Health – Happiness – Page 162

‘There’s No Spring Break Here’: Florida’s Gulf Coast Fights to Rebound After Hurricane Ian

The New York Times

‘There’s No Spring Break Here’: Florida’s Gulf Coast Fights to Rebound After Hurricane Ian

Shannon Sims – February 14, 2023

Al Marti, 80, watches the waves roll in on a Sanibel beach as work continues to rebuild the area's infrastructure devastated by Hurricane Ian, on Sanibel Island, Fla., Feb. 9, 2023. (Scott McIntyre/The New York Times) — Al Marti, 80, watches the waves roll in on a Sanibel beach as work continues to rebuild the area’s infrastructure devastated by Hurricane Ian, on Sanibel Island, Fla., Feb. 9, 2023. (Scott McIntyre/The New York Times)

On Sept. 28, Hurricane Ian made landfall on Cayo Costa, a barrier island northwest of Cape Coral and Fort Myers, Florida, as a Category 4 storm with sustained winds of more than 150 mph. Killing 149 people in Florida, it was the state’s deadliest hurricane since 1935. More than four months later, the storm’s extraordinary power remains evident: In Fort Myers Beach, multistory oceanfront apartment buildings are still just piles of twisted steel and concrete rubble, and massive shrimping boats sit tilted and smashed together like toys in the corner of a tub.

The storm’s wrath extended up and down the west coast of Florida. But Sanibel Island, one of the area’s most popular vacation destinations, was hit especially hard. The fish-hook-shaped barrier island, some 12 miles long and 3 miles across at its widest, was devastated. Even the causeway that connects it to the mainland was partly destroyed.

On a recent afternoon, sitting at a table outside the Sanibel Grill, which roof and water damage kept closed for months, the mayor of Sanibel, Holly Smith, 61, was blunt. “There’s no spring break here,” she said. “As far as the recovery of tourism, we have a long way to go.”

Smith said that during the storm, the island had “a complete washover” — the 12-foot storm surge covered everything.

Beth Sharer, 66, a homeowner on the island, said when she went back to her ravaged condo, she couldn’t find the high-water mark that flooding usually leaves. “And then I realized there wasn’t one: The water was higher than the entire apartment,” she said.

When Smith visited the island with Gov. Ron DeSantis in the days after the storm, the area looked like a war zone, she said. “It was like ‘Mad Max,’ with dirt across the roads.”

Fears of Becoming a ‘New Miami’

Before the hurricane, Sanibel and Captiva, a smaller island connected to the north of Sanibel by a short bridge, offered an estimated 2,800 lodging units, including hotel rooms and short-term rentals, according to the Sanibel & Captiva Islands Chamber of Commerce. Today there are just 155 available, the chamber said. “We’ve changed our communication strategy from promoting the island to helping manage guest expectations for the next 12 months,” said John Lai, CEO of the chamber, which is now encouraging visitors to sign up for “voluntourism” options like helping to clear trails at the nature reserve or clean debris from the beaches.

By comparison, Fort Myers Beach had 2,384 hotel rooms before the storm, according to the Lee County government. In the wake of the storm, none of those rooms were open. As of this month, 360 of those rooms were available — just 15% of prehurricane inventory.

Before the hurricane, JPS Vacation Rentals, a local agency, had 32 properties available in Fort Myers Beach, said Heidi Jungwirth, the owner. Seven of those remain standing, but all were damaged, and none are currently rentable, she said. She has turned her office into a distribution center for donations. Distinctive Beach Rentals, which used to be the largest vacation management company in Fort Myers Beach, with 400 properties, saw 380 of those units “wiped out,” said Tom Holevas, the area manager, adding that the company has now pivoted to offering more inland rentals.

At the Lighthouse Resort’s Tiki Bar & Grill, where today the bathroom doors are shower curtains and the kitchen consists of a grill behind the outdoor bar, Betsy Anderson, 50, expressed concern about the area’s future. She owns an apartment in Cape Coral, just inland from the beach, that she rents via Airbnb. She said she had several guests cancel after the storm because the beaches were closed, and she is currently renting to a couple fixing up their own flooded house on Sanibel.

She worries that the storm will accelerate change. “We don’t think it can come back,” she said, referring to the area’s laid-back character and “old Florida” style. “Now people are saying big investors are going to come in with big money and turn this into the new Miami.”

Reviving an Economic Lifeline

On Sanibel, the push to rebuild began early, in part because the island draws so many visitors from across the country to its famous shelling beaches. A temporary causeway opened less than two weeks after the storm, allowing a convoy of electrical companies’ cherry picker trucks to reach the island. On Oct. 19, the bridges — one lane in each direction, with reduced speed limits — were opened to residents. For the rest of 2022, piece by piece, the area started to come back online.

“This place is on a lot of people’s bucket lists,” said Smith, alluding to visitors who “just want a shell from Sanibel.” But it will be at least a year before the island can accommodate tourists in any numbers, she said.

It doesn’t help that the island’s beaches are currently suffering from Florida’s persistent red tide, which is caused by a higher-than-normal level of microscopic algae that produce toxins in the water, turning it a rusty brown color and killing fish. The tide can significantly affect visitors’ experiences, aggravating respiratory problems, leaving beaches littered with rotting sea life and discouraging time spent near the water.

Still, residents and businesses are trudging toward getting tourists — their economic lifeline — back to the shore.

In just the past month, the first hotel rooms reopened for visitors at Sanibel’s Island Inn and the ’Tween Waters Resort & Spa on Captiva Island.

Some restaurants that were only lightly damaged have reopened quickly. Others are now operating out of food trucks. Some shops are back open, too, and many outdoor activities are once again available: renting kayaks and stand-up paddleboards or chartering fishing boats.

In early February, the first wedding since the storm was held at ’Tween Waters; the Bailey-Matthews National Shell Museum reopened with limited hours; and the doomsday-ish electronic sign that met visitors as they came off the bridge into Sanibel — “ALL SANIBEL BEACHES CLOSED” — was turned off, as the first beaches were officially reopened to the public. There is a sense on the island now that the wheels of tourism are finally beginning to turn.

Still, many hotels, restaurants and businesses that cater to tourists are a long way from reopening their doors. Some, like Sanibel Inn, are essentially starting from scratch, their buildings in ruins.

That’s why businesses are handing visitors the most useful item a tourist can pick up in Sanibel today: a printed list of what’s open, where and when.

‘It Breaks Your Heart’

For now, a visit to the area is more a pledge of support than a vacation.

On a sunny day in early February, Lisa Taussig of Overland Park, Kansas, and Christy, her adult daughter, were among the few tourists on the beach in front of the Island Inn, where they were staying. They come to the island about three times a year, Taussig said, and this year is no different. “After the storm passed, we just said, ‘You know what? We’re going to come down here and support Sanibel,’” she said.

