Report: Spring COVID booster to be authorized for high-risk people in US

At least 65 million people are still suffering from long Covid, the mysterious cocktail of symptoms that persist in some patients more than 12 weeks after an initial infection. Researchers are still working to understand this illness, but it’s been slow progress so far. 

This is because long Covid is not just a medical problem—it’s also a data problem, says Indra Joshi, director of health, research, and artificial intelligence at Palantir, which specializes in analyzing big data.  

Before the pandemic, US hospitals kept their data to themselves, Joshi told WIRED Health this March, making it difficult for policymakers and researchers to identify patterns of disease occurring across the country. That’s why Palantir worked with the US medical research agency, the National Institutes of Health, to create what Joshi describes as one of the largest collections of Covid-19 health records in the world. 

The National COVID Cohort Collaborative, aka N3C, is essentially a giant, collaborative database, enabling clinicians and researchers to study the deidentified data of people suffering from Covid-19 or related conditions. “If you’re diagnosed with Covid now, your data goes into this enclave,” says Joshi, explaining that N3C now includes 2.1 billion clinical observations. The data enclave also encourages clinicians to enter data in a standardized format, making it easy for their insights to be compared with data collected from other US hospitals. 

By harmonizing all this data, the N3C acts as a collective pool of information that researchers can dip into to try to find consensus on the ongoing mysteries of long Covid: What exactly are the symptoms? What treatments are people receiving? And how are they responding to those treatments? Already the N3C data has helped better define the symptoms that make up long Covid. It has also revealed that Black and Hispanic Americans, in comparison to white patients, appear to experience more symptoms and health problems related to long Covid, but are less likely to be diagnosed.

“By collating that information, and by allowing lots of different researchers to work on that information, you enable much more research to be done, and much more to be published,” says Joshi. “We’ve now learnt a lot more about the SARS-CoV-2 virus.”

Palantir’s Plan to Decipher the Mysteries of Long Covid

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Postdoctoral researcher Jess Hohenstein is lead author of "Artificial Intelligence in Communication Impacts Language and Social Relationships," published in Scientific Reports.

Co-authors include Malte Jung, associate professor of information science in the Cornell Ann S. Bowers College of Computing and Information Science (Cornell Bowers CIS), and Rene Kizilcec, assistant professor of information science (Cornell Bowers CIS).

Generative AI is poised to impact all aspects of society, communication and work. Every day brings new evidence of the technical capabilities of large language models (LLMs) like ChatGPT and GPT-4, but the social consequences of integrating these technologies into our daily lives are still poorly understood.

AI tools have potential to improve efficiency, but they may have negative social side effects. Hohenstein and colleagues examined how the use of AI in conversations impacts the way that people express themselves and view each other.

"Technology companies tend to emphasize the utility of AI tools to accomplish tasks faster and better, but they ignore the social dimension," Jung said. "We do not live and work in isolation, and the systems we use impact our interactions with others."

In addition to greater efficiency and positivity, the group found that when participants think their partner is using more AI-suggested responses, they perceive that partner as less cooperative, and feel less affiliation toward them.

"I was surprised to find that people tend to evaluate you more negatively simply because they suspect that you're using AI to help you compose text, regardless of whether you actually are," Hohenstein said. "This illustrates the persistent overall suspicion that people seem to have around AI."

For their first experiment, co-author Dominic DiFranzo, a former postdoctoral researcher in the Cornell Robots and Groups Lab and now an assistant professor at Lehigh University, developed a smart-reply platform the group called "Moshi" (Japanese for "hello"), patterned after the now-defunct Google "Allo" (French for "hello"), the first smart-reply platform, unveiled in 2016. Smart replies are generated from LLMs to predict plausible next responses in chat-based interactions.

A total of 219 pairs of participants were asked to talk about a policy issue and assigned to one of three conditions: both participants can use smart replies; only one participant can use smart replies; or neither participant can use smart replies.

The researchers found that using smart replies increased communication efficiency, positive emotional language and positive evaluations by communication partners. On average, smart replies accounted for 14.3% of sent messages (1 in 7).

But participants who their partners suspected of responding with smart replies were evaluated more negatively than those who were thought to have typed their own responses, consistent with common assumptions about the negative implications of AI.

In a second experiment, 299 randomly assigned pairs of participants were asked to discuss a policy issue in one of four conditions: no smart replies; the default Google smart replies; smart replies with a positive emotional tone; and ones with a negative emotional tone. The presence of positive and Google smart replies caused conversations to have more positive emotional tone than conversations with negative or no smart replies, highlighting the impact that AI can have on language production in everyday conversations.

"While AI might be able to help you write," Hohenstein said, "it's altering your language in ways you might not expect, especially by making you sound more positive. This suggests that by using text-generating AI, you're sacrificing some of your own personal voice."

Said Jung: "What we observe in this study is the impact that AI has on social dynamics and some of the unintended consequences that could result from integrating AI in social contexts. This suggests that whoever is in control of the algorithm may have influence on people's interactions, language and perceptions of each other."

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The mechanisms behind the lowering of blood pressure by aerobic exercise are well studied, but little research has been done on the effects of strength exercise on hypertension along similar lines to this review conducted by researchers at São Paulo State University (UNESP).

Led by Giovana Rampazzo Teixeira, a professor in UNESP's Department of Physical Education at Presidente Prudente, the group analyzed over 21,000 scientific articles and conducted a Cochrane meta-analysis, considered the gold standard for systematic reviews. According to the authors, the analysis focused on the effects of variables such as age, training dose-response, load, volume and frequency.

Cardiovascular diseases are the leading cause of death worldwide, and high blood pressure accounts for 13.8% of deaths from such diseases. Arterial hypertension is diagnosed when systolic blood pressure exceeds 140 millimeters of mercury (mmHg) and/or diastolic pressure exceeds 90 mmHg. It is a multifactorial disorder triggered by such problems as an unhealthy diet, drinking too much alcohol, smoking and a sedentary lifestyle.

Strength training has long been known to be a therapeutic option, but without sufficient clarity as to the most effective protocols. In this study, the sample comprised 253 hypertensive subjects with a mean age of 59.66, and the meta-analysis focused on baseline and post-training hypertension responses to controlled studies that assessed the effects of training for eight weeks or longer.

"We were interested above all in the volume and intensity found sufficient to achieve a significant blood pressure reduction. On average, eight to ten weeks of strength training led to a reduction of 10 mmHg in systolic pressure and 4.79 mmHg in diastolic pressure," Teixeira said.

The study showed that effective results appeared around the twentieth training session. BP remained lower for about 14 weeks after training ended. "In clinical practice and gyms or fitness centers, strength training can be a treatment option for people with high blood pressure as a non-pharmacological intervention as long as you know enough about the key variables and take the subject's goals into account," Teixeira said.

Systematic review

For a long time, only aerobic training was prescribed to treat high blood pressure, and molecular studies focused almost entirely on the effects of this type of exercise. "Strength training was recently included in the Brazilian guidelines on the management of arterial hypertension, but much more research is needed in order to garner more robust evidence. Future studies should investigate the molecular mediators responsible for lowering vascular and blood pressure during strength training," Teixeira said.

The systematic review analyzed a total of 21,132 scientific articles in search of wide-ranging and robust evidence of the effects of strength training on HBP. Previous reviews on the topic found such evidence, but this study innovated by garnering additional evidence on the influence of age, load, intensity and frequency.

After excluding 21,035 articles that did not meet the objectives of the review, the researchers excluded 43 of the remaining 97 articles owing to duplication, leaving 54 articles for full-text analysis. Fourteen were considered relevant for inclusion in the systematic review.

The results of the analysis showed that strength training was most effective in terms of lowering blood pressure in protocols with moderate to vigorous load intensity, a frequency of at least twice per week, and a minimum duration of eight weeks.

Moderate to vigorous load intensity was defined as more than 60% of the heaviest weight subjects could lift just once, known as the one-repetition maximum, or 1RM, so that for a 1RM of 10 kg, the most effective training load would be more than 6 kg.

Most study samples were aged between 60 and 68. Only two were younger (18-46). Seven comprised both women and men, seven involved women only, and one included only men. An analysis of subgroups revealed more about the influence of age on the effects of strength training, which lowered BP significantly more in the 18-50 than the 51-70 age group. "In any event, strength training can be practiced at any age. The effect on blood pressure is beneficial in older people, too," Texeira said.

Future studies should investigate the cellular and molecular mechanisms that underlie lower blood pressure in response to strength training. Current knowledge shows that it raises heart rate, increases production of nitrous oxide, which promotes vasodilation by expanding blood vessel diameter, and boosts blood flow.

In the longer term, it facilitates adaptations such as a lower resting heart rate, lower blood pressure, improved heart efficiency and higher VO2max, the maximum rate of oxygen consumption attainable during vigorous exercise. Typically measured in milliliters of oxygen consumed per kilogram of body weight per minute (mL/kg/min), VO2max is relevant to cardiovascular health.

Among the limitations of the analysis noted by the authors are the inclusion of patients who took antihypertensive medication, such as beta-blockers, diuretics, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors, in 11 of the 14 studies. Furthermore, in some studies the inclusion of men and women in the same group prevented gender-sensitive analysis of the effects of strength training.

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In countries such as Britain and Ireland, court witnesses must declare they will provide truthful evidence, but those who prefer not to swear a religious oath can instead choose to "affirm," making no mention of God.

The research, led by Royal Holloway, University of London, was conducted in stages, with the first two initial studies finding that people associate the religious oath with credible testimony; and that people, especially those who are religious, are biased against defendants who choose instead to affirm.

Professor Ryan McKay, from the Department of Psychology at Royal Holloway, University of London, said, "If taking the oath is seen as a sign of credibility, this could lead to discrimination against defendants who are not willing to swear by God.

"An earlier proposal to abolish the oath in England and Wales was defeated when opponents argued that the oath strengthens the value of witnesses' evidence. This is ironic, as it seems to acknowledge that swearing an oath may give an advantage in court."

In a more involved follow-up study of nearly 2,000 online participants, Professor McKay and his colleagues created videos of a mock trial involving a man accused of robbery. In one version of the trial, the defendant swore a religious oath before giving evidence, in the other he chose to affirm.

Participants acted as mock jurors in the trial and were themselves required to swear or affirm that they would try the defendant in good faith.

Overall, jurors who watched the video where the defendant affirmed, rather than swore, were not more likely to find the defendant guilty.

However, jurors who themselves swore an oath, were more likely to find the affirming defendant guilty.

Dr. Will Gervais, from Brunel University London, who collaborated on the studies, added, "The biases we report are subtle, but could potentially tip the balance in cases that could go either way."

