Nature spoke to say that climate change combined with the effects of Libya’s six-year civil war and subsequent crisis of governance exacerbated the disaster. “It’s the curse of war and weather,” says Mark Zeitoun, director-general of the research centre the Geneva Water Hub.

Supercharging Storm Daniel

Flooding specialists say the rainfall was unusually severe, and climate change probably intensified it by supercharging Storm Daniel, a low-pressure weather system that formed over the Mediterranean Sea around 4 September. According to the WMO, the storm caused record-breaking rainfall in Greece on 5–6 September. One weather station in the Greek village of Zagora reported 750 millimetres of rain in 24 hours, which the WMO says is “the equivalent of about 18 months of rainfall”.

The storm then intensified over the sea, becoming what meteorologists call a Medicane: a Mediterranean storm with hurricane-like characteristics. It made landfall in Libya on 10 September.

The National Meteorological Centre in Tripoli is reported to have issued severe-storm warnings 72 hours before Storm Daniel hit Libya, notifying all governmental authorities and urging preventative measures. A state of emergency was declared in eastern Libya, but this did not translate into a successful emergency response.

Unprecedented events

The rainfall and flooding are unprecedented in Libya, says geoscientist Jasper Knight at the University of the Witwatersrand in Johannesburg, South Africa. The country is sheltered from Atlantic storms by the Atlas Mountains to the west, so its main source of weather is the Mediterranean Sea. “The Mediterranean coast of Libya is relatively green,” he says, but it has not seen such heavy rain in decades. “When you go further inland, it gets very dry very quickly,” he says. “I can’t even think of the last time when [rain] extended further inland.”

More frequent and severe extreme weather events are among the expected and observed consequences of climate change. This was confirmed in the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. The report states that there is high confidence that “the frequency and intensity of heavy precipitation events have increased since the 1950s over most land areas for which observational data are sufficient for trend analysis”. It adds: “human-caused climate change is likely the main driver”.

Although no one can say for certain that a given event was caused or worsened by climate change, attribution studies can estimate the probability that climate change affected Storm Daniel, says Günter Blöschl, a hydrologist at the Vienna University of Technology. “The answer to that is, at this stage, without detailed analysis, yes. There is quite a clear causal link.”

“That intensification comes from the increase in sea surface temperatures,” agrees Hayley Fowler, who studies climate-change impacts at Newcastle University, UK. Raised sea surface temperatures injected energy and moisture into Storm Daniel, escalating the winds and rainfall.

The sea surface temperatures were “not exceptionally high”, but did get above 26 °C, says Álvaro Pimpão Silva, a climate specialist at the WMO. That is “more than enough to enhance and fuel such storms after they develop”. Furthermore, “near the coast of Libya, [sea surface temperatures] were above 27.5 °C”.

Another possible factor is changes in jet streams: high-altitude air currents that strongly affect weather patterns. Storm Daniel was held in place for many days by an ‘omega block’, in which the jet stream bent into a shape resembling the Greek letter omega, says Fowler.

Such blocking events have caused many extreme weather events in Europe, including severe flooding in Germany in July 2021, says Blöschl.

And there is evidence that climate change is making blocking events more frequent. “There’s definitely been a shift in patterns over the last three or four years,” says Fowler. “The jet stream in particular seems to have been becoming much more wavy.”

It is not yet certain that climate change is affecting blocking, says Blöschl. He is studying the question but is not yet ready to publish his results. “It’s plausible,” he says, but “not yet proven”. However, Europe does seem to be seeing floods more often: in a 2020 study1, he and his colleagues showed that the past 30 years have seen more floods than any other period in the past 500 years.

Sanctions and rival governments

There is consensus that the political and socio-economic situation in Libya has also contributed to the severity of the disaster. Libya was ruled by military leader Muammar Gaddafi for decades until the Arab Spring. When he was deposed in 2011, Libya was engulfed in a civil war, and was made subject to international sanctions the same year. “The country is in disarray,” says Knight. It currently has two rival governments — one in the west and one in the east — and the economy is struggling.

According to Zeitoun, the literature on the impact of war on infrastructure shows that if sanctions are placed on a country, maintenance of critical infrastructure cannot be kept up. "Sooner or later they will fail," he told Nature.

Libya’s poor infrastructure was as important as the extreme weather in creating devastation, says Blöschl. It is likely that the dams above Derna were not constructed to high standards and not regularly maintained, he says. “Lack of maintenance is certainly one of the reasons that contributed to the disaster.”

The problems extend to “social infrastructure”, including “the governance of flood defence”, adds Blöschl. There need to be warning systems that reach everyone who is at risk, and those people need to be trained in how to respond. “Flood drills are rarely done,” he says. If leaders “want to be prepared, we need to practice it regularly”.

“If the country had been better prepared in terms of preparedness plans and response plans, 5,000 people wouldn’t be dead now,” says Zeitoun.

doi: https://doi.org/10.1038/d41586-023-02899-6

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The Indian Space Research Organisation (ISRO) is currently training four astronauts and looking to expand the cohort as it aims for more future manned missions, Hutton said.

The Gaganyaan mission is aimed at developing a human-habitable space capsule that will carry a three-member crew into an orbit of 400 km (250 miles) for three days, before returning to safety in a planned splashdown in the Indian Ocean.

ISRO has said it will explore ways to achieve a sustained human presence in space once Gaganyaan is completed.

The team is aiming to test its crew escape system, which can be used to eject astronauts in emergencies, before undertaking a battery of other tests before the final launch phase, Hutton said, adding: "Safety is the most important thing we need to ensure".

About 90.23 billion Indian rupees ($1.1 billion) has been allocated for the mission, which comes after the space agency's historical landing of its Chandrayaan-3 craft on the lunar south pole.

While an exact timeline has not been shared, the mission is expected to be launched from the country's main spaceport in Sriharikota before 2024.

The space agency has previously said its Vikram Sarabhai Space Centre had successfully tested systems for stabilising the crew module and safely reducing its velocity during re-entry.

($1 = 83.0400 Indian rupees)

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After two dams in northeastern Libya failed, thousands of people are dead, thousands more are unaccounted for, and tens of thousands are displaced in the city of Derna and surrounding towns. The dams along the Wadi Derna river valley collapsed amid Storm Daniel, a Mediterranean cyclone that dropped up to 16 inches of rain over parts of the North African country in a single 24-hour period this week. The same record-breaking storm also inundated Greece, Bulgaria and Turkey, causing devastating flooding across the region of those nations before making landfall in Libya.

The scale of the catastrophe in Derna, a city of around 100,000 people, is massive. Yet its underlying causes are not unique. The disaster occurred at the confluence of sociopolitical instability wrought by civil war, a historic storm (likely exacerbated by climate change) and neglected infrastructure: the destroyed dams, first constructed in the 1970s, had reportedly not been maintained since 2002. Similar conditions are replicated in many other places worldwide. In the aftermath of Derna’s dam collapses, experts are calling for renewed attention to the international problem of aging, ill-maintained dams.

Most of the world’s large dams were built in the decades following World War II, between about 1950 and 1985, says Duminda Perera, a civil engineer and risk assessment researcher at the United Nations University Institute for Water, Environment and Health. These dams are important infrastructure that provide reliable drinking water, agricultural irrigation, flood control and electricity to many. Yet dams—like all human-made structures—have a limited life span, degrade over time and require upkeep. On the lower end, “50 years is the reasonable safe age limit,” Perera says; the Derna dams were fast approaching that age. A 2021 U.N. report co-authored by Perera assessed more than 50,000 large dams around the world. He and his co-researchers found that many countries’ dams are, on average, older than age 50 and are at increasing risk of failure. This includes in the U.S., which has the second-highest number of large dams in the world after China and where the average large dam is 65 years old.

The American Society of Civil Engineers regularly issues a “report card” on U.S. infrastructure. In the most recent 2021 assessment, the nation’s dams were given a grade of D. In part, that’s because engineering standards and our understanding of hydrology were far less robust when these dams were built, says Del Shannon, a civil engineer in Colorado and the dam report card’s primary author. Another contributing factor is the mounting, unaddressed structural issues these dams have accrued in recent decades.

Water is powerful. Even concrete dams, such as the eminently recognizable Hoover Dam, are vulnerable to its force over time, says Mark Baker, a retired dam safety engineer who spent more than 30 combined years working on dam safety for the National Park Service and Bureau of Reclamation. Erosion impacts the earth below and around the concrete structure. Often, these dams require reinforcement or new foundation anchors to stay stable. And concrete itself can weaken with exposure to the elements, undergoing subtle chemical reactions that undermine its stability, Baker explains.

Embankment dams—built from materials such as compacted clay, soil and stone—are more common than their concrete counterparts because they’re cheaper, Shannon says. But they’re also even more vulnerable to degradation over time. Embankment dams erode internally as water eats through the center of the structure and pushes supporting material downstream. Without remediation, this results in seepages that can progress into cracks and eventually collapse.

Also, if water outlets aren’t kept properly clear of debris and vegetation, or if a dam and its spillways aren’t large enough to manage the volume in a reservoir, embankment dams are at risk of being overtopped. This is when water pours over a dam’s rim, triggering very rapid erosion of the structure’s front side. In under an hour, Shannon says, water cascading over the front of such a dam can cause collapse. This, he adds, is likely the mechanism by which the clay-and-rock dams in Derna failed—though without more information and a thorough investigation, he emphasizes, this is not yet possible to know for certain.