“You feel welcome here,” she added, before turning and gesturing to the series of plywood-covered, battered condo buildings behind her. “Now it feels isolated, and there aren’t the lush trees that are usually here.

“It breaks your heart,” she said.

In Fort Myers Beach, residents still pick up their mail at a trailer. Glass, nails and unidentifiable twisted debris remain scattered along the ground. Around town, many flags, bumper stickers and T-shirts are emblazoned with “FMB STRONG.”

On a recent Saturday, a tiny spot called the Beach Bar was packed with a crowd of locals who looked storm-weary but exuded an ornery refusal to retreat. Even before the storm, the bar’s physical structure — right off Estero Boulevard, the beach strip that’s historically packed with visitors cruising in top-down vehicles — didn’t amount to much: It was a two-story, open-air wooden building facing the water. Now only the concrete slab remains.

But that hasn’t stopped the regulars. The crowd showed up with beach chairs and coolers, which they set up on the concrete. “They’re operating right now with a trailer, two outhouses and a band,” said Randy Deutsch, 72, from Chicago, who said he’d been coming to the bar since 1972.

“Our concept didn’t change,” said Matt Faller, the manager. “Cold beer, live music, toes in the sand.”

After their genitals were cut, some women search for healing

Associated Press

After their genitals were cut, some women search for healing

Mariam Fam – February 13, 2023

A 34-year-old Egyptian woman, who asked to be identified as N.S., visits a garden in Cairo, Egypt, Sept. 29, 2022. She remembers it all: How female relatives held her down when she was 11, legs spread and genitals exposed. The fear that stiffened her body. The stranger in black holding the scissors. And the pain. “I had a feeling of being incomplete and that I will never feel happy because of this,” she said. “It’s a horrible feeling.” (AP Photo/Amr Nabil)

A 34-year-old Egyptian woman, who asked to be identified as N.S., holds a flower as she visits a garden in Cairo, Egypt, Sept. 29, 2022. N.S. has been on a journey to heal from physical and psychological scars after female genital cutting when she was a child. “I had a feeling of being incomplete and that I will never feel happy because of this,” she said. “It’s a horrible feeling.” (AP Photo/Amr Nabil)

Dr. Reham Awwad, a surgeon and co-founder of Restore FGM, explains surgeries performed at her clinic for women suffering from the consequences of genital cutting, in Cairo, Egypt, Sept. 25, 2022. Awwad says many patients’ initial visits are emotional. “One of the first things they’ll say is, ‘I’ve never spoken about this to anybody.’” (AP Photo/Amr Nabil)

CAIRO (AP) — She remembers it all: How female relatives held her down when she was 11, legs spread and genitals exposed. The fear that stiffened her body. The stranger in black holding the scissors. And the pain.

Like so many others, the 34-year-old Egyptian woman has lived with the psychological and physical repercussions of that day, when she was subjected to a practice many activists call “mutilation.”

For N.S., who asked to be identified only by her initials to discuss the sensitive topic, the trauma continuing into adulthood was accompanied by a desire to reclaim control over her health and body.

“I had a feeling of being incomplete and that I will never feel happy because of this,” she said. “It’s a horrible feeling.”

A global target aims to eradicate the deeply entrenched practice by 2030, and protect the next generations of girls, though campaigners acknowledge the difficulties in achieving that. The United Nations has designated an International Day of Zero Tolerance for Female Genital Mutilation, or FGM, observed every Feb. 6.

Meanwhile, some women living with the consequences have embarked on deeply personal journeys to heal. They search for answers, sometimes scouring the Internet, amid treatment gaps in many countries, or shame and possible related sexual complications.

Prevalent in parts of Africa, the Middle East and Asia, cutting has been performed in communities of different cultures and faiths. It can be viewed as a rite of passage or linked to beliefs about chastity or femininity and cleanliness, and be fueled from generation-to-generation by social pressure.

“It’s an entrenched social norm and really deeply rooted in cultural beliefs and sometimes in religious beliefs,” said Nafissatou Diop, an official with the United Nations Population Fund. “So to be able to make any change, people need to be convinced that this is not threatening their culture.”

It’s estimated that at least 200 million women and girls are living with the aftermath of the practice, which can include partial or total removal of their external female genitalia and can cause excessive bleeding and even death. Long term, it can lead to urinary tract infections, menstrual problems, pain, decreased sexual satisfaction and childbirth complications, as well as depression, low self-esteem and post-traumatic stress disorder.

Some faith leaders have worked to eliminate the practice, while others condone it. In Egypt, where genital cutting has been widespread but illegal since 2008, top Islamic authorities condemn the practice. In online edicts or television appearances, they cite medical evidence of its harms and say it’s a custom with no sound religious basis. Still, there’s opposition to the bans in Egypt and elsewhere.

Besides resistance from some religious leaders and other “traditional gatekeepers,” Diop said the campaign to change minds is hindered by limited funding, lack of political will from some governments and a perception that ending cutting reflects a “Western-led agenda.”

Meanwhile, some women suffering the aftereffects post anonymously online in the quest for healing. They express feelings of distress, discomfort in their own skin, embarrassment or fears that being cut could stop them from getting married or condemn their marriages to failure. Some want information on medical procedures.

Some considering medical interventions have found specialized treatment, including in the United States and Europe, where opposition to the practice is longstanding. But in many countries, options can be scarce or too costly.

“There are so many treatment gaps in a lot of countries where FGM is really widely practiced,” said Christina Pallitto, a scientist leading the work on FGM at the World Health Organization. “A lot of health care providers receive no training at all.”

N.S. turned to a private clinic in Egypt, Restore FGM, that opened in 2020 and has promoted treatments on Instagram and other social media.

Dr. Reham Awwad, a plastic surgeon and clinic co-founder, said many patients’ initial visits are emotional. “One of the first things they’ll say is, ‘I’ve never spoken about this to anybody,’” she said.

The clinic, which also attracts clients from Sudan and elsewhere, offers surgical and non-surgical therapies. Psychological therapy is recommended, but many don’t pursue it, Awwad said.

N.S. has struggled with anger at her parents and low self-confidence. She’s wrestled with sensitive questions: Will sex hurt? Will cutting lead to sexual problems in a marriage? What about pregnancy and childbirth? She struggled with pain and difficulty reaching orgasm.

At Restore FGM, she opted for “reconstruction” surgery to remove scar tissue, expose uncut parts of the clitoris and make that more accessible. But some experts view the procedure with caution.

Surgeons who back it say it can improve function and appearance, and reduce pain. Others, including the WHO, call for more research and say there isn’t adequate evidence to assess benefits, possible complications or long-term outcomes.