Professor Colin Davis, from the University of Bristol, who also collaborated on the work, said, "The stakes here are high, so our findings have important practical implications. Discrimination against defendants who choose not to swear an oath could lead to dozens, if not hundreds, of additional convictions every year."

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It’s no secret that regular exercise has many benefits. It protects against developing chronic conditions, such as diabetes and heart disease, and in some cases can improve mental health. But what effect does it have on specific functions, like memory? Can a workout regimen help you remember the scores from last night’s Yankees game, where you went on your first date with your significant other or where you left your keys?

It’s possible. Studies over the years have suggested that a single workout can improve recall, and that engaging in regular exercise over the course of years or decades not only improves memory, but also helps fortify against future memory problems. Now, a recent study from Dartmouth focuses on how the intensity of exercise, over a period of time, may play an important role in bolstering different types of recall.

“We know that exercise works, but we don’t know which variables of exercise make the exercise more effective,” said Marc Roig, a physical and occupational therapy professor at McGill University who studies the effect of exercise on cognition and was not involved with the study. “We believe intensity is one of those factors.”

Different exercise intensities appear to affect different types of memory.

One of the major challenges with studying the link between regular exercise and memory is that the changes are hard to measure. This is complicated by the fact that many other factors affect memory, like working a sedentary office job or chronic sleep deprivation. Furthermore, there are different types of memory — which explains how a person might constantly lose their keys (poor spatial memory) but have a knack for remembering birth dates (strong semantic memory).

Activity trackers can offer one solution to these issues. In the recent paper, published in the journal Nature Scientific Reports, researchers were able to look at a year’s worth of Fitbit data from 113 participants, who also completed a series of memory tests, like recalling details from a short story, spatial details, foreign language terms and lists of random words.

The advantage of this method is that it linked a full year of information about participants’ activity patterns — how much exercise they got, how intense, how often — to their performance on memory tests.

Other studies have tracked patterns of activity through self-reported data, which is often less reliable than activity tracker data, as people tend to underestimate how much time they are sedentary and misremember their total activity levels.

“You can get a much more nuanced picture from activity tracker data,” said Jeremy Manning, a professor at Dartmouth College and one of the authors of the study.

Dr. Manning and his colleagues found that active people had better memories overall compared to those who were sedentary, but also found that the types of tests they did well on varied depending how intensely they exercised.

For instance, participants who engaged in light to moderate activity, such as going for regular walks, had better “episodic” memory. Think of episodic memory as “mental time travel,” Dr. Manning said, or the ability to remember details about everyday events, like meeting a friend in a coffee shop or watching for the school bus on your first day of kindergarten.

This tracks with a number of previous studies that have shown the more people are active, the better, on average, their episodic memory is.

Participants who regularly exercised more intensely — such as going for a run or doing a HIIT workout — were more likely to perform better on spatial memory tasks. Spatial memory is the ability to remember physical relationships between objects or locations in space, like where you put your keys. This mirrors a number of other studies that show high-intensity exercise improves memory, but goes further, suggesting it might be more helpful for this type of memory over another.

More study needs to be done to solidify these associations and determine what is causing them, the researchers said.

“The more that we can connect everyday patterns of activity to cognitive performance, the closer we are getting to thinking about lifestyle,” which includes how active you are during the entire day and sleep patterns, said Michelle Voss, a cognitive neuroscientist at the University of Iowa, who was not involved in the study.

According to Phillip Tomporowski, a professor of kinesiology at the University of Georgia who was not involved in the study, this paper is a “really good first guess” at how certain patterns of exercise affect certain types of memory.

Dr. Manning and his colleagues hope to follow up with controlled experiments to identify why certain exercises might affect specific types of memory.

Maybe someday there will be a workout to finally help you remember where you put your keys.

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Scientists are pointing to a surprising cause of some urinary tract infections: E. coli bacteria in meat. A new study used statistical modeling to estimate that E. coli, commonly known as the bacteria behind many food-borne illnesses, may cause hundreds of thousands of U.T.I.s in the United States annually — likely a small fraction of overall U.T.I.s, but enough to intrigue, and in some cases concern, experts.

The new study looked at chicken, turkey and pork in particular, as previous studies suggested that these foods can become contaminated with the type of E. coli that could induce a U.T.I. Over the last two decades, scientists have increasingly viewed food as a potential source of infection; the new study highlights just how pervasive these food-borne U.T.I.s may be.

A U.T.I. occurs when bacteria enters the urethra and infects the urinary tract. Sometimes an infection develops because of poor hygiene (i.e., not wiping correctly) or from sex, and some people are more anatomically or genetically prone to develop an infection than others. U.T.I.s can be pernicious and painful. People may experience symptoms like discomfort when urinating or a frequent need to urinate; they may feel cramps, fatigue or a stinging sensation during sex. Some may have “urinary hesitancy,” said Dr. Monica Woll Rosen, an OB-GYN at the University of Michigan Medical School — the urge to urinate that doesn’t produce any urine. U.T.I.s occur in both men and women, but they are more common in women because females have shorter urethras.

The symptoms of a U.T.I. are likely to be the same no matter the source of the infection, Dr. Rosen said. While the vast majority of U.T.I. infections are mild and treatable, in rare cases U.T.I.s can be severe, and even fatal, which is why researchers are so motivated to track down their causes.

How can food cause a U.T.I.?

A food-borne U.T.I. starts the way most U.T.I.s do: when E. coli from the gut migrates from the anus to the urethra, said Lance B. Price, a professor of environmental and occupational health at George Washington University and one of the authors of the new study.

Most of us carry E. coli around in our guts most of the time, said Dr. James R. Johnson, an infectious disease professor and leading researcher on urinary tract infections at the University of Minnesota and an author of the study. E. coli can contaminate food, but humans and animals can also carry and transmit the bacteria to one another. For the most part, this bacteria won’t bother us; only specific E. coli strains have the capacity to colonize the urinary tract and cause U.T.I.s. “As long as they stay where they belong in the gut, everybody’s happy,” Dr. Johnson said. “It’s only when they get confused and go somewhere that they shouldn’t be that trouble can happen.”

Other foods, including plants, can potentially harbor the E. coli that causes U.T.I.s, but those strains seem to be more commonly found in meats than in other foods, Dr. Price said.

There’s no way to determine the source of a U.T.I. based on symptoms, although you’re far more likely to get infected from a nonfood source of E. coli than from food-borne E. coli, Dr. Johnson said. And other bacteria can also cause U.T.I.s.

How to reduce your risk of getting a U.T.I. from food

The findings from this study don’t mean you should immediately change your eating habits, said Dr. Michelle Van Kuiken, a urologist at the University of California, San Francisco. “There’s not a one-to-one correlation” between eating meat and U.T.I.s., she said, adding that she sees plenty of patients with recurrent U.T.I.s who are vegetarians and vegans. But further research might illuminate how diet can impact the risk of infection.

The recent findings should remind people to double down on preventive measures when cooking meat, Dr. Price said. That means being mindful not just when you handle raw meat itself but also when you interact with the packaging — especially the potentially bacteria-laden juices in a raw chicken container, for example.

The Centers for Disease Control and Prevention recommends that people take basic steps to safely prepare food and prevent potential E. coli exposure, including washing hands before, during and after cooking; using separate cutting boards for raw meats and other items like produce; ensuring that meats are cooked to the appropriate temperature; and refrigerating foods properly.

While it may seem counterintuitive to associate kitchen hygiene with U.T.I. prevention, Dr. Johnson said that the emerging research on food-borne E. coli shows that taking these steps could potentially ward off infection, just the way urinating after sex, staying hydrated and properly wiping might.

“Most people don’t really understand how U.T.I.s happen,” he said. “They just happen.”

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Virgin Orbit, a satellite launch company whose fortunes have sunk since one of its rockets failed to reach orbit in January, filed for bankruptcy protection in the United States on Tuesday.

The company, founded by Richard Branson, had an unusual way of getting satellites into space: A converted Boeing 747 aircraft would carry aloft a satellite-packed rocket under its wing. When aloft, the rocket would detach and fire its engines, climbing upward into orbit before releasing the satellites.

But the company’s most recent attempt, in Cornwall, England, failed after the rocket fell short of reaching orbit, and the nine satellites on board were lost. The company, based in California, was attempting the first launch of satellites from Britain, and the mission was a high-profile event strongly supported by the country’s space community.

Afterward, Virgin Orbit said it would return and try again, but financing began to dry up, and the company’s stock price started to slide.

Last week, Virgin Orbit said it was laying off 675 employees, or about 85 percent of its work force, citing its “inability to secure meaningful funding.”

Dan Hart, the company’s chief executive, said Virgin Orbit would seek a purchaser.

“We believe that the cutting-edge launch technology that this team has created will have wide appeal to buyers as we continue in the process to sell the company,” he said in a statement.

Virgin Orbit’s launch format is considered more flexible and cheaper than vertical rocket launchers because it can operate from airstrips around the world. For that reason, some analysts have said, it may remain of interest to governments including the United States.

Until this year, Virgin Orbit’s previous launches had been from the Mojave Desert in California, and four out of five were successful.

But its method so far has failed to establish itself as reliable, and the underwing rocket had less capacity than more conventional systems used by companies like Elon Musk’s SpaceX. The failed launch in Cornwall wound up being a poor advertisement for prospective customers and investors.

In its bankruptcy filing, submitted to the U.S. Bankruptcy Court for the District of Delaware, Virgin Orbit listed about $243 million in assets and $153 million in debts.

Virgin Orbit, which went public in late 2021 via a merger with a so-called blank check company, was worth some $3.5 billion in market value at its peak.

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A team of students is about to beat NASA to a lunar first: sending a rover to the Moon before they have. The team of students from Carnegie Mellon University expect the Iris rover, and an additional sculpture project named MoonArk, to launch on May 4. 

"Hundreds of students have poured thousands of hours into Iris. We've worked for years toward this mission, and to have a launch date on the calendar is an exciting step," student and commander of the Iris mission, Raewyn Duvall, said in a press release. "Iris will open up lunar and space exploration by proving that a tiny, lightweight rover built by students can succeed on the moon."

Once on the Moon, the Iris rover will spend its 60-hour mission exploring the surface and sending back photographs to Earth. The vehicle will be the first un-crewed American rover on the Moon, joining rovers from China. It will also be the first student-developed lunar rover, and the smallest and lightest moon rover to date.

MoonArk, a project 10 years in the making, will be left on the Moon as a time capsule. The lightweight sculpture contains a selection of images, music, nano-objects, poems, and other samples from Earth. The intention is that the sculpture will be lost, and rediscovered by humanity far off in the distant future.