Regular maintenance, reinforcements and retrofitting can extend a dam’s safe operation well past 100 years and bring a structure up to current standards, Perera and Shannon say. But many dams don’t receive routine repairs and are not aging gracefully. Just making the recommended fixes to most U.S. dams would cost an estimated $157.5 billion dollars, according to a 2023 report from the Association of State Dam Safety Officials. And then there’s the rest of the world, where data on necessary dam rehabilitation and estimated costs are often sparse or difficult to obtain. Yet even when governments or private companies know dam repairs are necessary, they may lack the political will and appropriate funding to take action.

Perera’s 2021 U.N. report identified several dams as dangerous. One example is the Mullaperiyar Dam in the Indian state of Kerala. The structure is more than 125 years old and has visible signs of damage, and it sits at a state border where political relations are tense and in a region where earthquakes are common. If the dam were to fail, an estimated 3.5 million people would be impacted. But the necessary fixes to shore up the structure haven’t yet been made.

In Libya, too, engineers were aware of the Derna dams’ vulnerabilities. A hydrology study of the Wadi Derna Basin published just last year cautioned, “It is clear that the study area is exposed to flood risks.” The study author further wrote (translated from Arabic) that “immediate measures must be taken for regular maintenance of the existing dams, because in the event of a huge flood, the result will be disastrous for the residents of the valley and the city.” If this warning had been heeded, thousands of lives might have been saved.

But it’s not too late to spare other places and people from similar catastrophes. “We should be proactive rather than reactive,” Perera says. Investing in dams, creating early-warning systems and bolstering emergency planning are key, he adds. “It needs to be a global effort,” Perera says.

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What’s up with the iPhone radiation story? On the eve of Apple’s big iPhone 15 reveal, France demanded the company remove iPhone 12 from sale in that country because it said the product radiates too much.

Now that demand seems to be spreading across Europe.

What’s happening here?

The story so far

ANFR, the French agency that regulates these things, claims that certain iPhone 12 models emit unacceptable levels of electromagnetic radiation. The regulator subsequently ordered Apple to halt all sales of that model as of Sept. 12, pending a fix. Apple denied the claim, citing numerous radiation studies of its own, and now promises a software patch to bring the device into line with French regulations. But questions are now being asked across the EU, with Italy, Germany, and Belgium demanding a similar software patch.

With that in mind, it seems important to note that both the French regulator and Apple say there is no danger to public health from the radiation.

Which begs the question as to why a ban on sales is required.

What France said

The French agency claimed the iPhone 12 failed one of two types of tests for radiation. According to the agency statement, the device exceeded the Specific Absorption Rate (SAR) value with a 5.74 W/kg compared to the regulatory ceiling of 4W/kg. The results imply the device generates too much radiation when in your hand or pocket.

However, the regulator also described the problem as being caused by a succession of software updates since the device was originally introduced.

The French digital affairs minister even said the radiation emitted by iPhone 12 is still lower than what scientific studies see as potentially harmful to people. Incredibly, given all the media coverage this has generated, the radiation agency says its tests don’t even reflect typical smartphone use.

What Apple said

Apple was understandably a little shocked by the claims, particularly as they emerged within minutes of it launching the iPhone 15. From the company’s point of view, it engages in a stringent series of tests to ensure new products meet regulations in every country in which its devices are sold.

“Since it was introduced in 2020, iPhone 12 has been certified and recognized as meeting or exceeding all applicable SAR regulations and standards around the world,” Apple said in a statement following the declaration. "This is related to a specific testing protocol used by French regulators and not a safety concern. We will issue a software update for users in France to accommodate the protocol used by French regulators.”

"Apple has assured me that it will implement an update for the iPhone 12 in the next few days," said digital minister Jean-Noel Barrot.

What is the problem?

The French decision to order Apple to cease selling that model of iPhone would have become a blanket ban on sales of the device across all 27 EU member states after three months.

In addition to which, if Apple were unable to patch its device to bring it in line with French law, it would have been forced to engage in an expensive product recall of already-sold iPhone 12 devices from across the EU, which would be one major PR problem for anyone. At least, it might be if the problem actually were severe, which this software-based problem doesn't appear to be; that's why Apple can fix it with a software patch.

However, Apple’s original intention to update the device in France may ultimately need to be extended to at least some other European nations.

On a more general note, before the usual tinfoil hat arguments concerning smartphone use begin, it seems appropriate to observe that many, many studies from the World Health Organization have identified no adverse health effects from mobile phone use.

What I think

“Je pense que ce n'est rien de plus qu'une tempête dans une tasse de thé,” as the French might say. (I think it's nothing more than a storm in a teacup.)

Particularly when France’s own regulator confirms there’s no threat to health, and the problem can be resolved with a patch.

Indeed, if I were Apple, rather than nit-picking over which countries get that patch, I’d push it out fast and push it out globally to pinch the life out of the story. That’s while the company’s other teams work to keep the Apple Store online in the face of what appears to be undented demand for iPhone 15. C’est la vie, n’est pas? C’est la vie.

Quel dommage!

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The pitch for blue-light-filtering glasses is compelling: an easy way to counteract that bleary-eyed feeling that sets in after hours of scrolling on your phone or staring at a laptop.

The evidence for them, though, has largely been lacking. And a new review of 17 studies adds to a growing consensus that they probably don’t prevent or relieve eye strain.

The phrase blue light refers to a range of wavelengths of light that are all around us — the sun emits it and so do screens. In recent decades, some experts have wondered whether blue light could be a culprit behind “computer vision syndrome” — a condition that encompasses the eye irritation and other issues, including headaches and blurred vision, that many people experience after extended screen time. But blaming blue light for this is contentious, said Laura Downie, an associate professor of optometry and vision sciences at the University of Melbourne and an author on the new review.

She and the team found that there appeared to be no benefit to using blue-light-filtering glasses, compared to just standard lenses, to reduce eye strain. The trials included in the review were relatively small — the largest had 156 participants.

Researchers have long been skeptical that blue-light glasses can curb eye strain, said Mark Rosenfield, a professor at the State University of New York College of Optometry. Previous studies have also typically been small, but several have found that the lenses did not prevent people’s eyes from tiring or getting irritated, and did not appear to improve vision.

The new review found mixed results for blue-light-filtering glasses and sleep: Some studies showed improved sleep scores among wearers, while others showed the opposite. There’s evidence that blue light may also take a toll on sleep by inhibiting our brain’s ability to secrete melatonin, the hormone that gets us ready to rest, said Dr. Raj Maturi, a spokesman for the American Academy of Ophthalmology and a retina specialist at the Midwest Eye Institute.

The amount of blue light that a phone or computer emits is actually quite low, Dr. Downie said, which might be why blocking it doesn’t do much to ameliorate eye strain. But if you spend four or more hours a day on a computer, you’re nonetheless at risk for screen-induced eye irritation, she added. The way we use our eyes when we stare at a screen for long periods of time, especially close up to our faces, can cause discomfort.

Dr. Downie and other experts recommended a few tips that may help.

Lubricate your eyes.

Part of the reason your eyes might ache is that you blink far less when glued to a screen, said Dr. Craig See, an ophthalmologist at Cleveland Clinic’s Cole Eye Institute. This means that your eyes dry out more easily. If you regularly experience eye strain, consider using eye drops three to four times a day, Dr. Maturi recommended.

“I often tell people that if you know that your eyes tend to start to feel gritty, sandy, almost as if there’s something in them after using the computer, you might even try putting artificial tears in before sitting down,” said Dr. Joshua Ehrlich, an assistant professor of ophthalmology and visual sciences at the University of Michigan.

Give yourself a break.

Eye health experts often recommend the “20-20-20” rule: Every 20 minutes, take a 20-second break to look at something 20 feet away. This exercise helps the eye muscles relax, Dr. Maturi said. However, some researchers have suggested that 20-second breaks may not be long enough.

Reduce glare.

It’s important to consider the light in your entire room, not just the kind coming from your computer. Reflections and glares on your screen can strain your eyes, Dr. Downie said. Make sure your computer is positioned to minimize reflections from light sources and reflective surfaces like windows and glass doors.

Placement is everything.

Keep the center of your screen just below eye level, and if you’re experiencing eye strain, try moving your computer farther away from you — the ideal range is generally around 20 to 30 inches away from your head, Dr. Downie said.

The same advice goes for your phone: Your eyes have to work harder when you hold your phone close up to your face, said Dr. Rosenfield. Try to hold it at least 16 inches away, he suggested.

Get help.

If you’re consistently feeling eye strain, and none of these solutions are working after three or four weeks, seek out an eye specialist, Dr. Maturi advised.

What about sleep?

There are a few tools that might be equally effective at helping you sleep as special glasses, Dr. Rosenfield said. For example, some smartphones automatically shift screens to warmer tones after a certain hour. The American Academy of Ophthalmology recommends people use apps like F.lux to change the color of their screens at night, which can help emit less blue light.

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Sunday, 17 September

• Who: China
• What: Long March 2D
• When: 4:15 a.m. UTC
• Where: Launch Complex 3 – Xichang Satellite Launch Centre
• Why: In this mission, China will launch three Yaogan 39 satellites into orbit. They are remote sensing satellites and will be used in scientific experiments, land and resources surveys agricultural production estimates, and disaster prevention and mitigation.

Tuesday, 19 September

• Who: Rocket Lab
• What: Capella 12
• When: 6:30 a.m. UTC
• Where: Mahia, New Zealand
• Why: This mission will launch the Acadia 2 satellite for Capella Space. This satellite is a synthetic aperture satellite and is part of a 30-satellite constellation. This constellation of satellites provides high-quality imagery at a ground-range resolution for commercial customers.

Wednesday, 20 September

• Who: SpaceX
• What: Falcon 9 B5
• When: 1:47 a.m. UTC
• Where: Space Launch Complex 40, Cape Canaveral, Florida, US
• Why: SpaceX will be launching a bath of 22 Starlink v2 “Mini” satellites into a low-Earth orbit. The Starlink constellation is used to provide internet connectivity on Earth. Ultimately, SpaceX is aiming to have thousands of Starlink satellites in orbit to provide connectivity around the world.