“We don’t have a recommendation in favor of that at this moment because of the lack of evidence on the safety and the efficacy,” said WHO’s Pallitto. “Any woman who has clitoral reconstruction should be offered sexual health counseling in conjunction with it.” Neither the procedure nor such counseling is widely available in high prevalence countries, she added.

It’s been more than a year since N.S. underwent the surgery. After treatment for post-surgery bruising, she’s feeling better. “I no longer feel pain,” she said. “Sensation has also improved a lot.”

But her journey isn’t over. “I still need to work on accepting myself, accepting that this has happened to me and that it has been treated,” she said. “The operation on its own is not enough. … I don’t feel like I am completely over the trauma and I still struggle with the idea of physical touch.”

She wants to pursue psychological therapy but says she can’t afford it and worries about finding someone she can trust with such intimate details.

Basma Kamel recalled bleeding badly days after getting cut — at the hands of a doctor — when she was 9. For a long time, the 30-year-old Egyptian couldn’t trust her mother. Eventually, she concluded her mother didn’t know better and didn’t mean to hurt her. But feelings of being “different” lingered.

After moving from Egypt to England, she started looking for answers and turned to an FGM clinic and charity group for talk therapy. She’s made progress, but her self-acceptance work is ongoing.

“The goal is to find peace with myself and accept my body and accept that I am a normal person,” she said. “Even if I have, like, a missing part from my body, I’m still a normal woman.”

Dr. Jasmine Abdulcadir, a gynecologist at Geneva University Hospitals, treats women, mostly from East and West Africa, who underwent genital cutting.

The women have options for medical intervention, including a procedure to re-open a narrowed vaginal opening to help with everything from urination and menstruation to natural childbirth.

Clitoral reconstruction surgery also is an option. Abdulcadir said the procedure for that includes meeting with a psychologist, who is also a trauma-trained sex therapist, and making sure patients are prepared if the surgery ends up being mentally triggering.

She said some patients said they felt “born again” post-surgery, which she attributes to her practice’s holistic approach.

“What is very important is that you are not just focusing on the clitoris,” Abdulcadir said. “It’s really the health of the person.”

N.S. has yet to tell her family about her surgery. One day she might; she especially wants to tell her sister who was cut the same day she was.

But she does speak up when she can.

She threatened to call the police on learning some relatives were considering genital cutting for their daughters even though the practice is outlawed in Egypt.

“I didn’t want anyone else to be tormented like I was,” she said. “Someone must put their foot down and say: ‘Enough.’”

Deepti Hajela in New York contributed.

Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.

Natural disasters, boosted by climate change, displaced millions of people in U.S. in 2022

NBC News

Natural disasters, boosted by climate change, displaced millions of people in U.S. in 2022

Lucas Thompson – February 12, 2023

Natural disasters forced an estimated 3.4 million people in the U.S. to leave their homes in 2022, according to Census Bureau data collected earlier this year, underscoring how climate-related weather events are already changing American communities.

The overwhelming majority of these people were uprooted by hurricanes, followed by floods, then fires and tornados. Nearly 40% returned to their homes within a week. Nearly 16% have not returned home (and may never do so), and 12% were evacuated for more than six months.

The Census Bureau count is based on 68,504 responses it received as part of the Household Pulse Survey conducted Jan. 4-Jan. 16. The data collection is one of the few federal efforts to track displaced people, starting only in 2020. The bureau does note that the data is “experimental,” and is extrapolated based on its sample data.

“These numbers are very distressing,” said Michael Gerrard, director of the Sabin Center for Climate Change Law at Columbia University, who was not involved in the data collection. “These numbers are what one would expect to find in a developing country. It’s appalling to see them in the United States. … They’re only going to get worse in the years to come because climate change is making extreme weather events more frequent and more severe.”

Some states experienced far more of an impact than others. Florida had more than 888,000 people displaced. Louisiana had more than 368,000 displaced.

The U.S. was hit by a series of major disasters in 2022. The National Oceanic and Atmospheric Administration said that 18 extreme weather events had each caused at least $1 billion in damage. Climate experts have warned for years to expect more intense weather disasters as global temperatures rise.

The Census Bureau estimate, almost 1.4% of the U.S. adult population, is higher than other estimates. Data from the Internal Displacement Monitoring Center, part of the humanitarian organization The Norwegian Refugee Council, previously estimated that disasters displaced an average of 800,000 U.S. residents a year from 2008 through 2021.

“The United States is not in the least prepared for this,” Garrard said. “Our settlement patterns have not reflected the emerging risks of climate change to the habitability of some parts of the country.”

The data showed that the more than half a million people who never returned home experienced multiple hardships, including lack of housing, food, water, sanitation and child care.

“These are all things that we take for granted in a modern society,” Gerrard added. “Its absence is deeply disruptive to physical and emotional health as well as to child development.”

The data also showed disparities between people of different economic status, race and identities. Those earning less than $25,000 a year had the highest evacuation rate of any economic group, and Black and Hispanic residents had slightly higher evacuation rates than white residents.

According to the data, adults who identify as LGBTQ were disproportionately affected — 4% of LGBTQIA+ adults had to leave their homes compared with 1.2% of straight, cisgender people.

“It’s important to note that a lot of these individuals that are LGBTQ are often also considered to be socially vulnerable, and really putting a strong intersectional lens to disaster response preparedness and recovery,” said Michael Méndez, a professor of environmental policy and planning at the University of California, Irvine.

“Much of the LGBT community that’s vulnerable, and most socially vulnerable to disasters, are those that are African American, transgender and low income,” he said. “Oftentimes, that’s why they’re rendered invisible in the context of disaster policy and planning and preparedness. People write them off as not needing to provide extra resources for this community.”

Imperial Valley has made enough sacrifices already in the water rights war

Palm Springs Desert Sun

Imperial Valley has made enough sacrifices already in the water rights war

Craig William Morgan – February 12, 2023

There is an old saying in the water world that it is better to be upstream with a shovel than downstream with a law book, which is the position California finds itself in as it stands apart from its neighbors on the Colorado River in negotiations over the use of the river’s water.

On Jan. 31, representatives for the six other basin states submitted a proposal to the Bureau of Reclamation describing the measures by which the supply deficit on the Colorado River should be closed in the near term. Not surprisingly, the other basin states have asked that California reduce its water use beyond that which the state had previously proposed last fall. California was right to decline its neighbors’ new proposal notwithstanding its position on the river.

As many readers know, California water users have priority rights to Colorado River water that allow them to receive water first in times of drought. These rights are derived under the appropriative rights doctrine known as “first in time, first in right” that has been a mainstay of western water law for more than a century and a half. Those without such rights are legally bound to reduce their use.

Not surprisingly, those without such rights have developed a new theory of law that effectively says the priority system of water allocation is no longer applicable because of climate change.