"Context is such an important part of deconstructing art, and when you remove those contexts you have a whole new set of challenges," MoonArk project manager, Dylan Vitone, said in a press release about the project in 2019. "We wanted to build a narrative off of our universal experiences that's moving to people now, but also 1,000 years down the road."

The two projects are penciled in to be launched on May 4, traveling on a United Launch Alliance rocket, before landing on the Moon in the Peregrine lunar lander. 

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The amount of sea ice surrounding Antarctica fell to the lowest level ever detected in the modern era this Southern-Hemisphere summer. This is the second year in a row that the record for the minimum sea ice extent has been broken, although it’s still too early to say if this downward trend is likely to continue.

Scientists have been tracking Antarctic sea ice levels using satellites since 1979 and are used to observing massive fluctuations in coverage as the ocean freezes and melts at different times of the year. Typically, sea ice reaches a maximum extent of roughly 18.5 million square kilometers (7 million square miles) in September, before dropping to around 2.5 million square kilometers (one million square miles) in late February.

However, on February 21, data showed that just 1.79 million square kilometers (691,000 square miles) of sea ice remained around the Antarctic coastline, according to the National Snow and Ice Data Center (NSIDC). This is around 40 percent lower than the average between 1981 and 2010 and is 136,000 square kilometers (52,500 square miles) less than the previous record low, which was detected on February 25, 2022.

The third lowest sea ice extent was recorded in 2017, while 2018 saw the fourth smallest frozen area. However, despite this recent downturn, scientists say that trends over such a short time period are not necessarily indicative of an overall pattern. 

Whether or not Antarctic sea ice is vanishing is therefore still a matter of debate, especially when one considers that record high levels were recorded in 2013 and 2015. Overall, frozen coverage dropped by around 1 percent per decade between 1981 and 2010, indicating that the ice around the southern pole is far more resilient than that in the Arctic, which is disappearing at an alarming rate.

“Antarctica’s response to climate change has been different from the Arctic’s,” explained Ted Scambos from the Cooperative Institute for Research in the Environmental Sciences (CIRES) in a statement. “The downward trend in sea ice may be a signal that global warming is finally affecting the floating ice around Antarctica, but it will take several more years to be confident of it.”

Should this trend continue, however, the effects could be catastrophic. According to Julienne Stroeve from the NSIDC, “the sea ice helps to buffer large floating ice shelves and major outlet glaciers such as Pine Island and Thwaites, and if these glaciers begin a more rapid runaway loss of land ice, it could trigger a dramatic increase in sea level rise rates before the end of this century.”

Sea ice also contributes to the albedo effect, whereby light surfaces reflect the Sun’s rays back into space and prevent the planet from warming. As the ice melts, however, the dark ocean beneath is exposed and absorbs these rays, thereby accelerating global temperature increases.

What happens in Antarctica, then, certainly doesn’t stay in Antarctica.

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Note the person for scale. Image credit: Alexander Van Driessche / Wikimedia Commons (CC BY 3.0)

Conditions in the cavern 

While its picturesque interior may look like the perfect photo-op, the Cave of Crystals is closed to the public as the conditions inside are both treacherous and potentially deadly.

With a stable interior temperature of around 58 degrees Celsius (136 degrees Fahrenheit), and humidity levels that reach between 90 and 99 percent, spending any longer than 10 minutes in the cavern unprotected could lead to a build-up of fluid in the lungs and even death. 

To withstand the conditions inside the cave, teams researching the crystals must dress in heat-protective suits with breathing apparatus supplying them with fresh air. This enables the exploration time to be extended from around 10 minutes to between 15 and 60 minutes.

Even with protective equipment, the incredibly smooth and condensation-covered surfaces of the crystals prove hazardous to those attempting to traverse the interior. The crystals, some of which weigh over 50 metric tons, are made from gypsum, a soft mineral with a Mohs scale of hardiness score of just 2 – that’s only one level above the scale’s softest mineral. This means the crystals are likely to break and move under the pressure of foot traffic.

Crystal formation

The mountain, which contains a number of giant gypsum crystal caves, formed roughly 26 million years ago from a mound of magma straining against the Earth’s surface, forming a mound. The caverns in the mountain filled with hot, calcium sulfate-rich waters that in turn allowed the growth of the crystals.

While calcium sulfate can form several different minerals, the dominant mineral in the mountain’s cave system is a transparent variety of gypsum called selenite.

Anhydrite, a mineral that forms in the presence of acid sulfide water and calcium ions, was also abundant in the hot cave waters. Shortly after the formation of the mountain, when the waters were at their hottest, anhydrite deposits formed.

As the water’s temperature dropped, the conditions fell below anhydrite’s high stability zone, dissolving the mineral. Gypsum crystals began to form when the temperature of the cave’s water reached around 58°C (136°F), and the slowly dissolving anhydrite deposits infused the water with just enough calcium and sulfate to sustain gypsum crystal growth.

A neighboring chamber just 120 meters (394 feet) down, called the Cave of Swords, experienced a faster drop in temperature than the Cave of Crystals. This caused many smaller gypsum crystals to form inside the caves, while the slow cooling of the water in the Cave of Crystals allowed fewer crystals to grow to much larger sizes.

Research has been conducted to try and determine the exact reason these crystals specifically have been able to grow to such impressive sizes, but it’s thought that their continued submersion beneath the mineral-rich waters has allowed these giants to continue growing for an estimated 500,000 to a million years.

In 2017, a team of NASA microbiologists researching the cave discovered microbes trapped in fluid inclusions within the crystals. Having been removed and successfully revived in the lab, they estimated these microbes to be around 50,000 years old and suspected they had been living off the crystals’ manganese and iron deposits.

Mining activity

The mountain surrounding the cave systems is rich in lead, zinc, and silver, making it a hotbed for mining activity. While the Cave of Crystals was discovered just 23 years ago, the much shallower Cave of Swords was first stumbled upon by miners in 1910 and was subsequently pillaged for the next 100 years.

To gain access to these cave systems the miners first had to remove the mineral-rich waters that filled each cavern. Creating an artificial lake near the town of Naica, mining companies pumped the equivalent of an Olympic-sized swimming pool out of the caves every 40 minutes.

Despite granting access to miners and researchers studying the caves, the removal of the water also jeopardized the integrity of these giant crystals as the lack of buoyancy threatened to collapse some of the larger structures under their own weight.

The removal of the water also halted the formation and growing process of the gypsum crystals. Mining in the mountain was stopped in 2015 and the caverns were allowed to gradually fill once more with water.

While the water level continues to rise, it hasn’t yet reached the Cave of Crystals, and it’s unknown if the waterbed will ever return to the level it once was. The hope, however, is that the waters will one day reach the crystal-filled caves and aid in the growth and repair of some of the largest crystals in the world.

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All of a sudden, NASA’s return to the Moon feels rather real

A highly drug-resistant bacteria that was linked to eyedrops imported from India and that spread from person to person in a Connecticut long-term care center has prompted concerns that the strain could gain a foothold in U.S. health care settings, according to the Centers for Disease Control and Prevention.

Infectious disease specialists said the strain had not been previously detected in the United States, and that it was particularly difficult to treat with existing antibiotics.

In recent months, three deaths, eight cases of blindness and dozens of infections have been traced to EzriCare artificial tears, according to the C.D.C., leading to a widespread recall this year.

The Food and Drug Administration, which regulates over-the-counter medicine, has stopped imports of the product. But these outbreaks highlight regulatory gaps in controlling imports of overseas medications.

The F.D.A. confirmed that it had not inspected the factory where the eyedrops were made in India before the infections were reported, but that the agency had since visited the plant, which is operated by Global Pharma Healthcare.

The agency has long been criticized for lapses in inspections of overseas manufacturing in China and India, which are the two major producers of drugs and raw ingredients for medicines. Other instances of contaminated products from overseas included blood pressure medications suspected of containing a possible carcinogen and deadly batches of heparin, both of which prompted mass recalls.

The F.D.A. said it was continuing to work with the C.D.C. and had urged retailers to make sure the products were removed from shelves.

In the latest instance, the eyedrops are linked to bacteria that is even more drug-resistant than a similar bacteria that the C.D.C. tends to see in about 150 cases per year, mostly in intensive-care settings, according to Maroya Walters, lead investigator for the C.D.C.’s antimicrobial resistance team.

Dr. Walters said the spread of the newest strain “really could change the outlook for that.”

The bacteria showed signs of spreading within the Connecticut center among asymptomatic patients who had the bacteria colonized in their bodies. Such spread tends to occur when patients touch common items or when health care workers transmit the germs.

The bacterium linked to the eyedrops, drug-resistant Pseudomonas aeruginosa, is already a top concern for health care providers, especially among those with compromised immune systems, nursing home residents and patients with invasive medical devices like catheters and breathing tubes.

Dr. David van Duin, an infectious disease specialist at the University of North Carolina School of Medicine, said resistant pseudomonas was especially difficult to eradicate, both from health care facilities, where it clings tenaciously to sink drains, water faucets and other moist environments, and from patients who develop bloodstream infections.

“It’s very hard to get rid of,” he said.

By now, cases associated with the eyedrops have largely been contained, thanks to a product recall and widespread attention from the news media, Dr. Walters said. The F.D.A. had also announced the recall of Delsam Pharma’s Artificial Eye ointment, which was made in the same factory as the eyedrops, because of possible contamination.

The C.D.C. is asking doctors to work with public health labs to determine the genetic fingerprint of hard-to-treat Pseudomonas infections in the eye and throughout the body.

“I think we are going to see the impact of this play out over the course of months to years,” Dr. Walters said.

In late December, the C.D.C. linked the EzriCare drops to an outbreak that has affected 68 patients in 16 states, including eight patients who lost their vision and four who had an eyeball removed.

The F.D.A. has not said how much of the product made by Global Pharma Healthcare in Chennai, India, was imported.

However, records provided to The New York Times by Panjiva, the supply chain research unit of S&P Global Market Intelligence, show that Global Pharma sent U.S. distributors four shipments in 2021 and 2022 amounting to tens of thousands of half-ounce bottles of EzriCare artificial tears.

While the F.D.A. requires a pre-approval inspection of plants that manufacture prescription drugs, there is no such mandate for those that make over-the-counter medicines like artificial tears. Compounding the problem, the number of inspections the agency conducts has plummeted since the pandemic began.