• Who: Galactic Energy
• What: Ceres GX-1
• When: 2:00 p.m. UTC
• Where: LC-43/95A – Jiuquan Satellite Launch Centre
• Why: The rocket is launching with an unknown payload. The mission is called Autumn Sonata.

Saturday, 23 September

• Who: SpaceX
• What: Falcon 9 B5
• When: 7:00 a.m. UTC
• Where: Vandenberg AFB Space Launch Complex 4, California, US
• Why: SpaceX will be launching 21 Starlink v2 “Mini” satellites into low-Earth orbit. Similar to the mission earlier in the week, this launch will help to bolster the Starlink constellation.

Recap

• The first launch last week was a Long March 6A carrying the Yaogan-40 satellite which will be used for electromagnetic environment detection.

• Next up, United Launch Alliance launched the Atlas V 551 carrying the NROL-107 mission for the US National Reconnaissance Office and the US Space Force.

• On Monday (local time), a SpaceX Falcon 9 launched 21 Starlink satellites and landed the first stage of the rocket.

• On Friday, Russia launched the Soyuz MS-24 spacecraft from Baikonur on a Soyuz 2.1a. The mission was to ferry astronauts to the International Space Station.

• Finally, a SpaceX Falcon 9 launched another 2 Starlink satellites to low-Earth orbit.

That’s all for this week, check in next time.

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• Taking probiotics while on antibiotics does not significantly boost beneficial gut bacteria, according to new research.

• The findings debunks the previous notion that it's important to take probiotics along with antibiotics, when prescribed, to maintain the gut's microbiome.

• Experts maintain that it's better to get probiotics from fermented whole foods—like yogurt, kimchi, and sourdough bread—rather than from supplements.

Supplementing antibiotics with probiotics doesn’t restore beneficial bacteria in the gut, a new study has found.

Antibiotics fight harmful bacteria that cause illness, but that’s not the only thing the prescription drugs go after. They also kill the “good” bacteria necessary for essential bodily functions, such as digestion and keeping harmful bacteria in check.

Because probiotics add beneficial bacteria to the gut, taking probiotic supplements while on antibiotics has become a popular strategy for offsetting bacteria loss and keeping the gut microbiome balanced. 

The new research, however, debunks that previous notion, showing that the tactic may be ineffective.

To reach this conclusion, researchers analyzed 15 randomized controlled trials examining the differences in gut microbiome diversity between participants taking antibiotics with probiotics and without them. Nearly 1,200 people were included in the studies.

In five studies selected for meta-analysis, the researchers found that people who took probiotics along with antibiotics boosted gut microbiome diversity by a minuscule amount—just 0.23%. The researchers concluded that taking probiotic supplements with antibiotics “was not found to be influential on microbiome diversity.”

“This is the first meta-analysis and the most comprehensive review of the topic to date using high-quality methods,” the researchers wrote in the study, published in July in the journal BMC Medicine.

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Activists worldwide are set to stage the largest climate protest since 2019, with demonstrations planned in 54 countries starting Friday and continuing through the weekend.

From Germany and the Philippines to the United States, tens of thousands of climate activists, led by several climate organizations, including Swedish activist Greta Thunberg's Fridays for Future movement, have planned over 500 rallies across many cities worldwide.

These strikes demand an end to the use of planet-warming fossil fuels, especially as the world confronts increasing casualties and economic challenges due to unprecedented floods, wildfires, earthquakes, hurricanes and droughts.

"The fossil fuel industry runs on greed and exploitation, sacrificing the lives of others in order to line their pockets," Thunberg's Fridays for Future stated in a press release. "We must end the Era of Fossil Fuels, not only for the sake of our planet and our survival but to break free from the chains of neocolonialism. Fossil fuel extraction perpetuates a cycle of colonial dominance."

Protest organizers anticipate millions of people participating in the global turnout over the weekend, which could be the biggest global climate protest since the 2019 School Strike for Climate movement by Thunberg that mobilized millions.

Earlier this month, the World Meteorological Organization revealed data confirming that June to August 2023 was the hottest three-month period ever recorded globally.

The WMO reported that last month was the "hottest August" and the second-hottest month on record after July 2023. August 2023 exceeded preindustrial averages by approximately 1.5°C.

The United Nations has attributed all these climate changes and disasters to increased carbon fuel consumption, which emits greenhouse gases that trap heat, and cited the influence of this year's El Niño on global temperature rise.

A strike is set for Sunday in New York City to kick off the city's Climate Week and ahead of the U.N. climate summit on Sept. 20, according to the Associated Press. 

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After spending decades on pharmacy shelves, the leading nasal decongestant in over-the-counter cold and allergy medicines has met its downfall.

Advisers for the Food and Drug Administration this week voted unanimously, 16 to 0, that oral doses of phenylephrine—found in brand-name products like Sudafed PE, Benadryl Allergy Plus Congestion, Mucinex Sinus-Max, and Nyquil Severe Cold & Flu—are not effective at treating a stuffy nose.

The vote was years in the making. In 2007, amid doubts, FDA advisers called for more studies. With the data that has trickled in since then, the agency's own scientists conducted a careful review and came to the firm conclusion that oral phenylephrine "is not effective as a nasal decongestant."

Looking back, the FDA noted that key data supporting its original acceptance of phenylephrine in 1976 was likely "too good to be real." And looking forward, the agency saw a bleak future for the drug. While this week's vote concluding ineffectiveness applies only to the oral dosages currently approved for use, the FDA found that higher, potentially more effective doses of the drug could significantly increase blood pressure, posing a safety risk. "[T]here may be no path to evaluating higher doses," the agency concluded.

To be clear, the advisers did not discuss phenylephrine-containing nasal sprays, which do appear to have some efficacy. And, most importantly, the safety of phenylephrine-containing products is not in question; the FDA and its advisers did not raise any safety concerns. It's safe, just useless.

Rise and fall

It's still unclear how the FDA will proceed following the advisory panel's vote, which it is not obligated to heed but usually does. But it's certainly possible that widely used phenylephrine-containing medicines could eventually disappear from drug store aisles.

In a clarifying statement Thursday, the FDA noted there will not be a swift blowout of the popular decongestant. If the agency acts on the advisers' votes and decides to wipe it off its list of effective over-the-counter drugs (the "OTC monograph"), the agency would first have to propose the removal from the monograph, then provide a public comment period, issue a final ruling, and work with manufacturers to reformulate products.

Still, however slow the process, if the FDA strips phenylephrine from the monograph, it will undoubtedly upend the over-the-counter cold and allergy medicine market. Popularity of phenylephrine skyrocketed after 2006, when its leading competition moved behind the pharmacy counter.

The "Combat Methamphetamine Epidemic Act of 2005" went into effect that year, restricting sales of the more effective drug pseudoephedrine, which could be diverted to making methamphetamine. As pseudoephedrine use dropped, phenylephrine's rose. By 2022, the FDA estimates that Americans bought 242 million phenylephrine-containing products, taking the lion's share of the decongestant market and generating nearly $1.8 billion in sales.

Given phenylephrine's overwhelming market success and complete clinical failure, it's worth revisiting how we got here—and the FDA provides a deep dive on just that. The agency notes that the original 1976 acceptance of phenylephrine was based on just 14 studies—only 12 of which included efficacy data, and of those, only seven reported some level of positive efficacy data (though most were weakly positive). Eleven of the 14 studies were sponsored by a drug maker. Last, all of the studies used a dubious measure of nasal airway resistance to assess effects on congestion. This is a highly variable, unvalidated method that is no longer accepted by the FDA in clinical trials.

Original regulatory review

Overall, the FDA determined that the original 14 studies were all small and had numerous statistical and methodological problems, with mixed results. While the FDA considered these problems to be "valid and overwhelming" across all the studies, the agency homed in on two specific studies for extra scrutiny. The two studies were done at one study center, Elizabeth Biochemical labs, which conducted a total of five of the 14 studies on phenylephrine. While some of the Elizabeth studies reported relatively weak positive results, two were strongly positive. They were so positive, in fact, that they tipped the scales for the initial determination of efficacy.

But, on closer inspection, the FDA found that they "were not only the most positive studies, but they also produced near textbook perfect results that could not be duplicated in other similarly designed studies that used the same methodology but were conducted at two other centers by the same sponsor," the FDA wrote. The agency noted that even at the time, scientists from other study sites were puzzled as to how the Elizabeth site had gotten such strong, clear results. Some of them even visited the Elizabeth site to observe testing there in an effort to determine what the difference was, but ended up walking away "without a satisfactory answer."

The FDA was so skeptical of these Elizabeth studies the agency strongly suggested there were "data integrity issues" at the site, and that the results "reflect data that are simply too good to be real." As such, the agency conducted a forensic analysis on the data, including looking for digit preference in the last significant digit of reported data. While one of the studies passed this test, the other failed, revealing that it had "a disproportionately high occurrence of the digit '5'," which provided "sufficient statistical evidence to cast doubt upon the results."

Damning data

Phenylephrine is a specific alpha-1 adrenergic receptor agonist in blood vessels—that is, the drug binds to a specific cellular receptor in blood vessels, which causes them to constrict. Narrowing blood vessels in the nose is how phenylephrine supposedly works to reduce congestion. The common cold and allergies cause blood vessels in the nose to become wider, which is followed by increased mucus production and narrowing of nasal passages. Constricting the blood vessels helps prevent that downstream stuffiness. Pseudoephedrine works in a similar but less specific (more effective) way.