The new buzzword describing this change is “aridification.” The terms “shortage” and “drought” that have historically been used they claim are no longer relevant to describing water conditions. The reason for this change in nomenclature is because existing law is very clear that water is apportioned based on priority during times of shortage and drought.

They argue that aridification is somehow different. It is not.

If state and federal courts were to interpret a distinction in such terms, water law would not only be upended along the Colorado River system, but indeed across the entire United States.

The Upper Basin states of Colorado, Wyoming, Utah and New Mexico have joined the chorus of Nevada and Arizona in arguing that aridification demands the priority system be ignored. They also argue that the requirement under the 1922 Colorado River Compact among the basin states guaranteeing a fixed quantity of water be delivered to the Lower Basin states should be ignored on the same grounds. Their fears are that such a requirement will limit their existing and proposed future diversions of Colorado River water. To date, these states’ diversions have been well below their junior allotment. The imbalance on the Colorado River they argue is a Lower Basin concern, not an Upper Basin concern.

But such a position is inconsistent and self-serving. If in fact, aridification demanded that the priority system be ignored along the river, wouldn’t it make sense that all water users within the Colorado River basin take a reduction, not just those in the Lower Basin as Upper Basin users have proposed? It is noteworthy that Upper Basin states thus far have not meaningfully participated in reducing demands on the Colorado River. Yet they should.

Why haven’t Arizona and Nevada looked harder at the Upper Basin states to reduce their water use to balance demands instead of focusing on California? Perhaps they are hoping that California’s Imperial Valley will once again come to the rescue of the river’s water users as was done in 2003 when the Imperial Irrigation District signed the Quantification Settlement Agreement (QSA) and reduced its water use by more than 15 %. As the river’s biggest water user (and least politically potent), surely, they must have more water to spare.

The residents of Imperial Valley are right to be concerned about the future of their community. In 2003, the Imperial Irrigation District, despite holding senior water rights to the river for the benefit of its farming community, succumbed to the political pressures within California and from other basin states to reduce their demands on the Colorado River.

The argument made at the time by the river’s other water users was that the district was wasting water. However, the fact of the matter was that the district’s water use was no different than that of other irrigation districts across the west. The QSA water transfers have created significant hardships on the local communities and an ecological nightmare for the Salton Sea.

As the basin states and federal government move forward in crafting solutions to the water shortage problem on the Colorado River, they must consider the sacrifices that have already been made by those living in Imperial Valley: Sacrifices that have been made by those holding senior water rights. They must also consider the damage that would be done to the legal structure governing water use across the west if the priority system is to be ignored.

Craig William Morgan is a water resources engineer who served as consultant to farmers opposing the QSA. He is the author of the recently published book about the QSA and the fight for Imperial Valley’s water called “The Morality of Deceit.”

Living with natural gas pipelines: Appalachian landowners describe fear, anxiety and loss

The Conversation

Living with natural gas pipelines: Appalachian landowners describe fear, anxiety and loss

Erin Brock Carlson, Assistant Professor of Professional Writing and Editing, West Virginia University and Martina Angela Caretta, Senior Lecturer in Human Geography, Lund University – February 11, 2023

Pipeline construction cuts through forests and farms in Appalachia. Provided by Erin Brock Carlson, <a href= — Pipeline construction cuts through forests and farms in Appalachia. Provided by Erin Brock Carlson, CC BY-SA

More than 2 million miles of natural gas pipelines run throughout the United States. In Appalachia, they spread like spaghetti across the region.

Many of these lines were built in just the past five years to carry natural gas from the Marcellus Shale region of Ohio, Pennsylvania and West Virginia, where hydraulic fracturing has boomed. West Virginia alone has seen a fourfold increase in natural gas production in the past decade.

Such fast growth has also brought hundreds of safety and environmental violations, particularly under the Trump administration’s reduced oversight and streamlined approvals for pipeline projects. While energy companies promise economic benefits for depressed regions, pipeline projects are upending the lives of people in their paths.- ADVERTISEMENT -https://s.yimg.com/rq/darla/4-10-1/html/r-sf-flx.html

As a technical and professional communication scholar focused on how rural communities deal with complex problems and a geography scholar specializing in human-environment interactions, we teamed up to study the effects of pipeline development in rural Appalachia. In 2020, we surveyed and talked with dozens of people living close to pipelines in West Virginia, Ohio and Pennsylvania.

What we found illuminates the stress and uncertainty that communities experience when natural gas pipelines change their landscape. Residents live with the fear of disasters, the noise of construction and the anxiety of having no control over their own land.

‘None of this is fair’

Appalachians are no strangers to environmental risk. The region has a long and complicated history with extractive industries, including coal and hydraulic fracturing. However, it’s rare to hear firsthand accounts of the long-term effects of industrial infrastructure development in rural communities, especially when it comes to pipelines, since they are the result of more recent energy-sector growth.

For all of the people we talked to, the process of pipeline development was drawn out and often confusing.

Some reported never hearing about a planned pipeline until a “land man” – a gas company representative – knocked on their door offering to buy a slice of their property; others said that they found out through newspaper articles or posts on social media. Every person we spoke with agreed that the burden ultimately fell on them to find out what was happening in their communities.

A map shows U.S. pipelines carrying natural gas and hazardous liquids in 2018. More construction has been underway since then. <a href= — A map shows U.S. pipelines carrying natural gas and hazardous liquids in 2018. More construction has been underway since then. GAO and U.S. Department of Transportation

One woman in West Virginia said that after finding out about plans for a pipeline feeding a petrochemical complex several miles from her home, she started doing her own research. “I thought to myself, how did this happen? We didn’t know anything about it,” she said. “It’s not fair. None of this is fair. … We are stuck with a polluting company.”

‘Lawyers ate us up’

If residents do not want pipelines on their land, they can pursue legal action against the energy company rather than taking a settlement. However, this can result in the use of eminent domain.

Eminent domain is a right given by the Federal Energy Regulatory Commission to companies to access privately held property if the project is considered important for public need. Compensation is decided by the courts, based on assessed land value, not taking into consideration the intangibles tied to the loss of the land surrounding one’s home, such as loss of future income.

Through this process, residents can be forced to accept a sum that doesn’t take into consideration all effects of pipeline construction on their land, such as the damage heavy equipment will do to surrounding land and access roads.

One man we spoke with has lived on his family’s land for decades. In 2018, a company representative approached him for permission to install a new pipeline parallel to one that had been in place since 1962, far away from his house. However, crews ran into problems with the steep terrain and wanted to install it much closer to his home. Unhappy with the new placement, and seeing erosion from pipeline construction on the ridge behind his house causing washouts, he hired a lawyer. After several months of back and forth with the company, he said, “They gave me a choice: Either sign the contract or do the eminent domain. And my lawyer advised me that I didn’t want to do eminent domain.”