Representative Rosa DeLauro, Democrat of Connecticut, expressed concern about the F.D.A.’s ability to oversee what she described as “substandard safety practices” at U.S. and foreign plants, and called for providing the agency with more funding and greater authority to recall products. “Lives are at stake,” she said in a statement.

On Jan. 3, the F.D.A. blocked Global Pharma’s imports, saying the company had provided “an inadequate response to a records request” and violated manufacturing rules. Shannon P. Hatch, a spokeswoman for the agency, said that the import alert was unrelated to the outbreak.

The F.D.A. also said it recommended a voluntary recall on Feb. 2 over a “lack of appropriate microbial testing,” formulation issues and the absence of proper controls around tamper-evident packaging. The agency conducted an unannounced inspection at the India plant from Feb. 20 through March 2 and found a litany of problems with the plant’s sterility practices, according to an inspection report that was first reported by STAT news.

Clean-room operators were not qualified for the job, and they wore discolored and worn-out foot covers, the report said. An inspector noted “a black, brown colored greasy deposit” on machinery in a room where bottles were filled with the eye drops. One worker acknowledged to an inspector that there was no procedure for cleaning one of the filling machines, according to the report.

Global Pharma did not respond to questions in March. But on Feb. 1, the company said it had “not determined whether our manufacturing facility is the source of the contamination.” EzriCare said on its website that it marketed the drops, but that it had no role in the “actual manufacturing of this product.” Wal-Mart and Amazon, among the larger retailers that sold the drops, did not respond to requests for comment.

Clara Elvira Oliva, 68, a contact lens wearer from Florida, began using EzriCare Artificial Tears to moisturize her eyes at the recommendation of the ophthalmologist at her health clinic.

One morning in August, she woke up to find her right eye red and itchy and oozing liquid. Alarmed, she returned that day to the ophthalmologist, who prescribed antibiotic drops. But in the weeks that followed, she said, the irritation persisted and her eyesight began to deteriorate, stumping eye care providers who prescribed an ever-changing variety of antibiotic and antifungal drops.

All the while, she kept using the EzriCare drops in both eyes. “No one told me to stop using them,” Ms. Oliva said in an interview.

By the end of August, the infection in her right eye had become so dire that specialists told her she would need a cornea transplant. After the operation, she was told the eye was so ravaged by infection that doctors had no choice but to remove it.

“Since that day, my life has never been the same,” said Ms. Oliva, a retired cosmetologist who lives with her son in Miramar.

Dr. Walters collected mounting reports of antibiotic-resistant infections in several states that had a strikingly similar genetic fingerprint.

C.D.C. investigators examined an outbreak of about two dozen cases at the long-term care center in Connecticut, where they saw evidence of bacterial spread among residents. That investigation pointed to eyedrops, but the center’s records made it difficult to tell what type had been used.

By late December, the C.D.C. had tested 23 open bottles of eyedrops. Eleven of the EzriCare artificial tear bottles harbored bacteria, and seven of those matched the outbreak strain, Dr. Walters said.

While the finding is not definitive proof that the bacteria came from the bottle and not from touching an infected eye, the evidence was compelling, Dr. Walters said.

For Ms. Oliva, the vision in her left eye, already compromised by scarring, continues to deteriorate, making it difficult to drive, cook and read.

Unsteady on her feet, she avoids going out. “Sometimes I bump into people because I don’t see them, but they think I’m just not paying attention,” she said.

Ms. Oliva’s lawyer, Natasha Cortes, said she was investigating two cases of patients who went to the same clinic and developed vision problems, as well as five others.

The outbreak has renewed longstanding concerns about the quality and frequency of the F.D.A.’s overseas inspections.

In June 2020, Senator Chuck Grassley, Republican of Iowa, held an oversight hearing on the F.D.A.’s foreign inspection process, noting that the plants were given 12 weeks’ advance notice, “plenty of time to doctor up a facility to make sure that it passes inspection.” The agency has since received budget authority to conduct unannounced overseas inspections.

The F.D.A. paused overseas inspections during the height of the coronavirus pandemic, and the number of foreign inspections remained low last year, at 684 compared with 3,272 in 2019, according to agency data.

The F.D.A. has 4,000 overseas facilities to inspect, with about 20 percent in India; one of its six inspector positions in that country was vacant in late 2021, according to a report issued last year by the Government Accountability Office.

For over-the-counter drugs, the F.D.A. uses a system that essentially lists a medication recipe. Companies can make the products without express agency approval but are expected to follow agency rules for manufacturing quality products, said John Serio, a lawyer with Withers who has pharmaceutical clients.

“If you’re not out there inspecting facilities,” Mr. Serio said, “these sorts of problems will crop up because there’s no threat that if you’re out of compliance that the inspector will come knocking at your door.”

Dr. Vicente Diaz, the chief of ophthalmology at Yale Health Plan in Connecticut who specializes in infectious diseases, said the infections evading the “big gun” antibiotics had alarmed experts. He worries that if doctors use ineffective antibiotics for too long or wait to culture a bug, “that gives the bacteria more time to multiply and get more aggressive,” he said.

EzriCare drops do not contain preservatives, a fact that Dr. Diaz found troubling. He said he had never seen another reusable eye product without preservatives or other safety features to limit bacterial growth. Preservative-free drops usually come in single-use bottles, given the risk, he said.

“I’m surprised that formulation was allowed to go on the market without more scrutiny,” he said. “It’s kind of like the perfect storm.”

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Monogamy is frequently portrayed as the ideal form of romantic love in many modern societies. From the stories we read as children, to the films and books we consume as adults—we are told that to achieve happiness we need to find our one true soulmate to share the rest of our lives with.

At the same time, states and governments offer financial, legal, and social incentives to married couples. Meanwhile men and women who deviate from these monogamous norms are treated as pariahs and publicly shamed.

However, despite this, polyamorous relationships are on the rise. It is estimated that between 4% and 5% of the U.S. population is currently involved in consensually non-monogamous relationships.

Furthermore, in 2010 a study found that roughly one out of every 500 adults in the United States identified as polyamorous.

Time for reform?

Increasing numbers of legal and political scholars are arguing for reforms to current family laws so that they recognize the wide variety of intimate personal relationships in which humans can thrive.

"Polyamorists face the risk of being fired, denied housing or citizenship, or having their children taken away from them because of their polyamorous identities and lifestyles," says Justin Clardy, a professor of philosophy at Santa Clara University.

"However, in many cases poly relationships are more durable than monogamous ones, because their flexibility allows them to meet shifting needs over time in a way that monogamous relationships don't."

Professor Clardy has dedicated his academic career to studying the ethicality of non-monogamous relationship styles and the unjust political consequences faced by non-monogamists.

In his first book, Why It's OK to Not Be Monogamous, Clardy summarizes the main arguments that are commonly put forward to support monogamy. He then debunks each one with thorough research.

A moral debate

For example, there is a theory that humans evolved to be monogamous because human babies require greater care, as they are born at a younger gestational age than other mammals.

Professor Clardy explains, "Monogamy is therefore seen as the 'natural' order of things. However, many homosexual and heterosexual monogamous couples either do not want, or cannot have children, yet this doesn't exclude them from being able to marry, and enjoy the rights and privileges that come with marriage.

"Others may see monogamy as a moral command given by God, however, does this mean that atheists and agnostics are disqualified from romantic love, even if they find themselves in happy, healthy, and satisfying monogamous romantic relationships?"

Refocusing attention

One of the most common arguments against polyamory is that it incites painful feelings of jealousy, however monogamous couples experience this emotion too. In fact, Clardy argues that in many cases vulnerability, possessiveness, and a sense of entitlement to another person's love are more at the heart of jealousy then we care to admit.

Clardy argues that polyamory, on the other hand, can benefit relationships by refocusing our attention on how one's partner fares in their other intimate relationships.

"When governed by mutual consent and understanding, polyamorous relationships can allow people to share more fully in the happiness of others," says Clardy.

"This can be achieved by confronting and managing one's vulnerability, by softening our propensity to be jealous, and by learning to pay attention to the flourishing of others."

Different forms of family

Some of the harshest critics of polyamorists argue that non-monogamy is harmful to the family unit, leading to divorce and the breakdown of families. However according to Clardy, polyamorous families both exist and thrive, and such an arrangement can actually benefit children.

"It may not take an entire village to raise a child, but it stands to reason that all things being equal, having more than one 'father' or 'mother' as a caregiver may be even more conducive to meeting children's needs, as children may be loved and nurtured in unconventional families," says Clardy.

"Indeed, it may turn out that on average, the existence of more than two caregivers is the superior parenting arrangement."

'Othering' the unknown

In the final chapter of his book, Clardy argues that it is morally wrong to impose monogamy on society, and calls for the state to support polyamorous relationships as well as monogamous ones.

"Polyamorous relationships need support and protection that the state is uniquely able to provide and is best placed to carry out," argues Clardy.

"Just because a way of relating might deviate from well-established social norms like monogamy, this does not mean that they don't have considerable value—morally, socially, or politically."

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But these studies are flawed, a new evidence review asserts, and the potential health benefits of moderate alcohol use vanish when those flaws and biases are taken into account.

At best, a drink or two each day has no effect good or ill on a person's health, while three or more drinks daily significantly increase the risk of an early death, researchers report.

"Low-level or moderate drinking is roughly defined between one drink per week and two drinks per day. That's the amount of alcohol that many studies, if you look at them uncritically, suggest reduces your risk of dying prematurely," said co-researcher Tim Stockwell. He is former director of the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia.

But after adjusting for study flaws and biases, "the appearance of the benefit from moderate drinking greatly diminishes and, in some cases, vanishes altogether," Stockwell said.

A standard drink in the United States contains roughly 14 grams of pure alcohol, according to the U.S. National Institutes of Health. That equates to about 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

For this analysis, Stockwell and his colleagues evaluated 107 studies that assessed the relationship between alcohol use and death. These studies included nearly 5 million participants from multiple countries.

"This is an overview of a lot of really bad studies," Stockwell said. "There's a lot of confounding and bias in these studies, and our analysis illustrates that."

Former drinkers aren't lifetime abstainers

For example, many studies tend to place former drinkers in the same group as lifetime abstainers, referring to them all as "non-drinkers," Stockwell said.

But former drinkers typically have given up or cut down on alcohol because of health problems, Stockwell said. The new analysis found that former drinkers actually have a 22% higher risk of death compared to abstainers.

Their presence in the "non-drinker" group biases the results, creating the illusion that light daily drinking is healthy, Stockwell said.

For the new study, the researchers pooled the data and then made adjustments that took into account problems like the "former-drinker bias."

"We've put Band-Aids on all of these bad studies to try and explore how these different characteristics result in the appearance of health benefits," Stockwell said.