While constricting blood vessels in your nose can help relieve stuffiness, constricting blood vessels all over the body can increase blood pressure, as well as heart rate and jitteriness. This is why people with high blood pressure are cautioned about using cold medicines with decongestants. But for phenylephrine, FDA clinical pharmacologists found that clinically relevant blood pressure changes weren't seen until the maximum oral dosage approved is at least doubled. Early on, the lack of big increases in blood pressure and heart rate were positive safety data, but in retrospect, it was also a clue that the oral doses were ineffective.

In the past reviews, outdated methods suggested that oral doses of phenylephrine resulted in 38 percent bioavailability of the active version of the drug after ingestion. But modern studies have suggested that phenylephrine is highly metabolized in the gastrointestinal tract, resulting in less than 1 percent bioavailability of the active drug.

Since the 2007 FDA meeting, there have been three clinical trials on phenylephrine—two by Merck for treatment of seasonal allergies and one by Johnson and Johnson on treatment of the common cold. All used clinically acceptable designs and nasal congestion symptom scores as a way to measure decongestant efficacy. "These three trials represent by far the largest and most carefully constructed trials that have ever been performed to evaluate the decongestant effect of oral [phenylephrine]," the FDA wrote. And all three found no significant difference between phenylephrine and placebo.

“A done deal”

After reviewing all of the data and the FDA's analysis, the agency's advisory committee agreed unanimously that phenylephrine is not effective.

"This is a done deal as far as I'm concerned," Paul Pisarik, a voting committee member and an expert in family medicine and epidemiology at Archwell Health in Oklahoma, said after the vote. "It doesn't work."

Pisarik, like many of his fellow committee members, said they did not support doing future studies on efficacy of phenylephrine because the current body of data is already conclusive. "We're kind of beating a dead horse," Pisarik said. Other members noted that while phenylephrine is not in itself unsafe, its use could be unsafe in that it could delay effective treatments.

Jennifer Schwartzott, the patient representative on the panel, emphasized that consumers deserve to treat their symptoms safely and effectively. "I feel that this drug in this oral dose should have been removed from the market a long time ago."

After the vote, the industry group Consumer Healthcare Products Association (CHPA), which represents makers of phenylephrine-containing products and also gave a presentation at the FDA meeting defending effectiveness, released a statement by CHPA President and CEO Scott Melville. "We are disappointed by the outcome of today’s FDA Advisory Committee meeting because its non-binding recommendation is at odds with the numerous clinical trials and previous regulatory determinations affirming oral [phenylephrine] as a safe and effective decongestant at its labeled dose," Melville said.

While phenylephrine remains on the market—for now at least—it's likely many consumers will want to avoid buying products containing it moving forward. In its statement Thursday, FDA noted that some products contain only phenylephrine, while others are combination therapies that have multiple active ingredients to treat multiple symptoms.

"[T]he presence of phenylephrine in these products does not affect how other active ingredients work to treat those symptoms," the FDA wrote.

"Because a variety of different drug products may be sold under the same brand name, consumers should always read the drug facts label to determine which ingredients are in a medication, as well as important warnings and directions for use."

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It turns out that scientists have discovered the Moon is drifting away from Earth, and it’s changing everything we thought we knew about our planet’s relationship with its only natural satellite.

It’s also having a very real impact on the length of days on our planet – albeit at an incredibly slow rate.

By moving away from Earth over the course of millions of years, the Moon is simultaneously making the length of the average day longer.

A study by a team at the University of Wisconsin-Madison focused on rock from a formation aged at 90 million years. By doing so, they were able to analyse the Earth’s interactions with the Moon 1.4 billion years ago.

It turns out that the Moon is moving away from Earth at us at 3.82 centimetres a year. That means that, eventually, it’ll result in Earth days lasting 25 hours in 200 million years time.

Stephen Meyers, who is a professor of geoscience at the University of Wisconsin-Madison, said: “As the moon moves away, the Earth is like a spinning figure skater who slows down as they stretch their arms out.”

He added: “One of our ambitions was to use astrochronology to tell time in the most distant past, to develop very ancient geological time scales.

“We want to be able to study rocks that are billions of years old in a way that is comparable to how we study modern geologic processes.”

It’s not the only story that changes our understanding of the Moon recently.

Scientists have also just uncovered billions of years’ worth of secrets buried beneath the surface of the moon – all thanks to China’s space programme, which has uncovered hidden structures which can help us start to piece together the Moon’s past.

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THE HEAT TAKES a slow and brutal toll on the teens in Sarah Mueller’s high school chemistry class in Pittsburgh, Pennsylvania. By 7:30 in the morning, the classroom can hit 84 degrees Fahrenheit. Mueller tries to keep students’ spirits up by joking with them. (“People pay a lot of money for saunas, and you’re getting it for free!”) She estimates that over the years she has spent at least $1,000 of her own money on fans. It’s still not enough. By the end of the day, her students are sweating, exhausted, and unable to focus. “Trying to make someone who’s practically melted learn about different types of matter is just against the Geneva Convention,” says Mueller.

Blistering heat and humidity pummeled schools across the United States last week, just as young people were returning for the new school year. As temperatures soared to the 90s during the first week of September, students in Detroit, Michigan, and Newark, New Jersey, were dismissed early; in Mueller’s district, schools without air-conditioning pivoted to remote learning for two days, in a move that recalled Covid-19 emergency remote learning. Schools are getting hotter—and it’s getting increasingly impossible to teach and learn in them.

Heat affects the brain in a few key ways. First of all, overheating is just distracting. If a kid is miserably sweating out a heat wave, they’re not focusing properly on the test in front of them. On hot days, Mueller says her students struggle to keep their heads up off their desks, much less focus on a lesson about lab safety.

And physiologically, young people are extra vulnerable to heat stress because their bodies are still developing. To keep from overheating, the body sweats, of course. But it also diverts some blood from the organs toward the skin, releasing heat into the surrounding air. (That’s why skin flushes when it’s hot out.) This can lead to a deficiency in oxygen in certain tissues, which in turn leads to cognitive impairment. This can happen to overheating teachers, too, potentially reducing the quality of their instruction on hot days.

“When we don't have as much blood—with a lot of hemoglobin and oxygen—going into the brain, we can't focus, we can’t think, and we can't learn as efficiently as we should,” says Tarik Benmarhnia, an environmental epidemiologist at UC San Diego. “Concentration is just not a priority, obviously, because the body is working very, very hard to try to cool down the temperature—that's a priority.”

Children with asthma are particularly at risk, because high temperatures lead to the formation of ozone, which irritates the airways. At its least harmful, this discomfort further distracts asthmatic students. But extreme heat can also send them to the hospital if an asthma attack escalates. That’s not only dangerous, it also disrupts their schooling.

Heat waves raise the risk of mental health issues like mood and anxiety disorders, and are well known to increase aggression. Mueller, the teacher in Pittsburgh, observes that fights tend to happen more frequently on her campus when it’s warmer. Just last week, she says, two broke out on the same day.

Lengthy heat waves are especially damaging because they prevent students from resting at night and coming back to school refreshed. For kids without AC at home, it’s already hot when they wake up. Then many of them walk to school in the heat, or ride a less-than-comfortable bus. They may return home to a hot house and struggle to sleep. “They can't sleep very well, so they're super tired when they go to school, and this is just exacerbating all of these patterns,” says Benmarhnia. “Kids, especially teenagers, need a lot of sleep—and good sleep—for incorporating the learning, but also just to be ready for the next day.”

Scientists are beginning to quantify just how significantly heat is affecting schoolchildren in this way. In one 2020 paper, researchers gathered data on students who’d taken the PSAT multiple times, most commonly in October of their sophomore year, then again a year later. They also got daily temperature data from thousands of weather stations dotted across the US showing what the weather was like in those years. They surveyed some of those students, asking, for instance, how often it was too hot to learn in their classrooms. They were able to show how high temperatures—and lack of air-conditioning—in the run-up to the PSATs affected scores. In schools with no AC, for each increase of 1 degree Fahrenheit, students’ PSAT scores the second year were 1 percent lower than a typical year’s gain between PSAT takes.

“It turns out when a student experiences a particularly hot year, they score lower on that exam than you would expect given their other test scores,” says Boston University education economist Joshua Goodman, who coauthored the paper. “And so we took that as evidence that it's not just heat on the day of the exam that matters, it's heat having a longer-term impact. Having spent the year learning in an unusually hot classroom has that cumulative effect on the day of the exam, even if the day of the exam itself is perfectly temperate.”

COURTESY OF SARAH MUELLER

A 2021 follow-up study conducted in 58 countries found that this trend is internationally true: Students schooled in warmer years do worse on exams than students from those same countries schooled in cooler years.

In the US, there are both geographical and demographic disparities that affect who ends up struggling in a hot classroom. A 90-degree day in Phoenix, for example, is a different beast than a 90-degree day in Boston. Phoenix is built on air-conditioning, whereas northern climates have until recently managed with less AC penetration. The human body also adapts to heat over time, to a certain extent: Phoenix residents might be physiologically better equipped to deal with 90-degree temperatures than Bostonians.

“Areas of the country that appear to be less adapted—that have cooler climates—on average there appears to be a higher marginal effect,” says University of Pennsylvania environmental economist R. Jisung Park, coauthor of both the 2020 and 2021 papers. “So the same hot day appears to do more damage in terms of learning.”

Goodman and Park’s 2020 paper finds that the learning of Black and Hispanic students is three times as inhibited by excessive heat as that of white students—most likely because schools in their neighborhoods lack AC. The researchers further estimate that somewhere between 3 and 7 percent of the PSAT score gap between white students and their Black and Hispanic schoolmates could be explained by temperature. “Even within a major metropolitan area, we find evidence consistent with there being a correlation between higher-minority schools having less adequate air-conditioning,” says Park. “That is certainly the case in many urban contexts, where low-income folks tend to live in places that are more susceptible to urban heat islands.”