Pipeline construction cuts through a farmer’s field. Provided by Erin Brock Carlson, <a href= — Pipeline construction cuts through a farmer’s field. Provided by Erin Brock Carlson, CC BY-SA

There was a unanimous sense among the 31 people we interviewed that companies have seemingly endless financial and legal resources, making court battles virtually unwinnable. Nondisclosure agreements can effectively silence landowners. Furthermore, lawyers licensed to work in West Virginia who aren’t already working for gas companies can be difficult to find, and legal fees can become too much for residents to pay.

One woman, the primary caretaker of land her family has farmed for 80 years, found herself facing significant legal fees after a dispute with a gas company. “We were the first and last ones to fight them, and then people saw what was going to happen to them, and they just didn’t have – it cost us money to get lawyers. Lawyers ate us up,” she said.

The pipeline now runs through what were once hayfields. “We haven’t had any income off that hay since they took it out in 2016,” she said. “It’s nothing but a weed patch.”

‘I mean, who do you call?’

Twenty-six of the 45 survey respondents reported that they felt that their property value had decreased as a result of pipeline construction, citing the risks of water contamination, explosion and unusable land.

Many of the 31 people we interviewed were worried about the same sort of long-term concerns, as well as gas leaks and air pollution. Hydraulic fracturing and other natural gas processes can affect drinking water resources, especially if there are spills or improper storage procedures. Additionally, methane, a potent greenhouse gas, and volatile organic compounds, which can pose health risks, are byproducts of the natural gas supply chain.

Oil spills are a major concern among land owners. Provided by Erin Brock Carlson, <a href= — Oil spills are a major concern among land owners. Provided by Erin Brock Carlson, CC BY-SA

“Forty years removed from this, are they going to be able to keep track and keep up with infrastructure? I mean, I can smell gas as I sit here now,” one man told us. His family had watched the natural gas industry move into their part of West Virginia in the mid-2010s. In addition to a 36-inch pipe on his property, there are several smaller wells and lines. “This year the company servicing the smaller lines has had nine leaks … that’s what really concerns me,” he said.

The top concern mentioned by survey respondents was explosions.

According to data from 2010 to 2018, a pipeline explosion occurred, on average, every 11 days in the U.S. While major pipeline explosions are relatively rare, when they do occur, they can be devastating. In 2012, a 20-inch transmission line exploded in Sissonville, West Virginia, damaging five homes and leaving four lanes of Interstate 77 looking “like a tar pit.”

A gas line explosion near Sissonville, West Virginia, sent flames across Interstate 77. <a href= — A gas line explosion near Sissonville, West Virginia, sent flames across Interstate 77. AP Photo/Joe Long

Amplifying these fears is the lack of consistent communication from corporations to residents living along pipelines. Approximately half the people we interviewed reported that they did not have a company contact to call directly in case of a pipeline emergency, such as a spill, leak or explosion. “I mean, who do you call?” one woman asked.

‘We just keep doing the same thing’

Several people interviewed described a fatalistic attitude toward energy development in their communities.

Energy analysts expect gas production to increase this year after a slowdown in 2020. Pipeline companies expect to keep building. And while the Biden administration is likely to restore some regulations, the president has said he would not ban fracking.

“It’s just kind of sad because they think, once again, this will be West Virginia’s salvation,” one landowner said. “Harvesting the timber was, then digging the coal was our salvation. … And then here’s the third one. We just keep doing the same thing.”

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This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. The Conversation is trustworthy news from experts. Try our free newsletters.

It was written by: Erin Brock Carlson, West Virginia University and Martina Angela Caretta, Lund University.

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Dr. Carlson has received funding this project from the West Virginia University Humanities Center.

Dr Caretta has received funding for this project from the Heinz Foundation and the West Virginia University Humanities Center.

Amsterdam plans to ban weed from Red Light District streets

The Washington Poat

Amsterdam plans to ban weed from Red Light District streets

Hannah Sampson – February 10, 2023

Amsterdam, Netherlands – October 1, 2012: Amsterdam’s red-light district at night. There are about three hundred cabins rented by prostitutes in the area. (sborisov via Getty Images)

In their latest effort to rein in carousing visitors, Amsterdam officials announced plans this week to tamp down disruptive behavior in the city’s Red Light District, including barring pot-smoking on the streets, reducing hours for restaurants and brothels, and tightening some alcohol restrictions.

The rules are meant to ease the impact of hordes of sometimes-rowdy tourists on people who live in the area. An announcement from the city council referenced an alcohol- and drug-fueled atmosphere at night that makes the neighborhood unsafe and prevents residents from sleeping.

Officials are taking public comments on many of the proposed measures for the next four weeks before finalizing amendments to municipal bylaws.

Under the measures announced Thursday, the smoking ban would go into effect in mid-May. The city could take more action if the ban doesn’t go far enough to reduce nuisance behavior.

Also under consideration: banning to-go sales of drugs at coffee shops at certain times and potentially restricting smoking on cafe terraces.

The Netherlands has a tolerance policy for weed, meaning people will not be prosecuted for buying up to five grams of cannabis, which is classified as a “soft drug” and sold in coffee shops. Only visitors 18 and older can enter cannabis cafes, which are not allowed to sell alcohol. While weed can be consumed in coffee shops, most clubs or bars do not allow people to smoke pot on-site.

The city issues permits for brothels and sex clubs to operate. Under rules that had already been decided, brothels will only be able to stay open until 3 a.m., not the 6 a.m. closing time in place now. Restaurants and sex establishments with catering licenses will have to close at 2 a.m. on Fridays and Saturdays, rather than 3 or 4 a.m.

No new visitors would be allowed into businesses with a catering license after 1 a.m., the English-language publication NL Times reported. The time changes would go into effect April 1, the publication said.

Officials also want to close terraces at 1 a.m. in the summer, a change from the previous closing time of 2 a.m.

Alcohol sales at stores and cafeterias in the district will continue to be blocked starting at 4 p.m. from Thursday through Sunday. The city says alcohol displays must also be removed from the shops or hidden from view. Visitors are already not allowed to drink on the streets.

Amsterdam has tried for years to address overtourism concerns, restricting some tours of the historic Red Light District before the pandemic and voting to move sex workers to an erotic center outside of the district in 2021. According to a November story in the Guardian, however, residents of the proposed neighborhoods for relocation don’t want the businesses – and the workers also don’t want to move.

Late last year, authorities said they planned to take steps to combat tourism problems, including limiting river cruises, curbing rowdy bachelor parties, cracking down on organized pub crawls and taking other measures. Part of the plan included some of the rules announced this week, such as reducing hours for sex businesses and catering establishments and banning smoking in some parts of the city.