The combined adjusted data from the studies showed that neither occasional drinkers (less than 1.3 grams of alcohol, or one drink every two weeks) nor low-volume drinkers (up to 24 grams a day, or nearly two drinks) had a significantly reduced risk of death.

The researchers found a slight, but not significant, increased risk of death among those who imbibed 25 grams to 44 grams daily, around three drinks.

And there was a significantly increased risk of death for people who drank 45 or more grams of alcohol a day, the results showed.

The highest risk was among people who drink 65 grams of alcohol or more a day, or more than four drinks. Their risk of death was about 35% higher than occasional drinkers.

"There's this question about whether low-level drinking is beneficial, and I think I'd take this to mean that it's really not particularly beneficial," said Catherine Lesko, an assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, in Baltimore. "I don't know that it's harmful, very low-level drinking. But a lot of the results are reinforcing the harmful effects of even moderate to high level drinking."

The analysis also found that alcohol has a more dramatic effect at lower amounts on women's risk of death.

Women's increased risk of death from drinking consistently ran higher than the risk of men. For example, the increased risk of death for women who drink 65 grams or more daily was 61%, nearly double that of men drinking that much.

"Women experience alcohol differently than men because of biological factors. Even when drinking the same amount of alcohol, women will have higher blood alcohol levels, feel intoxicated more quickly and take longer to metabolize it," noted Pat Aussem. She is associate vice president of consumer clinical content development for the Partnership to End Addiction.

These results make sense given that alcohol use has been linked to at least 22 specific causes of death, Stockwell said.

Alcohol use increases the risk of liver disease, some cancers, stroke and heart disease, Stockwell said. It also contributes to injury deaths from accidents, car crashes, homicides and suicides.

Other studies that take into account genetics "confirm our conclusion that people who drink moderately aren't protected against heart disease or premature death. So our results are consistent with other studies using stronger design," Stockwell said.

Continuum of risk

Aussem said research has established a "continuum of risk" associated with weekly alcohol use, where the risk of harm is:

•     2 standard drinks or less a week—You are likely to avoid alcohol-related consequences for yourself or others at this level.

•     3 to 6 standard drinks a week—Your risk of developing several types of cancer, including breast and colon cancer, increases at this level.

•     7 standard drinks or more a week—Your risk of heart disease or stroke increases significantly at this level.

"Each additional standard drink radically increases the risk of alcohol-related consequences. These risks increase in lockstep with consumption as it is more difficult to repair the damage done to cell tissue in the body and brain," Aussem said.

"Simply put, less is better," she added. "Any steps to cut back can be helpful in terms of reducing the risks of alcohol-related cancers and cardiovascular disease."

The researchers pointed out some limitations to their work. Measurement of alcohol consumption was imperfect in most of the studies, they said, and self-reported alcohol consumption was probably underreported in many cases.

To more accurately assess alcohol's risks, future studies should look at specific drinking-related diseases and link them to specific groups, Stockwell said. For example, studies could examine the cancer risk posed by alcohol for men versus women.

The studies also would do better to use occasional drinkers as the reference group, because they tend to have more "normal" health characteristics than teetotalers, the researchers concluded.

The new evidence review was published online March 31 in JAMA Network Open.

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Over 700,000 people visit A&E in England and Wales because of chest pain. And they account for 25% of medical admissions to hospital.

These patients usually have varying symptoms, related complex health conditions, and are often on several medications. Assessing them is difficult. But it usually includes reviewing their medical history, taking a heart trace of the electrical activity of the heart (called an electrocardiogram), and taking a chest X-ray.

The electrocardiogram, or ECG, can show changes in the heart rhythm associated with a heart attack in about 50% of patients. The remainder do not show an altered rhythm and need further investigations. These include important blood tests.

One test is for a protein found in the heart cells called troponin. This protein plays a key role in making the muscle cells in the heart contract and relax. When cells are starved of oxygen due to a blockage in the arteries that supply blood to the heart, the cells start to die and release troponin into the blood supply.

The troponin can be measured in a hospital laboratory from a sample taken from a patient—normally from a vein in the crease of the elbow or from a catheter in the back of the hand. This test is repeated two or three hours after the patient is admitted.

A change in the amount of troponin in the blood can indicate a heart attack. This is especially useful for the patients who do not show any changes on the ECG.

How angioplasty works. Credit: Pepermpron/Shutterstock

Patients with a diagnosis of a heart attack need urgent treatment, normally by surgery where a catheter is fed into the blocked artery in the heart and a balloon is blown up to open the blockage. This procedure is called an angioplasty. In many cases a metal mesh tube called a stent is inserted along with the balloon. When the balloon is deflated the stent stays in place to keep the artery open.

But this troponin blood test requires someone to draw blood. It is common for people to have a fear of needles—needle phobia affects between 4% and 10% of the population. The anxiety and stress can make chest pain worse.

No blood sample required

The new wrist-worn device can measure troponin without taking a blood sample. This device is worn on the wrist like a smartwatch. It uses infrared light across the skin layers (transdermally) to detect troponin in the blood system.

A recent study, published in European Heart Journal—Digital Health, has shown this device can detect 90% of heart attacks within five minutes. "With this level of accuracy, if you use this device and it comes out positive, you're fairly sure this patient can be admitted for fast-tracking diagnostic tests, treatment and intervention," the study's lead author, Dr. Partho P. Sengupta, said.

If larger studies confirm these early findings, this revolutionary device for detecting troponin could prove useful for detecting heart attacks in GP surgeries, or for emergency services who first attend a patient with chest pain. It also means patients would not have to wait for blood samples to be sent to the laboratory, analyzed and results returned when they arrive at the hospital.

It is important that patients have a fully functional supply of blood to the heart as quickly as possible to stop more heart cells dying. As the saying in cardiology goes: time is muscle. This new wrist-worn device could speed up diagnosis and treatment of patients with chest pain.

The technology could also potentially be used for other tests to detect blood clots, ectopic pregnancy or sepsis. And it could be a lifeline for those people with severe needle phobia.

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NASA has today announced the four astronauts who will travel round the moon on the next Artemis mission. The joint project between NASA and the Canadian Space Agency will see three Americans and one Canadian taking flight.

The team will be made up of Americans Victor Glover, Christina Hammock Koch and Reid Wiseman, along with Canadian Jeremy Hanson. It includes the first woman and first person of colour who will eventually go on to step onto the surface of the moon itself.

An announcement was made at a media event at the NASA Johnson Space Center's Ellinton Field in Houston, Texas. People tuned in from around the world to watch the announcement.

The Artemis II mission will be the first crewed mission on NASA's path to establish a long-term presence at the moon for science and exploration.

Roles of crew members have also been announced. Reid Wiseman will be commander, Victor Glover as pilot, Christina Hammock Koch as mission specialist one and Jeremy Hansen as mission specialist two. The flight, expected to last around 10 days, will launch on the agency's Space Launch System rocket, prove the Orion spacecraft's life-support systems and also look into capabiulities and techniques necessary for humans to live and work in deep space.

The flight will set the stage for the first woman and first person of colour on the moon through the Artemis program. It's hoped this expedition will pave the way for future long-term human exploration missions to the moon, and eventually Mars.

 This combination of photos shows, from left, astronauts Victor Glover, Jeremy Hansen, Christina Koch, and Reid Wiseman.

( Image: Uncredited/AP/REX/Shutterstock)

Director of the Johnson Space Center, Vanessa Wyche, said: "For the first time in more than 50 years, these individuals- the Artemis II crew - will be the first humans to fly to the vicinity of the moon.

"Among the crew are the first woman, first person of colour, and first Canadian on a lunar mission, and all four astronauts will represent the best of humanity as they explore for the benefit of all.

"This mission paves the way for the expansion of human deep space exploration and presents new opportunities for scientific discoveries, commercial, industry and academic partnerships and the Artemis Generation."

Astronaut Christina Koch has taken a giant leap towards becoming the first woman on the moon after being named as part of NASA’s Artemis II mission. Koch will be making her second space flight with Artemis II, having served as an engineer aboard the space station for Expedition 59, 60, and 61.

 NASA astronaut Christina Koch ( Image:
NASA/ZUMA Wire/REX/Shutterstock)

 NASA astronauts Jessica Meir and Christina Koch in the hatch of the International Space Station and preparing to begin the historical first ever all female spacewalk

(Image:NASA/ZUMA Wire/REX/Shutterstock)

Koch also set the record for the longest single spaceflight by a woman, with a total of 328 days in space, and participated in the first all-female spacewalks. She was named as part of a four-person crew alongside fellow Americans Victor Glover and Reid Wiseman as well as Jeremy Hansen of the Canadian Space Agency.

Making the announcement, director of the flight operations directorate Norm Knight told Koch: “Your relentless drive is unmatched”.

Pilot Victor Glover could be the first person of colour to step foot on the moon, providing the Artemis II flight is successful and allows the project to progress. It will be his secod spaceflight, having previously spent 168 days in space as pilot on NASA's SpaceX Crew-1.

“This is a big day. We have a lot to celebrate and it’s so much more than the four names that have been announced,” said Glover.

 The stage is set for Victor Glover to become the first person of colour to step on the moon ( Image: @NASA)

The four were introduced during a televised ceremony from Houston, home to the nation's astronauts as well as Mission Control.

"This is humanity's crew," said NASA Administrator Bill Nelson.

Canadian astronaut Jeremy Hansen will be making his first flight into space. He was formerly a colonel in the Canadian Armed Forces and former fighter pilot. He was one of just two recruits selected by the Canadian Space Agency (CSA) in May 2009 through the third Canadian Astronaut Recruitment Campaign, and in 2017 became the first Canadian to be entrusted with leading a NASA astronaut class, leading the traning of astronaut candidates from the United States and Canada.

Artemis II will be the first of NASA’s new missions to the moon with astronauts aboard. It will not launch until November 2024 at the earliest.

The crew will travel around the moon and back to earth on a 10-day mission readying for Artemis III. They will not set foot on the satellite.

(Image: NASA – Johnson Space Center)

The announcement comes after the Artemis I mission was completed in December last year after making a 1.4 million mile journey around the moon. The 25-day mission was the first step of NASA's ambitious plan to establish a long-term presence on the moon.

Artemis II will be the first crewed mission aboard NASA's new Orion spacecraft and the first to launch on the agency's new heavy-lift rocket, the Space Launch System.

"With Artemis I, we set out to prove that the hardware was ready, that SLS was prepared to launch our astronauts skyward, that Orion was equipped to carry them to the moon and back safely again," said Knight.