COURTESY OF SARAH MUELLER

Park is referring to the increasingly severe phenomenon of urban areas getting way, way hotter than surrounding rural ones. Concrete and buildings soak up the sun’s energy by day and slowly release it at night, and cities lack vegetation that can “sweat” to cool the landscape. “Unfortunately, the case is that we see lower-income communities—which tend to be those that have a larger preponderance of impervious surfaces, buildings, and asphalt, and a lower cover of trees and other vegetation—those do tend to be the hotter ones,” says Edith de Guzman, who studies urban heat at the UCLA Luskin Center for Innovation. Schools are themselves little urban heat islands, with lots of densely packed buildings surrounded by impermeable surfaces like basketball or tennis courts, parking lots, and courtyards.

There’s an obvious fix: more school air-conditioning. That will come at a cost, for sure, and US schools are already catastrophically underfunded. But in their 2020 paper, Goodman and Park frame it as an investment, estimating that when the climate warms by 5 degrees Fahrenheit during a school year, equipping a school with AC would avoid $1,060 in future earnings loss per student, thanks to their improved academic performance. “You better air-condition schools, you plant more trees,” says Goodman. “This one has a fairly clear policy solution. Not necessarily cheap, but clear at least.”

Revamping American schools to prepare them for hotter temperatures will be an immense undertaking. An estimated 41 percent of school districts require upgrades to their heating, ventilation, and air-conditioning systems, according to a 2019 survey from the US Government Accountability Office. This represents about 36,000 schools.

There’s federal Covid relief funding available to help fix schools, and an analysis from the nonprofit FutureEd found that half of school districts in the US plan to spend it on HVAC upgrades. But it’s unclear how much will be put toward air-conditioning. In older buildings, installing AC could mean overhauling a decades-old electrical system, a costly, years-long undertaking that may require public votes for approval.

And even when schools secure the resources to install air-conditioning, the pandemic’s lingering supply chain issues can cause significant slowdowns. In Highland Park, Illinois, superintendent Michael Lubenfeld says that recent major renovations to two middle schools took over four years from approval to completion. As part of the renovation, the district overhauled a 1950s heat-only HVAC system to install air filtration and air-conditioning. The HVAC and cooling renovation costs alone for one middle school were estimated at $6.7 million. “We need help,” he says. “We almost need a Marshall Plan for school infrastructure from the federal government.”

Air-conditioning is also just one item on a long list of much needed (and increasingly urgent) upgrades to schools as temperatures climb. Franca Muller Paz, a Spanish teacher at Baltimore City College High School, says her students can’t drink from school water fountains because of high levels of lead. Instead, schools provide water coolers. “Students are really thirsty. They feel groggy from the heat,” she says. “You’re not going to retain what you’re learning when your body is feeling like that.” Last week, Baltimore City Public Schools instructed teachers in 20 schools without air-conditioning, including Muller Paz’s campus, to switch to remote learning due to extreme heat, per the district’s inclement weather protocol.

Representatives from the Baltimore City and Pittsburgh school districts did not immediately respond to requests for comment. But in May, Cyndi Smith, Baltimore City Public Schools’ director of facilities design and construction, told WBAL-TV that the district has plans and funding to update 13 schools that do not have air-conditioning, although in some cases that’s part of a major renovation. Last week, superintendent of Pittsburgh Public Schools Wayne Walters told Pittsburgh’s Action News 4 that because schools in his district are more than 80 years old on average, adding air-conditioning often requires also doing asbestos abatement, which is costly.

Bouts of extreme weather call into question whether schools are prepared for a worsening climate crisis. In June, schools across the US East Coast were closed due to dangerous levels of smoke from Canada’s wildfires. Protecting schools, advocates say, means combating the climate crisis at large. “Climate change and extreme weather is a threat multiplier around educational equity,” says Jonathan Klein, cofounder and CEO of UndauntedK12, a nonprofit that maintains a map of school closures due to extreme weather. He points to California’s Senate Bill 394 that would task a commission with coming up with a plan to fund and design “climate-resilient” schools.

Even in schools equipped with air-conditioning, teachers worry about high temperatures outdoors. Air-conditioning is the norm in Las Vegas, Nevada, where desert temperatures can soar into the triple digits. But first grade teacher Shivani Bhakta says that it’s hard to get her kids to focus after recess, when her classroom becomes “like a revolving door” of students asking for water and going to the bathroom. “If it gets any hotter, I’d be questioning the whole recess situation,” she says.

For now, schools without AC are resorting to short-term fixes that cause kids to lose valuable learning time—often in ways that exacerbate inequalities. In some schools, teachers must take time to move their students out of the classroom and into cooler areas. These are often common areas, like libraries, that are shared with other classes and aren’t always equipped with classroom supplies. Other schools resort to early dismissals, which are a challenge for working parents who struggle to find child care. Virtual learning on hot days is a band-aid; even though schools are now largely equipped with laptops for students, emergency remote learning has been associated with larger academic losses. Wealthier students can make up for lost learning time with tutoring, and in the event of school closures, they may have reliable access at home to air-conditioning and a comfortable learning environment. But low-income kids may continue to fall behind.

Muller Paz, the Spanish teacher in Baltimore, worries about how the worsening heat will affect her students’ futures. Many of them hope to be the first in their families to attend college. “It makes me angry because I want to see our students succeed, and it feels so unfair that they have to learn in these conditions, whereas their peers in other, wealthier schools are able to comfortably learn and not have to deal with these issues. It absolutely impacts my students’ focus,” she says. “Our kids deserve so much better.”

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Here is a look at what we know so far:

What is the Nipah virus?

The first Nipah outbreak was recorded in 1998 after the virus spread among pig farmers in Malaysia.

The virus is named after the village where it was discovered.

Outbreaks are rare but Nipah has been listed by the World Health Organization (WHO)—alongside Ebola, Zika and COVID-19—as one of several diseases deserving of priority research for their potential to cause a global epidemic.

Nipah usually spreads to humans from animals or through contaminated food, but it can also be transmitted directly between people.

Fruit bats are the natural carriers of the virus and have been identified as the most likely cause of subsequent outbreaks.

Symptoms include intense fever, vomiting and a respiratory infection, but severe cases can involve seizures and brain inflammation that results in a coma.

There is no vaccine for Nipah.

Patients have a mortality rate of between 40 and 75 percent depending on the public health response to the virus, the WHO says.

What has happened during previous outbreaks?

The first Nipah outbreak killed more than 100 people in Malaysia and prompted the culling of one million pigs in an effort to contain the virus.

It also spread to Singapore, with 11 cases and one death among slaughterhouse workers who came into contact with pigs imported from Malaysia.

Since then, the disease has mainly been recorded in Bangladesh and India, with both countries reporting their first outbreaks in 2001.

Bangladesh has borne the brunt in recent years, with more than 100 people dying of Nipah since 2001.

Two early outbreaks in India killed more than 50 people before they were brought under control.

The southern state of Kerala has recorded two deaths from Nipah and four other confirmed cases since last month.

Authorities there have closed some schools and instituted mass testing.

This marks Kerala's fourth recorded spate of Nipah cases in five years. The virus killed 17 people during the first instance in 2018.

The state has managed to stamp out previous outbreaks within a matter of weeks through widespread testing and strict isolation of those in contact with patients.

Are animal-to-human viruses becoming more frequent?

Having first appeared thousands of years ago, zoonoses—diseases that can be transmitted from animals to humans—have multiplied over the past 20 to 30 years.

The growth of international travel has allowed them to spread more quickly.

By occupying increasingly large areas of the planet, experts say, humans also contribute to disruption of the ecosystem and increase the likelihood of random virus mutations that are transmissible to humans.

Industrial farming increases the risk of pathogens spreading between animals while deforestation heightens contact between wildlife, domestic animals and humans.

By mixing more, species will transmit their viruses more, which will promote the emergence of new diseases potentially transmissible to humans.

Climate change will push many animals to flee their ecosystems for more livable lands, a study published by the scientific journal Nature warned in 2022.

According to estimates published in the journal Science in 2018, there are 1.7 million unknown viruses in mammals and birds, 540,000-850,000 of them with the capacity to infect humans.

Journal information: Science 

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Starship has been grounded since its inaugural test flight in April ended when the rocket — the most powerful launch vehicle ever built — exploded over the Gulf of Mexico.

Last week, the FAA said it had completed its safety investigation into the explosion and laid out 63 corrective actions SpaceX must take to obtain a launch license from the agency.

SpaceX CEO Elon Musk posted on social media on Sunday that the company had completed and documented 57 “required” actions out of a list of 63. (“Worth noting that 6 of the 63 items refer to later flights,” Musk said.)

He also has posted pictures of the rocket fully stacked and ready on the launchpad, which lies due east of Brownsville, Texas, on the state’s southernmost tip.

The FAA said the corrective actions also must pass an environmental review.

Starship’s spring test launch damaged the launchpad and started a 3.5-acre fire on Boca Chica State Park land, renewing environmental concerns about SpaceX’s presence in the area.

“The modifications SpaceX is making to (the) Starship program are also subject to an additional environmental review process. In August, as part of the environmental process, the FAA submitted a draft update of the Biological Assessment to U.S. Fish and Wildlife for review and requested consultation under the Endangered Species Act,” the agency said in a statement to CNN.

The statement indicated that the FAA’s review could be done by next month.

“The FAA is optimistic it may complete the safety review of the license application by the end of October,” the agency said.