A campaign is expected to start this year discouraging global visitors who want to party hard in the city.

“Amsterdammers live in every neighborhood, including the Red Light District and Leidseplein,” the official visitor information site I amsterdam says. “Limit noise and drunkenness, clean up your mess and don’t pee in the canals. Keep in mind the locals and they will welcome you with open arms.”

Fungal infections are becoming more common. Why isn’t there a vaccine?

NBC News

Fungal infections are becoming more common. Why isn’t there a vaccine?

Berkeley Lovelace Jr. – February 10, 2023

Fungal infections are becoming more common in the United States, but unlike illnesses caused by bacteria or viruses, there’s no vaccine to protect against a fungal threat.

While scientists aren’t worried that a fungal infection like the one seen in HBO’s “The Last of Us” will wipe out humanity, the infections are certainly a cause for concern.

Fungi cause a wide range of illnesses in people, from irritating athlete’s foot to life-threatening bloodstream infections.

In the U.S., fungal infections are responsible for more than 75,000 hospitalizations and nearly 9 million outpatient visits each year, according to the Centers for Disease Control and Prevention. In 2021, around 7,200 people died from fungal diseases. These numbers, the CDC said, are likely an underestimate.

One type of fungus, Candida auris, can be resistant to all of the drugs used to treat it, and is particularly dangerous for hospitalized and nursing home patients. The fungus was first identified in Japan in 2009 and has since been found in over 30 countries, including the U.S., the CDC said.

Climate change also threatens to make several infection-causing fungi more widespread: The fungus that causes Valley fever thrives in hot, dry soil, and the fungus that causes an illness called histoplasmosis prefers high humidity.

https://www.nbcnews.com/news/embedded-video/mmvo162153541600

Despite the growing threat, there are currently no licensed vaccines — in the U.S. or abroad — to prevent fungal infections.

“These are the most important infectious diseases that you have not heard of,” said Karen Norris, an immunologist and vaccine expert at the University of Georgia. “A vaccine has the potential to move forward and protect a large swath of individuals.”

Fatal fungal infections

Norris said that the ultimate goal would be to develop a single vaccine that protects against all fungal infections.

But a “pan-fungal” vaccine is incredibly challenging to make.

That’s because, she said, unlike the Covid vaccines, which target a single pathogen — the SARS-CoV-2 virus — a fungal vaccine would ideally protect against the wide spectrum of fungi in existence, each biologically different from the next.

For now, Norris and her team have decided to focus on the three fungi responsible for the vast majority of fatal fungal infections in the U.S.:

Aspergillus, a common mold that can cause an infection in the lungs and sinuses that can later spread to other parts of the body.
Candida, particularly Candida auris, a type of yeast that can cause serious blood infections, particularly in people in health care settings.
Pneumocystis, which can cause pneumonia.

In preclinical trials, the experimental vaccine developed by Norris and her team was shown to generate antifungal antibodies in animals, including rhesus macaques. With funding support, the researchers could start and finish the human vaccine trials within the next five years, she said.

In Arizona, researchers are focused on a vaccine to prevent Valley fever, a lung infection caused by the fungus Coccidioides. The fungus, typically found in the hot, dry soils of the Southwest, is an “emerging threat,” Norris said, because climate change is expanding its range.

So far, the vaccine has been shown to be effective in dogs, said John Galgiani, the director of the Valley Fever Center for Excellence at the University of Arizona College of Medicine.

Little urgency, lack of funding

While experts know which fungi are best to target, vaccine development has been slow, mostly due to a lack of funding, said Galgiani, who is working to start a trial in humans for the Valley fever vaccine.

Many in public and private spaces don’t see fungal vaccines as a “critical unmet need,” he said. Respiratory viruses, such as the ones that cause Covid, the flu or measles, infect millions of people and lead to thousands of hospitalizations worldwide each year, he said. The viruses can be deadly for anyone, in any part of the world, he said, illustrating the need for vaccines to prevent those diseases.

By comparison, hundreds of species of fungi can cause illness in people, but the most common ones — such as those that infect the skin and nails, or cause vaginal yeast infections or athlete’s foot — are non-life-threatening, according to Galgiani.

Additionally, severe cases are sporadic across the U.S., he said.

Valley fever, for example, is usually limited to the Southern and Western regions of the U.S. and are usually serious for people with weakened immune systems. Most people breathe in Aspergillus every day without getting sick, but it can be life-threatening for people with cystic fibrosis or asthma. Candida auris infections have been mostly limited to health care settings, and pose the biggest threat to very sick patients.

“As a risk-benefit investment proposal, it fails,” Galgiani said of developing a vaccine. “You would not put your retirement investment into this.” He said it could take eight years before a fungal vaccine is made available in the U.S.

But as awareness of climate change’s impact on fungal infections grows, funding support could grow and there could be a fungal vaccine developed sooner, Norris said.

In response to growing public health concerns about severe and life-threatening fungal diseases, the National Institutes of Health in September released a framework for how the U.S. could create a vaccine for Valley fever in the next 10 years.

Last October, the World Health Organization released its first-ever list of fungi that pose the greatest threat to public health, calling for more research into 19 fungal diseases.

Dr. Andrew Limper, a pulmonologist at the Mayo Clinic in Rochester, Minnesota, said that there are a handful of oral treatments for most mild to moderate fungal infections. Depending on the fungus, he said, people may need to take the medications for three to six months to clear the infection from their system. The drugs can come with side effects, including headache, stomach pain, vomiting and diarrhea.

People with strong immune systems oftentimes will recover with medication, but fungal infections, particularly those that affect lungs, can leave scarring, he said.

In severe cases, some people may need to take intravenous medications, such as Amphotericin B, he said.

Turkey earthquake fault lines mapped from space

BBC News

Turkey earthquake fault lines mapped from space

Jonathan Amos – BBC Science Correspondent – February 10, 2023

It seems almost insensitive to start to have a deep dive into the science behind Monday’s earthquake events in Turkey.

More than 22,000 people are already confirmed dead and an unknown number still lie trapped, with the window for their rescue closing rapidly.

And yet the science will go on. The insights gleaned from this event will save lives in the future.

Take a look at the map on this page. It is the most precise yet produced of how the ground lurched in response to the enormous energies that were unleashed.

The data behind it was acquired in the early hours of Friday by the European Union’s Sentinel-1A satellite as it traversed north to south over Turkey at an altitude of 700km (435 miles).

The Sentinel carries a radar instrument that is able to sense the ground in all weathers, day and night.

It is routinely scanning this earthquake-prone region of the world, tracing the often very subtle changes in elevation at the Earth’s surface.

Except, of course, the changes on Monday were not subtle at all; they were dramatic. The ground bent, buckled and in places ripped apart.