"Artemis I was a resounding success, and Artemis II will leverage that by putting humans in the loop.”

It will be the first set of missions that NASA has used to send a crew to the moon since the Apollo 17 mission in December 1972. Artemis III plans to fly four astronauts to the moon in 2025 while Artemis IV plans to be the second lunar landing in 2027.

In addition to setting up a permanent base camp on the satellite, the program aims to be the gateway to eventual human missions to Mars.

"Under Artemis, we will explore the frontiers of space and push the boundaries of what's possible," said Vanessa Wyche, director of NASA's Johnson Space Center. "You may walk on the moon or be one of the many explorers who venture onward to Mars. We're all looking forward to you being a part of our mission."

During Apollo, NASA sent 24 astronauts to the moon from 1968 through 1972, only half landed. It means only 12 human beings, all men and no women, have ever walked on the moon.

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Also:  Nasa names first female and African American astronauts on a lunar mission

A new study identifies two of these tipping points in relation to the Greenland ice sheet (GIS), a 1.7-million-square-kilometer (660,200-square-mile) frozen expanse that's the second largest body of ice in the world after the Antarctic ice sheet.

Based on the latest models, releasing 1,000 gigatons of carbon into the atmosphere will completely melt the southern region of the ice sheet. Go up to 2,500 gigatons, and almost the entire ice sheet would be wiped away permanently.

As CO2 levels go up, the ice goes down. (Höning et al., Geophysical Research Letters, 2023)

Since human activities started having a noticeable impact on carbon emissions, we've already put 500 gigatons of carbon into the atmosphere – so we're already halfway to losing a large chunk of the GIS.

"The first tipping point is not far from today's climate conditions, so we're in danger of crossing it," says climate scientist Dennis Höning from the Potsdam Institute for Climate Impact Research in Germany.

"Once we start sliding, we will fall off this cliff and cannot climb back up."

The complex simulation used by the research team factored in all the key climate processes, and the factors that influence ice melt, including air temperature, water temperature, ocean current activity, and precipitation levels.

These are complex models to run because the variables change all the time. As the ice sheet melts, it sinks, which in turn exposes it to warmer air at lower altitudes, which further impacts the melting rate.

The study suggests that even sticking to the 1.5 °C (2.7 °F) temperature rise above pre-industrial levels mandated in the Paris climate agreement won't be enough to stop the GIS from going past the point where it can't fully recover.

We're looking at a long-term sea level rise of 1.8 meters (5.9 feet) with 1,000 gigatons of carbon pumped into the atmosphere and a huge 6.9 meter (22.6 feet) rise with 2,500 gigatons of carbon, the researchers report.

Sadly, we're showing no signs of slowing down.

"Most of the ice sheet melting won't occur in the next decade, but it won't be too long before we will not be able to work against it anymore," says Höning.

Between 2003 and 2016, we've already seen about 255 gigatons of ice lost from the GIS every year. In fact, a recent study suggested that ice melt in Greenland has been happening more rapidly than previously thought.

That, in turn, leads to sea level rise and a host of other issues. For example, the less ice coverage there is, the less sunlight gets reflected back into space, which means temperature rises accelerate even further.

The study is the latest in a long line of stark reminders that drastic action must be taken quickly to put the brakes on runaway climate change and global warming. Otherwise, the Greenland ice sheet won't be all we lose.

"We cannot continue carbon emissions at the same rate for much longer without risking crossing the tipping points," says Höning.

The research has been published in Geophysical Research Letters.

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People who are overweight are flocking to the drug Ozempic to slim down. Looming is an even more powerful weight-loss treatment.

The drug Mounjaro helped a typical person with obesity who weighed 230 pounds lose up to 50 pounds during a test period of nearly 17 months.

No anti-obesity drug has ever safely made such a difference. In the coming months, it is widely expected to get the go-ahead from U.S. health regulators to be prescribed for losing weight and keeping it off, and some patients are already using it unapproved for that purpose.

The advance of Mounjaro, which is already on the market to treat Type 2 diabetes, has excited doctors and patients who have been waiting decades for effective treatments, while helping turn its maker, Eli Lilly & Co., into the most valuable standalone pharmaceutical company in the U.S. with a market value of more than $300 billion.

It’s a product of Lilly’s recent, sometimes painful overhaul of how it develops drugs. After several costly drug failures, Lilly abandoned some of its long-held practices, including waiting for multiple committees to weigh in before advancing a drug. The company had also been prioritizing its existing successful drug franchises at all costs, sometimes at the expense of promising new treatments.

That now discarded approach would have stifled the development of Mounjaro. Some people inside Lilly discouraged pursuing the drug in the mid-2010s because it might compete with a Lilly product that was already selling well. Overriding these concerns, Lilly pushed its labs to move fast, pursue ambitious projects and worry less about the business ramifications, even if that would mean cannibalizing sales of high-selling products with years of lucrative patent protection left. Lilly scientists were able to chase Mounjaro, and they worked quickly.

“Every program we do, we look at what our competitors have done, who’s done it the fastest, and then we set a goal to go even faster,” said Daniel Skovronsky, Lilly’s chief scientific and medical officer. “Speed becomes our No. 1 incentive, which is hard because it’s a cultural change.”

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Despite nearly 60 years of research, there is still a lack of high certainty evidence on the effectiveness and safety of commonly used painkillers (analgesics) for short bouts of low back pain, finds an analysis of the evidence published by The BMJ.

The researchers say that until higher-quality trials comparing analgesics with each other are published, “clinicians and patients are advised to take a cautious approach to manage acute non-specific low back pain with analgesic medicines.”

Analgesics such as paracetamol, ibuprofen, and codeine are widely used to treat acute non-specific low back pain, defined as pain lasting less than six weeks. But evidence for their comparative effectiveness is limited.

To fill this knowledge gap, researchers trawled scientific databases for randomized controlled trials comparing analgesic medicines with another analgesic, placebo, or no treatment in patients reporting acute non-specific low back pain.

From an initial 124 relevant trials, they included 98 randomized controlled trials published between 1964 and 2021 in their analysis. These involved 15,134 participants aged 18 and over and 69 different medicines or combinations.

The trials included non-steroidal anti-inflammatory drugs, paracetamol, opioids, anti-convulsant drugs, muscle relaxants, and corticosteroids. The researchers assessed their risk of bias using a validated risk tool.

The main measures of interest were low back pain intensity at the end of treatment (on a 0-100 point scale) and safety (number of participants who reported any adverse event during treatment). The average pain intensity among participants at the start of each trial was 65 out of 100.

The researchers noted low or very low confidence in evidence for reduced pain intensity (around 25 points) after treatment with muscle relaxant tolperisone, anti-inflammatory drug aceclofenac plus muscle relaxant tizanidine, and the anti-convulsant drug pregabalin, compared with placebo. 

Very low confidence was also noted in evidence for large reductions in pain intensity (around 20 points) for four medicines, such as the muscle relaxant thiocolchicoside and anti-inflammatory drug ketoprofen, moderate reductions (10-20 points) for seven medicines, including anti-inflammatory drugs aceclofenac, etoricoxib and ketorolac, and small reductions (5-10 points) for three medicines including ibuprofen and paracetamol. 

Low or very low confidence evidence suggested no difference between the effects of several of these medications.

The researchers noted moderate to very low confidence evidence for increased adverse events, such as nausea, vomiting, drowsiness, dizziness, and headache, with tramadol, paracetamol plus sustained-release tramadol, baclofen, as well as paracetamol plus tramadol compared to placebo. Moderate to low confidence evidence also suggested that these medications could increase the risk of adverse events compared to other medications.

The study also found similar moderate to low confidence evidence for other secondary outcomes, including serious adverse events and discontinuation from treatment, as well as a secondary analysis of medication classes.

This was a comprehensive review based on a thorough literature search, but the researchers acknowledge that most included studies had concerns related to risk of bias which, alongside other limitations, may have influenced the findings.

“Our review of analgesic medicines for acute non-specific low back pain found considerable uncertainty around effects for pain intensity and safety,” they write. As such, they say clinicians and patients “are advised to take a cautious approach to the use of analgesic medicines.”

No further reviews are needed until high-quality studies are published, they add.

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Ella Balasa was 26 when she realized the routine medical treatments that sustained her were no longer working. The slender lab assistant had lived since childhood with the side effects of cystic fibrosis, an inherited disease that turns mucus in the lungs and other organs into a thick, sticky goo that gives pathogens a place to grow. To keep infections under control, she followed a regimen of swallowing and inhaling antibiotics—but by the beginning of 2019, an antibiotic-resistant bacterium lodged in her lungs was making her sicker than she had ever been. 

Balasa’s lung function was down to 18 percent. She was feverish and too feeble to lift her arms over her head. Even weeks of intravenous colistin, a brutal last-resort antibiotic, made no dent. With nothing to lose, she asked a lab at Yale University whether she could volunteer to receive the organisms they were researching: viruses that attack bacteria, known as bacteriophages.

That January, Balasa trundled to New Haven from her home in Virginia, burdened with both an oxygen concentrator and doubts over whether the treatment might work. Every day for a week, she breathed in a mist of viruses that biologist Benjamin Chan, scientific director at Yale’s Center for Phage Biology and Therapy, had isolated for their ability to attack Pseudomonas aeruginosa, the multi-drug-resistant bug clogging Balasa’s lungs.

And it worked. The viruses penetrated the goo, attacked the bacteria, and killed a portion of them; the rest of the bacteria weakened enough that antibiotics could knock them out. Balasa’s body cleared the life-threatening infection faster than ever before. 

Today, Balasa is 30; she continues to suffer from cystic fibrosis, but two more rounds of phages plus a change in medications have kept her from reliving the crisis that phage treatment quashed. Now she consults with companies developing cystic fibrosis drugs and works to bring visibility to new treatments, including phages. “I view them very much as a novel way of treating infections,” she says. “If I had not been able to access phages, who knows what my life would be at this point?” 

There’s an asterisk to her success: Phages are unapproved drugs, not just in the United States, but in the United Kingdom and Western Europe, too. No company makes them for commercial sale in those countries, and hospitals and pharmacies don’t stock them. To administer them, physicians must seek a compassionate-use authorization from a government regulator—in Balasa’s case, the US Food and Drug Administration—showing their patients have no other options.

That process is inefficient and inherently unfair, since it limits availability to people who are lucky and persistent and whose doctors have strong professional networks. Still, journal articles and accounts by investigators suggest that well over 100 patients in the US have received emergency phage treatments, mostly unpublicized. Researchers are confident that if phages were legally available, more lives could be saved.