What’s riding on Starship’s success

The FAA’s statement comes nearly five months after the Starship exploded in the rocket’s first test flight. The vehicle lifted off from SpaceX’s sprawling Starbase facilities in Texas but erupted into flames about four minutes later. The company blamed the outcome, which it called a “rapid unscheduled disassembly,” on multiple engine failures.

The US Fish and Wildlife Service assessed the fallout from the launch and said it included “large concrete chunks, stainless steel sheets, metal and other objects hurled thousands of feet away, along with a plume cloud of pulverized concrete that deposited material up to 6.5 miles northwest of the pad site,” according to a statement from the agency.

Starship, which packs more power than even the Saturn V rockets NASA used for the Apollo moon landings, is essential to future deep-space exploration projects at the heart of goals that both NASA and SpaceX have set.

The space agency plans to use Starship to land its astronauts on the surface of the moon for the first time in half a century. That mission, called Artemis III, is scheduled to lift off as soon as December 2025. But officials are already questioning whether Starship will be ready in time.

“With the difficulties that SpaceX has had, I think that’s really concerning,” said Jim Free, associate administrator of NASA’s Exploration Systems Development Mission Directorate, in June. “You can think about that launch date slipping probably into ’26.”

Separately, SpaceX has pinned its founding mission — to send humans to Mars for the first time — on Starship’s success. Musk has talked about plans for the vehicle in presentations for nearly a decade.

SpaceX completed several suborbital test flights of the upper portion of Starship before making its first attempt to get the spacecraft off the ground riding atop its rocket booster, dubbed Super Heavy.

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Artificial intelligence in healthcare is used to describe the use of AI and machine-learning algorithms and software, to mimic human cognition in the analysis, presentation, and comprehension of complex medical and health care data, or “to exceed human capabilities by providing new ways to diagnose, treat, or prevent disease,” according to Wikipedia.

Specifically, AI is the ability of computer algorithms to approximate conclusions based solely on input data.

Now the Joe R. and Teresa Lozano Long School of Medicine at The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and the University College at The University of Texas at San Antonio (UTSA) are launching the first known program in the U.S. to combine medicine and artificial intelligence. A Doctor of Medicine (MD) from UT Health San Antonio and a Master of Science in Artificial Intelligence (MSAI) from UTSA will form a five-year MD/MS program enabling physicians trained in San Antonio to advance the use of AI to improve diagnostic and treatment outcomes.

Groundbreaking innovation

“This unique partnership promises to offer groundbreaking innovation that will lead to new therapies and treatments to improve health and quality of life,” said UT System Chancellor James Milliken. “We’re justifiably proud of the pioneering work being done at UTSA and UT Health San Antonio to educate and equip future medical practitioners on how to best harness the opportunities and address the challenges that AI will present for the field of health care in the years to come.”

AI’s presence can already be found in a variety of areas of the medical field including customized patient treatment plans, robotic surgeries and drug dosage. Additionally, UT Health San Antonio and UTSA have several research programs underway to improve health care diagnostics and treatment with the help of AI.

The World Economic Forum predicts that AI could enhance the patient experience by reducing wait times and improving efficiency in hospital health systems and by aggregating information from multiple sources to predict patient care. AI is also improving administrative online scheduling and appointment check-ins, reminder calls for follow-ups and digitized medical records.

“Our goal is to prepare our students for the next generation of health care advances by providing comprehensive training in applied artificial intelligence,” said Ronald Rodrigues, MD, PhD, director of the MD/MS in AI program and professor of medical education at The University of Texas Health Science Center at San Antonio. “Through a combined curriculum of medicine and AI, our graduates will be armed with innovative training as they become future leaders in research, education, academia, industry, and health care administration. They will be shaping the future of health care for all.”

The UTSA M.S. in Artificial Intelligence is a multidisciplinary degree program with three tracks: data analytics, computer science, and intelligent and autonomous systems. Students also will have the opportunity to conduct research alongside nationally recognized professors in MATRIX: The UTSA AI Consortium for Human Well-being, a research-intensive environment focused on developing forward-looking, sustainable and comprehensive AI solutions that benefit society.

In 2021, a pilot program was introduced to UT Health San Antonio medical students. Two students who applied for and were accepted into the MD/MS program for fall 2023 are projected to graduate in the spring of 2024. For these students, the combined degrees mean multiple possibilities in health care.

“I believe the future of health care will require a physician to navigate the technical and clinical sides of medicine,” says Aaron Fanous, a fourth-year medical student. “While in the program, the experience opened my mind to the many possibilities of bridging the two fields. I look forward to using my dual degree, so that I can contribute to finding solutions to tomorrow’s medical challenges.”

“The courses were designed with enough flexibility for us to pick projects from any industry, and medical students were particularly encouraged to undertake projects with direct health care applications,” added Eri Osta, also a fourth year medical student in the program. “My dual degree will help align a patient’s medical needs with technology’s potential. I am eager to play a role in shaping a more connected and efficient future for health care.”

Medical students who are accepted to the dual degree program will be required to take a leave of absence from their medical education to complete two semesters of AI coursework at UTSA. Students will complete a total of 30 credit hours: nine credit hours in core courses including an internship, 15 credit hours in their degree concentration (Data Analytics, Computer Science, or Intelligent & Autonomous Systems) and six credit hours devoted to a capstone project.

To learn more about the Long School of Medicine MD/MS in Artificial Intelligence (MSAI) Dual Degree Program at UT Health San Antonio, please contact Stephanie Gutierrez, manager of the Long School of Medicine dual degree program, at 210-567-0183 or visit lsom.uthscsa.edu/mdmsai.

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What happens when we actually die—when our heart stops and all electrical activity “flatlines” in our brain?

Humans have been asking this question since time immemorial. It’s a tough one because the dead do not normally ping back to us about the nature of their experiences. Religious texts are capable of supplying a multitude of explanations. But scientists have not given up on providing their own set of answers, and they are making some strides in better understanding the brain’s process of transitioning from life to death.

Most recently, this has become possible because of research that has monitored the brains of people who have been in the throes of actually dying. Some of these individuals have been able to report back about what they experienced. According to findings published on September 14 in Resuscitation, the flatlined brains of some cardiac arrest patients burst into a flurry of activity during CPR, even though their heart had stopped beating up to an hour before. A small subset of study participants who survived were able to recall the experience, and one person was able to identify an audio stimulus that was played while doctors were trying to resuscitate them.

The researchers interpret the brain recordings they made of these patients as markers of “lucid, recalled experiences of death”—an observation that has “never been possible before,” says lead author Sam Parnia, an associate professor of medicine at NYU LangoneHealth and a longtime researcher of what happens to people as they die. “We’ve also been able to put forward a coherent, mechanistic explanation for why this occurs.”

“Recalled experiences of death”—a term Parnia prefers over “near-death experiences” for accuracy—have been reported across diverse cultures throughout recorded history. Some Western scientists previously dismissed such stories as hallucinations or dreams, but recently a few research teams have begun to pay more serious attention to the phenomena as a means to investigate consciousness and shine light on the mysteries of death.

In the new study, Parnia and his colleagues sought to find a biological signature of recalled experiences of death. They teamed up with 25 hospitals, primarily in the U.S. and the U.K. Medical personnel used portable devices that could be placed on the heads of patients who were having a cardiac emergency to measure their brain oxygen levels and electrical activity without interfering with their medical treatment. The researchers also tested for conscious and unconscious perceptions by placing headphones on patients that played a repeated recording of the names of three fruits: 

banana, pear and apple. In terms of unconscious learning, a person who does not remember hearing these fruit names but is asked to “randomly think of three fruits” may still give the right answer, Parnia says. Past research has shown, for example, that even people in a deep coma can unconsciously learn the names of fruits or cities if those words are whispered in their ear.

Between May 2017 and March 2020, 567 people suffered cardiac arrests at participating hospitals. Medical staff managed to gather usable brain oxygen and activity data from 53 of these patients, most of whom showed an electrical flatline state on electroencephalographic (EEG) brain monitors. But about 40 percent then experienced electrical activity that reemerged at some point with normal to near-normal brain waves that were consistent with consciousness. This activity was sometimes restored up to 60 minutes into CPR.

Of the 567 total patients, just 53 survived. The researchers conducted interviews with 28 of the survivors. They also interviewed 126 people from the community who had gone through cardiac arrests because the sample size of survivors from the new study was so small. Nearly 40 percent reported some perceived awareness of the event without specific memories attached, and 20 percent seemed to have had a recalled experience of death. Many in the latter group described the event as a “moral evaluation” of “their entire life and how they’ve conducted themselves,” Parnia says.

In their interviews with survivors, the researchers found that just one person was able to recall the names of fruits that had been played while they received CPR. Parnia acknowledges that this individual could have guessed the correct fruits by chance.

He and his colleagues have developed a working hypothesis to explain their findings. Normally, the brain has “braking systems” in place that filter most elements of brain function out of our experience of consciousness. This enables people to efficiently operate in the world, because under regular circumstances, “you couldn’t function with access to your whole brain’s activity being in the realm of consciousness,” he says.

In the dying brain, however, the researchers hypothesize that the braking system is removed. Parts that are normally dormant become active, and the dying person gains access to their entire consciousness—“all your thoughts, all your memories, everything that’s been stored before,” Parnia says. “We don’t know the evolutionary benefit of this, but it seems to prepare people for their transition from life into death.”

The findings also raise questions about the brain’s resiliency to oxygen deprivation. It could be, Parnia says, that some people who have conventionally been thought to be beyond the point of saving could in fact be revived. “The traditional thinking among doctors is that the brain, once deprived of oxygen for five to 10 minutes, dies,” he says. “We were able to show that the brain is quite robust in terms of its ability to resist oxygen deprivation for prolonged periods of time, which opens up new pathways for finding treatments for brain damage in the future.”