Researchers use the technique of interferometry to compare “before” and “after” views. But you do not really need to be an expert to see the consequences for Turkey in the latest Sentinel map.

The red colours here describe movement towards the satellite since it last flew over the country; the blue colours record the movement away from the spacecraft.

It is abundantly clear how the ground has been deformed along and near the East Anatolian Fault line.

For both the Magnitude 7.8 quake that struck first on Monday at 01:17 GMT and the Magnitude 7.5 event at 10:24, the motion is “left-lateral”. That is to say: whichever side of the fault you are on, the other side has moved to the left. And by several metres in places.

The shocking thing is that the lines of rupture have gone right through settlements; in lots of places they will have gone right through buildings.

Sentinel-1 — Artist’s impression: The Sentinel routinely maps earthquake-prone Turkey

The Sentinel map will help scientists understand exactly what happened on Monday, and this knowledge will feed into their models for how earthquakes work in the region, and then ultimately into the risk assessments that the Turkish authorities will use as they plan the recovery.

There is sure to be a lot of discussion about how the two major tremors were related and what that could mean for further instability.

The map was processed by the UK Centre for Observation and Modelling of Earthquakes, Volcanoes and Tectonics (Comet). Its director, Prof Tim Wright, said the Sentinel observations vividly brought home the scale of the forces involved.

“News outlets always show earthquakes as ‘the epicentre’, as if it is a single point source (like a bomb). Actually, all earthquakes are caused by slip on extended faults, and the bigger the quake the bigger the fault that ruptured,” he told BBC News.

“We can map those ruptures with satellites because the ground around them is displaced, in this case by up to 5m or 6m. The rupture of the first event was 300km or so long and the second big event ruptured another 140km or so of a different fault. To put those distances in context, London to Paris is roughly 345km.

“Damage will be highest near the fault but of course spreads over a wide region either side of the fault, too. It’s absolutely horrific.”

Collapsed house — The insights will assist Turkish authorities as they plan the recovery

In the era before satellites, geologists would map earthquake faults by walking the lines of rupture. It was a laborious process that naturally also missed a lot of detail. Radar interferometry from space was developed in the 1990s, and in recent years it has become a particularly compelling tool.

In part that is down to the quality of the sensors now in orbit, but it is also the result of more powerful computers and smarter algorithms.

It is possible today to get a data product on to the computers of experts, ready for analysis, within hours of a satellite making an overhead pass. Comet, unfortunately, had to wait several days for Sentinel-1A to be in the right part of the sky to get an optimal view of Turkey. But this will improve as more and more radar satellites are launched.

“By the end of the decade, we should be able to do this kind of analysis within a day of most damaging earthquakes, and then we would be more useful for the relief effort. As things stand, we are of course outside the 72-hour window for search and rescue,” Prof Wright said.

The Republican Distraction Farm Is Failing Because They’re Employing Less Talented Grievance-Farmers

Esquire

The Republican Distraction Farm Is Failing Because They’re Employing Less Talented Grievance-Farmers

Jack Holmes – February 10, 2023

little rock, arkansas february 07 arkansas gov sarah huckabee sanders delivers the republican response to the state of the union address by president joe biden on february 7, 2023 in little rock, arkansas biden tonight vowed to not allow the us to default on its debt by calling on congress to raise the debt ceiling and chastising republicans seeking to leverage the standoff to force spending cuts photo by al drago poolgetty images — Republican Grievance-Farmers Lose Green ThumbsPool – Getty Images

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Sarah Huckabee Sanders, now the governor of Arkansas, gave a rebuttal to President Joe Biden’s State of the Union address this week that suggested Republicans have learned precious few lessons from their dramatic underperformance in the midterms. Biden’s speech was a full-throated appeal to everyday Americans on populist economic grounds—one that actually echoed some of Donald Trump’s rhetoric in the 2016 campaign. Sanders brought the now-standard routine about The Woke Mob “that can’t even tell you what a woman is,” and that is ushering in a world where “children are taught to hate one another on account of their race.” She referred to “C.R.T.” as if everyone listening would know that stands for Critical Race Theory (and that it is inherently evil). Sanders did outline a plan to raise starting salaries for Arkansas teachers, which is welcome in an era in which the American right increasingly seeks to paint educators as rogue agents of Woke determined to brainwash your kids.

The latter is the kind of stuff that cost them seats in the midterms. It hits squarely with people who are up-to-date on their Fox News folklore, fluent in the language of culture-war apocalypto. But for most people, it’s probably pretty weird. They mostly like their kids’ teachers, who are usually trying to do the best job they can in sometimes challenging circumstances. For years, the Democratic Party was the one considered out of touch, if only because of the alienating way that some liberals talked about the issues. But that’s now the Republican Party’s stock-in-trade. The right’s rising star—at least in the view of media-politico types—is the governor of Florida, Ronald DeSantis, who has replaced his pandemic anti-interventionist crusade (which at least dealt with a major issue of public concern) with campaigns against Woke Corporations and in favor of the government’s prerogative to police what teachers teach in schools. It’s gotten fewer national headlines that he, too, has sought to raise salaries, but that nugget is competing with news that teachers have been told to remove or cover up books out of fear they could face criminal charges for their content.

Maybe DeSantis is reluctant to talk about other parts of his record because, as the political press finally turns to it, we’re fully realizing how committed he once was to changing Social Security and Medicare. (We’ve also seen how touchy Republicans get when you talk about this since Biden brought it up at the State of the Union. Even a talk-radio host interviewing Ron Johnson was explicitly trying to brand this stuff as “reforms” not “cuts.”) The president pointed out that some Republicans—including chair of the National Republican Senatorial Committee and Lizard-American Rick Scott—have called for sunsetting all federal legislation after five years. This would by definition include Medicare and Social Security.

daytona beach shores, florida, united states 20230118 florida gov ron desantis speaks at a press conference to announce the award of $100 million for beach recovery following hurricanes ian and nicole in daytona beach shores in florida the funding will support beach projects within 16 coastal counties, with hard hit volusia county receiving the largest grant, over $37 million photo by paul hennessysopa imageslightrocket via getty images — Time will tell if Ronald DeSantis is the kind of right-winger who can still thread the needle.SOPA Images – Getty Images

Maybe they would be renewed as-is, but that’s quite a bet to make, particularly when you examine the record of the hospital chain Scott once ran. DeSantis, though, used to be even more forthright. He supported privatizing aspects of both programs in his 2012 congressional campaign, CNN found, and once in Congress he supported Paul Ryan’s agenda on “entitlements.” (They are earned benefits.) All this is based on the combined notions that these programs are fiscally unsustainable and raising taxes is a kind of supreme evil. None of this is new: George W. Bush tried to privatize Social Security. Ronald Reagan launched his political career with this stuff. Maybe DeSantis is an example of how how you can get away with this kind of policy record, considering he’s extremely popular in the old folks’ Mecca of Florida. Or maybe we in the press have just done a godawful job.