And, at last, that could be the case. In 2021, the National Institutes of Health gave 12 US institutions $2.5 million to research phage therapies. Last year, the NIH launched its first federally funded clinical trial of the beneficial viruses, backing 16 centers to test safety and possible dosing levels against Pseudomonas, the pathogen that sickened Balasa. Other academic centers and private companies have launched roughly 20 trials in the US and about 30 in the UK and Europe. And in January, a committee of the UK Parliament launched an inquiry into whether phages could be brought to market there. 

A little more than a century after they were first used to cure an infection, it might finally be phages’ time. 

“I am hopeful that we have reached the stage where we can actually prosecute the case,” says Joe Campbell, a program officer at the National Institute of Allergy and Infectious Diseases who runs an internal interest group on phages. “We can move beyond the wonderful, but scientifically unsatisfying, patient stories into something that regulators can say is efficacious.”

To be fair, there are places where this would be old news. Phages pervade the natural world: There are possibly trillions of them distributed through every niche of the environment, each tuned by evolution to kill just one type of bacteria. And there are countries where doctors have been using them for decades. After World War I and a decade before the first recognition of antibiotics, a self-taught microbiologist named Félix d’Hérelle harnessed phages’ natural killing ability to cure dysentery in several children in Paris. By the 1930s, he had found a research home in what’s now the Republic of Georgia. After Stalinism closed the USSR off from Western Europe and the US, phage research quietly flourished there. 

It wasn’t until the USSR collapsed in 1991 that phage treatments came to the attention of countries with big research budgets, via atmospheric news accounts of funding-starved researchers jury-rigging equipment in the dark. That was good timing, because it was simultaneously becoming clear that antibiotics were losing their power against rising drug resistance. Globally, it’s estimated that 1.27 million people per year die from resistant infections.  The World Health Organization calls drug resistance a “silent pandemic” that could kill 10 million people per year by 2050. 

“As [resistance] concerns grow, there are not a lot of options out there,” says Graham Hatfull, a professor of biotechnology at the University of Pittsburgh, who maintains one of the largest phage collections in the US and researches their utility against mycobacteria, which cause diseases such as tuberculosis. “That’s really drawn focus to phages, because they seem to be one of the more promising aspects out there.”

In many ways, phages look like the solution to problems that beset antibiotics. They each kill only one type of bacteria, so they are less likely to disrupt microbiomes. They penetrate complex matrices that defeat antibiotics—not just the thick mucus caused by cystic fibrosis, but the thin films of organisms that develop on pacemakers and artificial joints. And they are unthinkably abundant, a refreshing change from an antibiotic pipeline that gets ever more narrow as companies search for novel ways to attack bacteria.  

“This is one of the challenges of the phage space right now: There are all these tantalizing little indications that maybe something good can come from this technology,” says Robert McBride, cofounder and CEO of Felix Biotechnology, which has been funded by the Cystic Fibrosis Foundation to develop a Pseudomonas phage that was identified at the Yale center. “And yet we still don’t have a rigorous, large, controlled, blinded set of data to support the general case.”

Assuming that phages can be put through trials the way antibiotics have poses questions the field can’t yet answer. Regulatory structures in the US, UK, and Europe ensure antibiotics’ safety and efficacy by evaluating them with well-established measures. Antibiotic chemistry has had more than 80 years, since the 1941 debut of penicillin, to answer basic questions about formulas, dosing, and timing: how fast a compound moves into particular tissues, for instance, or how slowly the body eliminates it. Phage research has barely begun to tackle them. 

Even achieving one successful trial won’t provide those answers. Because phages are so specific—narrow-spectrum, to use an antibiotic term—choosing the right one, and deciding how to administer it, will be different for sepsis, for a urinary tract infection, or for a heart valve cloaked in biofilm. And beyond determining formulas, there’s the formidable challenge of scale.

“When you’re dealing with an individual person’s infection, doctors have intimate knowledge of the case, and you can take the time to figure out how to pair these things optimally with antibiotics, and do different artisanal things,” says Paul Bollyky, an infectious disease physician and associate professor who leads a phage-research lab at Stanford University. “The boring, systematic, expensive work of figuring out how to optimally prepare and store and deliver these things hasn’t been done.”

The challenges of constructing trials to cover all these issues may mean that compassionate-use cases will dominate phage treatments for now. That doesn’t mean the field is stalled. Trials gather data from participants horizontally, so to speak, by examining the experience of many patients at the same time. But Paul Turner, an evolutionary biologist who directs the Yale center and is a scientific cofounder at Felix, points out that it’s also possible to learn by gathering data longitudinally from individuals, an approach used as far back at the HIV epidemic and deployed during Covid with the help of increasingly inexpensive sequencing. The Yale Center has treated roughly 50 patients under compassionate use so far, including Balasa, “and we are learning a lot from each of the individuals volunteering,” he says.

Whether a patient can get help at an academic center depends on which phages that institution has characterized and how rapidly other scientists can be recruited to help. Since its founding in mid-2018, UC San Diego’s Center for Innovative Phage Applications and Therapeutics has been contacted by 1,725 patients. The faculty there determined that 343 of them could benefit from phage therapy, but they were able to locate phages for only 140. (Due to clinical or bureaucratic barriers, only 56 were treated.) 

“Phage hunts” require spreadsheet searches, emails, and pleas on Twitter, and sometimes going out in the field to scoop up environmental samples as well. “It’s like having a million locks scattered around the world, and then having to match them to billions of keys,” says Steffanie Strathdee, an epidemiologist and the center’s codirector. Strathdee knows that search from the inside, because donated phages saved her husband, UCSD psychiatry professor Thomas Patterson, from a superbug infection in 2016.

When a key turns, though, it can open a door to wonders. In February, the Centers for Disease Control and Prevention reported that brands of artificial tears contaminated with extremely drug-resistant Pseudomonas had sickened 68 people, killing three and causing four others to lose an eye. The agency passed three bacterial samples to the UCSD center, which matched them to phages that could combat the infection. “Hopefully there won’t be more cases,” says Robert Schooley, a professor of medicine who is the center’s codirector. “But if there are, we can ship these phages and explain to physicians how to use them.”

That speaks to how important it will be to achieve unified, public phage libraries—a gap that currently is filled only by the volunteer nonprofit Phage.Directory, which lets clinicians send out international calls. A better solution would be philanthropic and federal funding resembling the kind of support that fueled the pandemic’s Operation Warp Speed—and that, decades ago, built up the then-new field of antibiotics. That would be appropriate, because modern phage research is an equally new field, and the economics of combating infection are more difficult than they were in 1941.

The researchers who built Phage.Directory—Jan Zheng and Jessica Sacher, currently working in Australia—were inspired to start it by a Twitter plea for phages launched by Strathdee in 2017. The search was on behalf of a 25-year-old cystic fibrosis patient named Mallory Smith, whose newly transplanted lungs had been taken over by a multi-drug-resistant bacterium called Burkholderia that she had been battling since she was 12. She received the right phages, but the infection had progressed too far. Smith died in November 2017, but an autopsy showed the phages had begun to control the bacteria. 

“They told us at the time that we were five years too early,” says Diane Shader Smith, Mallory’s mother, who guided her daughter’s story into being developed for a book and movie, and who now speaks internationally about antibiotic resistance and phage research. “Well, here it is five years later. And maybe things are happening now.”

In the War on Bacteria, It’s Time to Call in the Phages

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Hair analysis may hold the key to understanding adolescent drug use, as a recent study revealed that nearly double the number of children were found to have used substances than those who self-reported in a US survey. The study, published in the American Journal of Drug and Alcohol Abuse, analyzed over 1,300 children between the ages of 9 and 13, and showed a 9% rise in substance use when hair analysis results were combined with survey results.

The study indicates that hair analysis is a more accurate method of evaluating drug use than surveys alone and experts suggest that future substance use research should incorporate both techniques.

“It’s vital that we understand the factors that lead to drug use in teenagers so that we can design targeted health initiatives to prevent children from being exposed to drugs at a young age,” says Natasha Wade, an assistant professor of psychology at the University of California, San Diego, who led the study.

Adolescent substance use is a serious public health issue, with 5% of US 8th graders (ages 13–14) reporting cannabis use in the last year. The numbers are even higher for alcohol and nicotine use, with 26% of 8th graders admitting to drinking and 23% to smoking nicotine in the past year.

These numbers are worrying enough, as substance use during adolescence is linked to a whole host of negative life outcomes – including poor academic achievement, mental health problems, and changes in brain function.

But what if the figures are actually greater than this?

To find out a multidisciplinary team of experts, led by Dr. Wade, asked 1,390 children whether they had taken drugs in the last year. Hair samples were then also taken so that independent tests could confirm whether recent drug-taking had taken place.

Of the children who were asked if they had taken drugs, 10% agreed that they had. Hair analyses also showed that 10% of adolescents overall tested positive for at least one drug, with 6.1% testing positive for cannabinoids, 1.9% alcohol, 1.9% amphetamines, and 1.7% cocaine.

However, the children that self-reported drug-taking were not the same as those who tested positive through hair samples. In fact, of the 136 cases that self-reported any substance use and 145 whose hair samples were positive for any drug, matches were found for only 23 cases.

Most importantly, hair drug analysis revealed an additional 9% of substance use cases over and above self-report alone, nearly doubling the number of identified substance users to 19%.

“A long-standing issue in substance use research, particularly that relating to children and adolescents, is a reliance on self-reporting despite the known limitations to the methodology. When asked, children may misreport (unintentionally or intentionally) and say they take drugs when they don’t, or conversely deny taking drugs when they actually do,” Dr. Wade adds.

“But rather than scrapping self-reporting of drug use altogether, a more accurate picture of teenage substance use can be gained by measuring both. Self-reporting has its own strengths, for instance, young people may be more willing to disclose substance use at a low level but are less likely to when frequent drug-taking patterns emerge. Conversely, hair assays are not sensitive enough to detect only one standard drink of alcohol or smoking one cannabis joint. Instead, the method is better at detecting frequent and moderate to heavy drug use. Combining both methodologies is therefore vital to accurately determine the levels of substance use in the teenage population.”

Commenting on the findings of their paper, the authors also add however, that it is important to note that there is a chance that some, perhaps even many, of these youth are unaware that they even used a substance, as it could have been given to them by a parent or peer or they may have simply forgotten they had used it.

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A passenger aircraft that flies around the world at Mach 9? Sure, why not

Renowned photojournalist Thierry Falise recently returned from a month in Myanmar’s Kayah state, a front line in the nation’s raging civil war. This is the second article of a two-part series. Read part 1 here.