The new study “represents a Herculean effort to understand as objectively as possible the nature of brain function as it may apply to consciousness and near-death experiences during cardiac arrest,” says Lakhmir Chawla, an intensive care unit physician at Jennifer Moreno Department of Veterans Affairs Medical Center in San Diego, Calif., who was not involved in the research but has published papers on spikes of EEG activity at the time of death in some patients.

While the results Parnia and his colleagues report are “striking” from a scientific point of view, “I believe that we should allow these data to also inform our humanity,” he adds. For one, the findings should “compel clinicians to treat patients who are receiving CPR as if they are awake,” which is something “we rarely do.”

And for those individuals who do seem to be beyond saving, Chawla says, doctors could invite their families in to come say goodbye, “as the patient may still be able to hear them.”

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The Justice Department is arguing in a trial that began on Tuesday that the Alphabet (GOOGL.O) unit sought agreements with mobile carriers to win powerful default positions on smartphones to dominate search. The government argues that this antitrust trial, the biggest in decades, will determine the future of the internet.

The government wrapped up questioning of Antonio Rangel, who teaches behavioral biology at the California Institute of Technology, on Thursday.

Rangel argued that consumers were likely to stick with browsers on computers and mobile phones that were pre-installed as the default application.

The government says Google paid $10 billion annually to wireless companies like AT&T (T.N), device makers like Apple (AAPL.O) and browser makers like Mozilla to be the default search engine to fend off rivals and keep its market share near 90%.

John Schmidtlein, a lawyer for Google, during cross-examination of Rangel, pointed to instances where a significant number of user search queries went to Google even when another search engine was the default.

Schmidtlein also showed an internal Microsoft document from several years ago about search use by people who carried a BlackBerry, an early smart device. Verizon BlackBerries had Bing as the default, AT&T and T-Mobile BlackBerries had Yahoo, while Sprint had Google as the default, the document showed.

When users wanted to search, they turned to Google no matter the default, the document showed. Verizon BlackBerries with Bing as the default still showed 91% of searches were on Google.

Google says the government is wrong to assert that Google broke the law to hold onto its massive market share. It argues that its search engine is wildly popular because of its quality, and that any payments to wireless companies or others were fair compensation for partners.

The fight has major implications for Big Tech, which has been accused of buying or strangling small rivals but has defended itself by emphasizing that its services are free, as in the case of Google, or inexpensive, as in the case of Amazon.com (AMZN.O).

The government alleges Google's clout in search has helped it build monopolies in some aspects of online advertising, which accounted for more than three-quarters of Google's revenue in 2022, financial statements showed.

The government has also alleged that Google illegally took steps to protect communications about the payments.

If Google is found to have broken the law, U.S. District Judge Amit Mehta, who is deciding the case, will then decide how to resolve it. He may order Google to stop practices he has found to be illegal or to sell assets.

Previous major antitrust trials include Microsoft (MSFT.O), filed in 1998, and AT&T, filed in 1974. The AT&T breakup in 1982 is credited with paving the way for the modern cell phone industry, while the fight with Microsoft is credited with opening space for Google and others on the internet.

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The study also projects that within the next 70 years, river systems, especially in the American South, are likely to experience periods with such low levels of oxygen that the rivers could “induce acute death” for certain species of fish and threaten aquatic diversity at large.

“This is a wake-up call,” said Li Li, Penn State’s Isett Professor of Civil and Environmental Engineering and corresponding author on the paper. “We know that a warming climate has led to warming and oxygen loss in oceans, but did not expect this to happen in flowing, shallow rivers. This is the first study to take a comprehensive look at temperature change and deoxygenation rates in rivers — and what we found has significant implications for water quality and the health of aquatic ecosystems worldwide.”

The international research team used artificial intelligence and deep learning approaches to reconstruct historically sparce water quality data from nearly 800 rivers across the U.S. and central Europe. They found that rivers are warming up and deoxygenating faster than oceans, which could have serious implications for aquatic life — and the lives of humans. The National Oceanic and Atmospheric Administration estimates that most Americans reside within a mile of a river or stream.

“Riverine water temperature and dissolved oxygen levels are essential measures of water quality and ecosystem health,” said Wei Zhi, an assistant research professor in the Department of Civil and Environmental Engineering at Penn State and lead author of the study. “Yet they are poorly understood because they are hard to quantify due to the lack of consistent data across different rivers and the myriad of variables involved that can change oxygen levels in each watershed.”

The research team developed novel deep learning approaches to reconstruct consistent data to enable systematic comparison across different rivers, he explained.

“If you think about it, life in water relies on temperature and dissolved oxygen, the lifeline for all aquatic organisms,” said Li, who is also affiliated with Penn State’s Institute of Energy and the Environment. “We know that coastal areas, like the Gulf of Mexico, often have dead zones in the summer. What this study shows us is this could happen in rivers as well, because some rivers will no longer sustain life like before.”

She added that declining oxygen in rivers, or deoxygenation, also drives the emission of greenhouse gases and leads to the release of toxic metals.

To conduct their analysis, the researchers trained a computer model on a vast range of data — from annual precipitation rates to soil type to sunlight — for 580 rivers in the United States and 216 rivers in Central Europe. The model found that 87% of the rivers have been getting warmer in the past four decades and 70% have been losing oxygen.

The study revealed that urban rivers demonstrated the most rapid warming, whereas agricultural rivers experienced the slowest warming but fastest deoxygenation. They also used the model to forecast future rates and found that across all the rivers they studied, future deoxygenation rates were between 1.6 and 2.5 times higher than historical rates.

“The loss of oxygen in rivers is unexpected because we usually assume rivers do not lose oxygen as much as in big water bodies like lakes and oceans, but we found that rivers are rapidly losing oxygen,” Li said. “That was really alarming, because if the oxygen levels get low enough, it becomes dangerous for aquatic life.”

The model predicted that, within the next 70 years, certain species of fish could die out completely due to longer periods of low oxygen levels, which Li said would threaten aquatic diversity broadly.

“Rivers are essential for the survival of many species, including our own, but they have historically been overlooked as a mechanism for understanding our changing climate,” said Li. “This is our first real look at how rivers throughout the world are faring — and it’s disturbing.”

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That's the advice from a panel of outside advisors that urged NASA to use its scientific expertise, as well as its existing and planned instruments that observe space and the Earth, to better gather data related to what's now often called "unidentified anomalous phenomena," or UAP.

"We want to shift the conversation about UAPs from sensationalism to science," says NASA administrator Bill Nelson, a former senator from Florida who once flew in the space shuttle Columbia.

While emphasizing that "the NASA independent study team did not find any evidence that UAP have an extraterrestrial origin," Nelson noted that "we don't know what these UAP are. The mission of NASA is to find out the unknown."

NASA has actively looked for potential signs of life on other planets and moons in the solar system and beyond, but it hasn't traditionally spent much time thinking about "little green men" closer to home.

The new report offers a roadmap for how NASA could contribute to this area of research, and officials embraced the idea, announcing that the agency had created a new position, a director for UAP research, to help guide and coordinate NASA's efforts.

They declined to name the person appointed to that position, however. Dan Evans, assistant deputy associate administrator for research at NASA's science mission directorate, said their unwillingness to reveal the name was partly to protect that person from being hassled by people with strong feelings about UFOs.

"Some of the threats and the harassment have been beyond the pale, quite frankly, towards some of our panelists," says Evans. "That's in part why we are not splashing the name of our new director out there."

While unearthly-seeming sightings in the sky aren't uncommon, the report says that the "vast majority" can be attributed to mundane airborne objects like airplanes, drones, and weather balloons.

Still, not all can be easily explained, and the NASA advisors say that any sightings that appear to deviate from known technology's constraints on velocities and accelerations "are scientifically interesting."

The Department of Defense now has a special office to look into mysterious sightings, and UFOs have gotten recent attention in Congress. Earlier this year, for example, a former government worker made headlines when he told lawmakers that officials had recovered alien "biologics" from crash sites, but a Pentagon spokesperson said such claims could not be substantiated.

In the past, NASA has emphasized that the space agency "has not found any credible evidence of extraterrestrial life," and it has no evidence that any UFO sightings are extraterrestrial.

The 16 researchers and other advisors who drafted recommendations to NASA weren't asked to weigh in on the nature of previous unidentifiable observations, but rather to tell the agency what kind of data was currently available or could be collected for objective study.

Already-planned large-sky surveys by telescopes such as the Vera C. Rubin Observatory could look for unusual objects beyond the Earth's atmosphere, the report says. And programs to look for near-Earth objects, such as potentially dangerous asteroids, collect a lot of information about phenomena close to the Earth's atmosphere.

The report did identify some data gaps, such as the lack of a standardized system that would allow civilian pilots to make reports of unusual sightings. Currently, civilians get advised to contact local law enforcement or other organizations. "As a result, the collection of data is sparse, unsystematic, and lacks any curation or vetting protocols," the report notes, adding that NASA could offer guidance to other government agencies on the best ways to collect such data.

Also, smartphone-based apps might offer a way to crowdsource observations from the public, the panel noted, saying that NASA should explore the viability of this kind of public engagement and data collection.

"The language of scientists is data," notes Nicola Fox, the associate administrator of NASA's science mission directorate, who called UAP "one of our planet's greatest mysteries."

Finally, the advisors say that NASA has an established record of openness and public trust that could benefit the study of UFOs, and the agency could help destigmatize the reporting of these sightings so that they can be studied more robustly.

"We're going to be open about this," vowed Nelson, stressing that the agency makes its activities and data transparent.

David Spergel, president of the Simons Foundation and chair of NASA's UAP independent study team, says it's important for scientists to fully understand "normal" conditions and objects in the sky, so they can tell when something is truly odd, and having a solid foundation based on data is essential.