Republicans lose votes when people get a good look at their proposals on these issues, so maybe it’s no wonder they’re now permanently engaged in culture-war food fights. Except that also seems to have lost its luster outside The Base. Trump at least had a canny ear for the more transcendent gripes, particularly in 2016. His would-be successors are less talented grievance farmers, and some absolute loony toons have joined their ranks in Congress. It’s not a change so much as it’s become more obvious than it was that Republicans have no plans to address problems in normal people’s lives. They’re getting so high on their own supply that they can no longer even explain some of these bedrocks of their politics. The Louisville Courier-Journal‘s Joe Sonka asked Kentucky Senate President Robert Stivers for his definition of “woke” on Friday and he replied, “Woke? That is the definition to me that is a describing of a mentality or a culture that certain individuals have about how things are progressing through society.” Hey man, maybe carve out some time to think about this or just admit that it’s become a hollow vehicle for reactionary rage.

Two cardiovascular medicines were well-tolerated for small vessel stroke

New Media Wire

Two cardiovascular medicines were well-tolerated for small vessel stroke

February 9, 2023

Research Highlights:

No standard medical therapy exists for a stroke occurring in a small vessel in the deep areas of the brain called a lacunar stroke.
A preliminary study of two common cardiovascular medications, cilostazol and isosorbide mononitrate, suggests these two medications were safe and well-tolerated by adults who have experienced small vessel stroke, when taken alone or together.
A larger, more extensive study is planned to examine the effectiveness of the medications in treating the complications of small vessel stroke.

(NewMediaWire) – February 09, 2023 – DALLAS A study of two widely used cardiovascular medications cilostazol and isosorbide mononitrate in more than 350 patients confirmed the two medications were well-tolerated and safe for people who have experienced a stroke in a small blood vessel deep in the brain. The results suggest the medications may help improve patient outcomes, according to preliminary late-breaking science presented today at the American Stroke Association’s International Stroke Conference 2023. The meeting, held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Small vessel disease of the brain accounts for about 20% -25% of all ischemic strokes, according to previous research. A lacunar stroke, or small vessel stroke, occurs when the inner lining of the tiny blood vessels inside the brain are damaged, leading to a stroke or dementia.

“Currently, there is no proven treatment to prevent poor outcomes after lacunar stroke, so the ultimate goal with this research is to evaluate if medications with potential modes of action on the inner lining of blood vessels might help improve small vessel function and prevent or slow long-term brain damage after lacunar stroke,” said lead study investigator Joanna M. Wardlaw, M.D., FAHA, professor of applied neuroimaging, honorary consultant neuroradiologist, head of neuroimaging sciences and the director of Edinburgh Imaging at Edinburgh University in Edinburgh, Scotland. She is also the foundation chair of the U.K. Dementia Research Institute.

The medications in the study are commonly prescribed for other cardiac conditions. Isosorbide mononitrate is used to treat chest pain by relaxing blood vessels and decreasing blood pressure. Cilostazol improves the flow of blood by relaxing the blood vessels and reducing blood clotting. It is often prescribed for people with peripheral artery disease a narrowing of the peripheral arteries that carry blood away from the heart to other parts of the body.

This study, called LACunar Intervention Trial 2 (LACI-2), is the second largest ever trial in lacunar stroke. It examined whether such a trial was feasible among people with lacunar strokes and if the medications would be well-tolerated for one year after lacunar stroke. Researchers also analyzed safety and other outcomes, including recurrent stroke, cognitive impairment, dependency, mood and quality of life. This detailed information is needed for the next stage of research a phase 3 trial, which would include more study participants. Results of the analysis on cognitive status at one year will be presented separately in the same Main Event session on Feb. 9.

From Feb. 2018 to May 2022, researchers enrolled 363 adults who had experienced lacunar stroke from 26 stroke centers throughout the United Kingdom. The participants were average age 64 years, and 31% were women. All study participants continued to take their usual prescribed medications as per stroke guidelines, including those that reduce blood clotting, lower blood pressure and/or lower cholesterol all of which may lower the risk of a second or recurrent stroke.

Participants were randomly assigned to one of four treatment groups: 40-60 mg/day of oral isosorbide mononitrate alone; 200 mg/day of oral cilostazol alone; both medications; or neither medication for one year. The participants completed phone surveys at 6 and 12 months to assess health status, including recurrent stroke and heart problems, cognitive tests, symptoms, quality-of-life surveys, and had brain imaging at 12 months.

The study met its initial goals to determine if a larger trial was feasible and if the medications were safe and tolerable. After one year, 358 of the adults were still participating in the study, with 95% of participants taking at least half of medication doses prescribed for the trial. Safety criteria were also met: four participants died; there were four episodes of bleeding outside of the brain; no excessive falls or dizziness. Some participants experienced mild symptoms (such as headaches), which were expected.

Researchers also saw some potential benefits from the medication groups, including data that indicated the group who took the combined isosorbide mononitrate and cilostazol had a reduction in the amount of assistance they needed with everyday living tasks, a reduction in cognitive impairment and positive impacts on mood and quality of life. Isosorbide mononitrate alone reduced recurrent stroke, cognitive impairment and improved quality of life; cilostazol alone reduced the need for daily assistance.

“There appeared to be some potential benefits that will need to be confirmed in a larger phase 3 trial,” Wardlaw said. “We saw good hints of efficacy, particularly for isosorbide mononitrate on reducing recurrent stroke and cognitive impairment, and we also found that both medications together seemed to work synergistically, rather than counteracting any benefit. This is very encouraging since no study has previously found any medications that positively affect cognitive impairment in small vessel disease strokes. So, we cautiously hope that these medications may have wider implications for other types of small vessel disease.”

The study has some limitations, including that it was relatively small at 363 patients and not designed to measure efficacy, thus the results showing effectiveness should be interpreted cautiously. The trial was open label, meaning participants and clinicians were aware of which medication/s and doses they were taking; however, the follow-up staff for the study were unaware of which treatment the patients were assigned. Additionally, the investigators did not collect data on race or ethnicity, and many ethnic groups were suspected to be underrepresented.

Study co-lead author is Philip M. Bath, D.Sc., FAHA, UK Stroke Association Professor of Medicine at the University of Nottingham. The list of authors’ disclosures is available in the abstract.

The study was funded primarily by the British Heart Foundation, with support from the UK Alzheimer’s Society, the U.K. Dementia Research Institute, the Stroke Association, the Fondation Leducq, NHS Research Scotland and the U.K. National Institutes of Health Research Clinical Research Networks. The work was conducted by the University of Edinburgh and the University of Nottingham.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.