KAYAH, Myanmar – Thoo Rey’s body lies under a foil blanket in a field hospital. The 24-year-old Karenni man’s open eyes and mouth reflect the stupefaction that only a brutal and unexpected death can bring.

His killing was precisely that. Two hours before, he was walking in his abandoned village in Kayah state’s Demoso district to fetch personal belongings when shrapnel from a mortar launched a few kilometers away by the Myanmar Army hit him fatally in the neck.

His name is now among the estimated 3,000 civilians killed by Myanmar security forces since the February 1, 2021, democracy-suspending coup. Before his death, Thoo Rey was among the countless internally displaced people (IDPs) who have fled their villages and moved to more secure ground mostly in forest and hill areas across civil war-wracked Kayah state.  

The body of Htoo Rey, a 24-year-old ethnic Karenni, lies under a foil blanket in a field hospital. The young man was killed by shrapnel from a mortar fired by the Myanmar military while returning to his abandoned village to pick up personal effects. Photo: Thierry Falise

Free Burma Rangers, the only foreign relief group to work with IDP communities from inside Kayah, estimates the state’s number of IDPs at 300,000. In the two years since the coup, hundreds of villages and hamlets have been deserted by their inhabitants, FBR says.

The IDPs have fled mortars and airstrikes, the proximity of fighting and the sinister threat of the Myanmar army’s imminent arrival in their villages. The army has destroyed and burnt down more than 1,100 houses since the coup, according to the Karenni Human Rights Group (KHRG), an independent rights monitoring group.

Soon after this correspondent’s trip, the Myanmar military launched a new offensive in a visited area in which 22 villagers, including three Buddhist monks, were massacred in southern Shan state near Kayah state’s border. 

Wandering through these ghost villages, it is clear that people had only enough time to lock their doors and close their front gardens with bamboo barriers before fleeing. Forgotten drying cloths hang covered in dust while bananas are left to rot on thirsty trees. All around, unattended rice fields are overrun by wild cacti and other invasive vegetation.

Traces of Myanmar military mortars and airstrikes testify to the junta’s civilian-targeting violence. At an intersection on a road close to Demoso, a woman shows a crater left the previous night by a mortar that landed on a volleyball court just a dozen meters from an IDP makeshift market.

“They launched five bombs, including one from a drone. Two people were injured, one badly, who was transported to Luke Hospital (a field facility run by the resistance in the jungle). Nowhere is safe for us,” she laments.

The Myanmar military, or Tatmadaw, has put a particular target on Christian minority places of worship. In Daw Ngay Khu, a village in Hpruso township, stands the bombed and burnt-out remains of a church named St Matthew’s.

A jumble of twisted corrugated plates and steel beams litter a floor surrounded by naked walls on the brink of collapse. Somehow, the bell tower and its cross remain intact. In another region further south, bombs and gunfire from a Myanmar military airplane have reduced a Catholic chapel to rubble.

The remnants of a Catholic church in Kayah state that was destroyed by a Myanmar military airstrike. Photo: Thierry Falise

IDPs are omnipresent across Kayah state. In nearly every valley, along every road and in every forest on the side of every hill visited by this correspondent, green tarpaulins labeled “Made in Korea” serve as roofs for makeshift bamboo houses and huts.

One of these IDP communities has settled along the Pawn River, in the state’s center. Here, around 900 civilians, mostly farmers from Loikaw, Kayah state’s capital district, are split into four “sub-camps.”

“We have made the long way in vehicles, ours or rented, a year ago,” explains Byar Reh, a 63-year-old man who is chief of Camp 4. “Before the coup, we had a lot of freedom, we were happy.”

Apart from the precious water from the river, this area, a dramatically dry plateau, lacks the resources for basic survival. “Here the soil is very poor, the only crop that grows is sesame. We have to pay a rent to the land’s owner, we send the production to Loikaw,” he adds.

“Life is very difficult,” confirms Boe Mya, a 35-year-old widow with six children. “In my village, I grew rice and raised cattle. Here for the food we have to rely on other people.”

In other communities, IDPs have managed to organize a basic economy. “People grow vegetables, raise pigs and chicken, fetch woodfire that they sell to each other but it’s still very limited”, comments a community leader.

Schools, clinics and other services such as water supply are provided by local opposition groups, mainly the Karenni National Progressive Party (KNPP) and Karenni Nationalities Defense Force (KNDF). Sometimes, when the security situation allows, families return to their abandoned homes to tend a field or care for their cattle.

“It can be very risky, Burmese [Myanmar] soldiers plant landmines in the villages and if they see you, they will capture and kill you,” says camp leader Byar Reh. “I know a family of five who had returned to their home, they were spotted and caught. The father and son-in-law were killed; the mother, daughter and grandchild were released later.”

People sit in front of a makeshift house in an Internally Displaced People (IDP) settlement erected in a narrow valley. Since the February 1, 2021, military coup, between 200,000 and 300,000 people have fled their homes in Kayah state. Photo: Thierry Falise

Tensions can also rise between IDPs and neighboring villagers. Although there is a strong tradition of mutual assistance in these ethnic territories, sometimes competition for resources – water, food, wood – erupts into conflict. “There are cases where villages have asked IDPs to move to other locations,” acknowledges a Karenni leader. 

It does not help that IDPs get very little aid from outside. United Nations agencies and big international nongovernmental organizations (INGOs) are conspicuous by their absence. (Sporadic aid in 2022 from Save The Children and World Vision were mentioned by some IDPs).

Material assistance is essentially provided by a handful of local NGOs and the FBR, a Christian-led multi-ethnic humanitarian service movement founded in 1997 and financed mostly by Christian private donors from the US.

FBR provides education for administering basic medical assistance, media reporting and other humanitarian functions and is staffed mostly by young volunteers. They come mostly from ethnic minority armed groups, but since the coup, the FBR has taken in Bamar (Myanmar’s ethnic majority) members from the Civil Disobedience Movement (CDM) and other opposition groups.

“Amongst the 250 graduates in 2022, there were almost 40 Bamar ethnics. This is the very first time, it’s encouraging”, says David Eubank, a 62-year-old former US Army Special Forces soldier who serves as FBR’s founder and director.

After a two-month training in a camp near the Thai border, teams of “Rangers” – as they call themselves – are sent all over the country to assist displaced and oppressed populations.

In Kayah state, FBR teams move from camp to camp to offer material and moral help to IDPs, including medical consultations where medics examine patients and deliver basic treatment and medicine, distribute food, blankets and other emergency equipment.

A medic member of the Free Burma Rangers gives a tooth filling to a man from an Internally Displaced People (IDP) settlement. Photo: Thierry Falise

and perform the Good Life Club (GLC), three-hour entertainment shows aimed at children involving theater plays, games, songs and raising health awareness skits that end with the distribution of cloths and candies.

“In two years, only in Kayah state, we have provided at least 12,000 tarpaulins, food and other material assistance to IDPs and helped to evacuate 100,000 of them with our own vehicles or by providing gas,” adds Eubank.

As for GLC programs, “they bring hope and love, tools for an abundant life, body and soul, we want to give the kids some tools, spiritually to have courage and hope, physically to understand sickness and health and be strong bodies”, says 54-year-old Karen Eubank, David’s wife and GLC’s creator.

At the same time, FBR members often face extreme danger on the frontline. FBR medics provide first aid to casualties – they have saved lives by amputating injured soldiers and civilians in the field – while media-trained staff document ongoing situations and send reports to the outside world. Since the coup, 18 Rangers have lost their lives due to Myanmar military fire.

Aung Zay Ya is one of the leading GLC hosts, a “career change” he says he would have never imagined. Before the coup, the 26-year-old Burmese citizen of Chinese origin was making a comfortable living as a mechanical engineer in a Yangon company equipping Ferrari and Lamborghini for wealthy Burmese.

“Two weeks before the coup, I had signed a seven-year contract with my boss that was going to send me to Singapore to complete my degree and then come back to Myanmar to work. Then the coup came. I was not really interested in politics, but the killing of young protestors in Yangon pushed me to join the underground movement,” he says.

A medical consultation is set up in a narrow valley near an Internally Displaced People (IDP) settlement by the Free Burma Rangers. Photo: Thierry Falise

After months of wandering from place to place, he landed in a FBR training camp where his talent was spotted and nurtured. “This is my revolution,” he adds. “At the beginning, I only wanted to win, but now I don’t care about winning or losing, I only want to help the people.”

Other young revolutionaries tell similar tales. Doris, a 25-year-old female Karenni, had an international sporting career before joining the youth revolution. In 2013, at the age of 16, she won a bronze medal in the 800-meter competition at the Southeast Asia Games.

“Before the coup,” she smiles, “I was a professional athlete within a military federation. After, I joined the KNDF and then a FBR training. As a FBR Ranger, I can serve everything, evacuate the injured and help the medics on the frontline, participate in GLC programs.”

FBR also provides financial assistance to individual projects such as the Nway Oo Guru Lay Myar social welfare group founded by Khin Sandar Nyunt, a 35-year-old Bamar anthropologist from Yangon. The group’s flagship project is an alternative education center built on a Pawn River bank.

“I want a revolution not only on the battlefield but also in education,” she says. “Here, in one year, our 18 teachers – full and part-time – have already given an alternative curriculum in Karenni and English languages to more than 165 young students. We teach them organic farming, music, arts and crafts. At the beginning, I was upset but now I have hope, I believe that it will take two or three more years for the revolution to succeed.”

Within IDP communities, the Myanmar junta’s official justification for their brutal campaign against civilians – fighting “terrorist groups” threatening the country’s unity – is a tired refrain that lacks credibility.

Free Burma Rangers members perform at a Good Life Club (GLC) session, a three-hour entertainment show mainly aimed at the children, in an Internally Displaced People (IDP) settlement. Photo: Thierry Falise

Wisaysha, a 43-year-old Karenni woman, found shelter in an IDP camp last year after her husband and two other men were stabbed to death by Myanmar soldiers and thrown into a latrine while returning to their village to retrieve belongings. “I don’t know why they do that,” she cries. “They are hungry with power, they just want to oppress the people.”

Indeed, the future is still bleak for Kayah state’s IDPs. As long as the Myanmar military stays on the offensive and maintains its threats against civilians, there is little chance they will return to their villages any time soon.

Boe Mya, the widow from the Pawn River IDP settlement is under no illusions: “We hope to return, but the Burmese [military] have the power and we disagree with them, so…”

Theirry Falise is a long-time photojournalist based in Bangkok, Thailand. The text and photos in this report are his copyright and may not be reproduced in any form without his express permission.

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