"Most events are going to turn out to be conventional things, balloons, airplanes, and so on," says Spergel.

He compared the search for something truly unusual to looking for a needle in a haystack —without knowing what the "needle" will look like.

"If you want to find something strange in a haystack," says Spergel, "you'd better know exactly what hay looks like."

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Abdulmenam al-Ghaithi, mayor of Derna, which was hardest hit by the storm, told the Saudi channel al-Arabiya that he believed the number of dead was between 18,000 and 20,000, “based on the number of neighborhoods destroyed.”

Efforts now are focused on combing through the disaster zone to find the bodies of the thousands estimated to be missing.

Residents and search teams have been burying the dead in hurriedly dug mass graves. Othman Abdul Jalil, minister of health for the eastern government, said 3,000 bodies had been interred so far in sites outside of Derna. Another 2,000 remain to be buried, he told Saudi channel al-Arabiya, adding that diving teams are combing the sea for more bodies.

Kamal al-Siyawi, the head of a commission responsible for locating the missing, beseeched citizens to “mark the locations of the cemeteries of the unidentified,” he told a Libyan channel, to help the government record the deaths and take the necessary samples.

Addressing the international community, Osama Hammad, prime minister of the eastern-based government in this divided nation, said the area is in dire need of specialists to retrieve casualties, as fears grow that the large number of decaying bodies could have severe health effects. “The area needs to be closed off completely, confined completely,” he told Libyan TV channel al-Masar in the early hours of Thursday.

“There are conflicts in the number … of deaths, but what matters is that the deaths number in the thousands,” said Ahmed Zouiten, the Libya representative from the World Health Organization. Speaking to TV channel al-Hurra late on Wednesday night, he said the WHO’s count of corpses recovered so far was 3,460.

The top priority right now, he emphasized, was extracting all the bodies and burying them. Three hospitals are completely out of service, and half of the remaining ones are only partially operative.

“This disaster is of mythic proportions,” he said somberly. “A disaster by all measures. Now, the retrieval of the corpses is important, as is burying the corpses before they disintegrate … and cause some environmental issues.”

There are also “tremendous” numbers of sick people who have been displaced and are in immediate need of medical attention, he added.

The International Committee for the Red Cross said it had distributed 6,000 body bags to help authorities extend dignified treatment to the dead. Yann Fridez, head of the ICRC’s Libya delegation, said in a statement that a wave approximately 23 feet (7 meters) high “wiped out buildings and washed infrastructure into the sea.”

Roads have been seriously degraded, the statement added, hindering humanitarian efforts to reach the flood-hit east. Unexploded ordnance and abandoned munition stores in Derna also pose a threat to those in the city.

The United Nations’ World Meteorological Organization said the scale of the tragedy would have been avoidable if there had been proper early-warning services in place. No evacuation orders were issued ahead of the storm despite its known severity.

Had there been normal operating services in Libya, “they could have issued a warning and also the emergency management authorities would have been able to carry out evacuation of the people, and we could have avoided most of the human casualties,” Petteri Taalas, the head of the WMO, told reporters.

Derna’s disaster came when floodwaters poured down the hills surrounding the city, burst through two dams and washed away about a quarter of the inhabited area, leaving much of it still underwater days later.

The scale of the disaster was apparent some 85 miles outside Derna where the landscape was marked by stagnant floodwaters clogging fields. Cars leaving the flood zone were caked in red silt as dozens of aid trucks and excavators from across the country headed the opposite direction into the affected region.

For years, the country has been divided between two warring rivals: a government in the east and one in the west. After the flood, the United Nations-backed western government said it had dispatched convoys of aid to the east. It instructed a cruise ship to moor at Derna port for at least 60 days to provide shelter for rescue teams working in the area.

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Allergies don’t only crop up in the spring. The persistent sniffles, clogged nose, itchy eyes and sneezing also happen in the fall — and, experts say, they’re getting more common, and more intense.

“Everyone knows spring is the big one, but fall can be just as bad,” said Dr. Purvi Parikh, an allergist and immunologist at N.Y.U. Langone Health.

Here’s what to know about the seasonal surge in allergies, and how to handle it.

What causes fall allergies?

Ragweed, a tall, willowy plant that grows in cities and rural areas alike, is the most common culprit behind fall allergies, said Dr. Michele Pham, an allergist and immunologist at the University of California, San Francisco. Just one pesky plant can release one billion grains of pollen, she said, which can irritate and inflame our sinuses. Ragweed starts to bloom in August and typically peaks in mid-September, but it can continue to grow into November.

“Labor Day to the first good snow is weed season,” said Dr. Sandra Hong, an allergist at the Cleveland Clinic.

You can find ragweed in nearly every state in the country, Dr. Pham said, though it tends to grow in particularly great numbers on the East Coast and in the Midwest. Those with fall allergies can also blame the mold from leaves that fall and decay, which can stir up the same symptoms.

“What a lot of people don’t realize is that the allergy seasons have almost doubled in length and gotten more intense because of climate change,” said Kenneth Mendez, the president and chief executive of the Asthma and Allergy Foundation of America. Higher carbon dioxide emissions spur plants to release larger amounts of pollen, he said. “That’s why allergies are feeling a lot worse.”

And as temperatures stay warmer for longer periods of time and the first frost happens later and later, plants like ragweed have more time to grow and release allergens, Mr. Mendez said.

Cities tend to have higher temperatures than suburban or rural areas, as a result of the urban heat island effect, he said. Crammed buildings and infrastructure absorb and retain the sun’s heat, making it as much as seven degrees hotter in urban areas during the day, according to the Environmental Protection Agency. That means allergies may be particularly intense if you live in a city, Mr. Mendez said, where those warmer temperatures allow ragweed to grow for longer.

How to tell the difference between allergies, colds and Covid

Symptoms can vary from person to person, but many people will exhibit the same signs of allergies in the fall as they do in the spring, said Dr. Anju Peters, an allergist at Northwestern Medicine. That means runny noses, sneezing, stuffiness, postnasal drip and fatigue — symptoms that sound a whole lot like colds and Covid.

The only way to be completely sure you don’t have Covid is to take a test — but there are a few clues to help pin down the source of your sniffles.

Viral infections tend to develop suddenly, and then run their course, Dr. Parikh said, while allergies slog on for four or six or eight weeks at a time.

And allergies — unlike colds, Covid and the flu — don’t usually cause fevers, body aches or gastrointestinal symptoms like diarrhea, she said.

Itchiness can be a telltale sign that you’re dealing with allergies, so watch out for scratchy, tingling ears, eyes, throats and noses, she added. Fall allergens can also cause rashes like eczema.

It’s important to monitor your allergy symptoms, in particular because allergies can trigger asthma. More than 4,000 people die from asthma each year, Mr. Mendez said, and Black Americans are three times more likely to die from asthma and five times more likely to be treated for it in an emergency room. Black women have the highest rate of mortality from asthma in the United States, he added. Emergency room visits and hospitalizations related to asthma tend to rise in the fall, partly because of allergies, Dr. Parikh said; “people don’t realize how serious it is.”

Coughing, wheezing and chest tightness can be signs that an allergy has led to asthma, especially if you wake up in the middle of the night with these symptoms, Dr. Parikh said. If you feel winded, fatigued, or dizzy after mild physical activity, like household chores, or like you cannot complete your normal exercise routine, those may also be signs of the disease.

How to handle fall allergies

There are basic habits that can help mitigate the amount of pollen you track into your home. Keep your windows closed as much as possible, especially on sunny, windy days when pollen levels are particularly high, and remove your shoes at the door. You may also want to take a shower and change your clothes when you arrive home. HEPA air filters can help clean the air indoors and remove mold and dander. Try to vacuum your home more frequently, especially if you have pets, Dr. Hong said — daily if you can. Consider washing your sheets regularly as well, and if possible, keep your pets out of your bedroom, Dr. Hong said, so they don’t track pollen onto your pillow.

When you do go outside, you might want to wear a hat and sunglasses, Dr. Pham said, which can shield your face from pollen. (Masks may also mitigate symptoms.)

Medications are also a critical tool. Over-the-counter intranasal steroids like fluticasone and triamcinolone can help alleviate sniffling and congestion; eye drops can wash away irritants and treat symptoms like itchy, red, watery eyes. These targeted interventions tend to be more helpful than oral antihistamines, Dr. Pham said, although oral antihistamine tablets can also alleviate symptoms — particularly itching, sneezing and runny nose. (Think Allegra or Zyrtec.) Some oral antihistamines, like Benadryl, may make people drowsy.

Some patients may want to turn to decongestants, like Afrin or Sudafed, Dr. Parikh said, but those medications can have a “rebound effect” — after you take them for a prolonged period, blood vessels in your nose do not respond as well, and you can end up with even worse congestion. If you want to refrain from medication, nasal irrigators like neti pots can rinse pollen out of your sinuses, but they won’t treat the allergy itself, she said.

If allergy symptoms are interfering with your daily life, it may be time to see a doctor. Mr. Mendez recommends seeking a board-certified allergist, who can administer allergy testing and evaluation, like a skin-prick exam or blood test, to identify what types of pollen trigger your allergies. A doctor may recommend immunotherapy in the form of allergy injections that contain amounts of the allergens that you are allergic to, which can offer longer-term relief. Another option for those who don’t want to receive shots is sublingual immunotherapy: a tablet or wafer that melts under your tongue and fights against ragweed, dust mites and northern pasture grasses like timothy, Dr. Hong said. You can take the wafer once a day, and start using it before allergy season starts. Both forms of immunotherapy boost a patient’s tolerance to the allergy, which reduces symptoms.

“Every year,” Dr. Peters said, “everyone says: ‘This is the worst possible allergy season.’”

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