Devin Nunes doesn’t get secrecy

Story highlights

  • Paul Callan: Democrats and others want intelligence committee chair to resign for odd late-night visit to White House
  • Callan: Nunes should do so; US has right to expect more circumspect behavior from head of committee in charge of America’s secrets

In the full technicolor version of this fantasy, the cuffs would next be fastened on Trump, ending the progressives’ enduring Trumpian nightmare.

It’s clear that a lot more information is required before anyone can fairly judge the propriety and legality of Nunes’ actions. What we do know is that shortly after this visit to view classified information, Nunes perhaps surprised even the President by requesting a meeting. He failed to tell the House Intelligence Committee about this meeting with the President, an action for which he recently apologized.

Nunes tried to explain all of this to Wolf Blitzer earlier today, fielding specific questions about the White House visit. The chairman hedged on some questions and flatly declined to answer other inquiries, invoking the need to protect “sources and methods” and still “classified” information.

As chairman of the intelligence committee, enjoying among the highest of security clearances, the chairman would clearly be committing a crime if he publicly disclosed classified information. Answers that appear to be specious and deceptive may fit that description or in fact just be an intelligence chairman trying to protect classified information as well as “sources and methods.” This can only be legally evaluated when more is known about the contents of the mysterious documents that are now causing such a controversy on Capitol Hill.

Many Democratic members of the House Intelligence Committee as well as others in Congress, including Senate Minority Leader Chuck Schumer, are calling for Nunes’ resignation, or recusal from any further role in the House committee’s investigation of the Trump campaign’s contacts with the Russians and the issues relating to the President’s Twitter-announced claim that President Obama ordered wiretaps on Trump Tower.

Nunes should seriously consider stepping aside, as his own actions have now become the center of an ever-widening and distracting controversy.

Though at this point there is no evidence that the chairman acted illegally, the country has the right to expect far more circumspect behavior from the chairman of the House committee in charge of America’s secrets. It’s a little late for him to be learning that secrecy is paramount in the business of investigating the intelligence community.

The missteps of Nunes and the inappropriate tweets of the President appear to be drawing both men into the dark fantasies of Trump opponents across the country. One lesson they both should have learned by now is that the denizens of America’s spy apparatus are nicknamed “spooks” for good reason.

The life-saving treatment that’s thrown in the trash

During a check-up, on his 43rd birthday, his doctor named summertime flu the most likely culprit.

Then the same thing happened again, and it settled into a disturbing pattern: midweek chills and an escalating fever that would break on Sunday. By Monday, Chris would feel fine, only to have the sequence repeat itself.

He joked about it with colleagues at T-Mobile, where he works in software development, “Well, I hope it’s not cancer!”

On alternating weekends from May to October, Chris would volunteer as a back country ranger for the US Forest Service — a physically demanding role that involves patrolling Washington’s Cascade Mountain forests and hiking along high-altitude trails with a backpack that can weigh up to 32 kilograms.

But now, even at sea level, he was getting winded just walking his two dogs around the block. What was going on?

A medical appointment revealed a heart murmur and suspicions of endocarditis, an infection of the heart’s inner lining. The scare triggered another series of tests that led Chris and his husband, Bill Sechter, to Emergency Room 4 at the University of Washington Medical Center.

A whiteboard checklist documented his Saturday morning: insertion of a large-bore IV as a potential conduit for antibiotics, a round of blood draws, and discussions with the ER doctor.

Then the phone rang and the nurse answered, listened and responded to multiple questions in quick succession: “Yes. Yes. Oh, OK. OK. Yeah.” He excused himself from the room and soon returned in a “full hazmat suit”, as Chris describes it. Yellow.

“And that’s when we were like, ‘Oh s***, it’s on. Something is seriously bad.'”

Chris learned that his level of infection-fighting neutrophil cells, normally churned out by the bone marrow, had fallen so low that his defenses were in tatters. He was also severely anemic, with roughly half the normal amount of red blood cells in his blood.

It wasn’t endocarditis. And when one of his doctors performed a blood smear, she saw something on the microscope slide that shouldn’t be there: blasts.

These leukemic cells, stuck in adolescence, were the harbingers of the coming horde that had so astonished 19th-century surgeons.

The doctor apologetically broke the news and Chris and his sister dissolved into tears. In an emotional Facebook post later that day, he attached a picture of himself in a hospital gown and pink face mask and wrote: “this avowed agnostic could actually go for your good juju / positive thoughts or even your (gasp) prayers.”

More tests, including a bone marrow biopsy of his pelvic bone, painted an increasingly disturbing picture. He had acute myeloid leukaemia, a fast-progressing cancer.

The biopsy suggested that an astonishing 80 per cent of his bone marrow cells were cancerous. Strike one.

Chris Lihosit was diagnosed with acute myeloid leukaemia, a fast-progressing cancer, in 2015.

Chris Lihosit was diagnosed with acute myeloid leukaemia, a fast-progressing cancer, in 2015.

Chris Lihosit was diagnosed with acute myeloid leukaemia, a fast-progressing cancer, in 2015.

Other results suggested that chemotherapy wouldn’t be as effective on his form of leukemia. Strike two.

And genetic tests put him in the unfavorable risk category by revealing that his cancer cells carried only one copy of chromosome 21, a rare anomaly associated with “dismal” outcomes, according to recent studies. Strike three.

Chris needed to start chemotherapy immediately.

But first, he had his sperm banked. Then, with family and a close friend at his side, he celebrated his impending treatment with prime rib and cheap champagne smuggled into his hospital room.

Over three days, he received multiple doses of the anticancer drugs cladribine, cytarabine and mitoxantrone, the last a dark blue concoction often dubbed “Blue Thunder.” The drug turned his urine a shade he describes as “Seahawks green” in honor of Seattle’s football team. Other patients have had the whites of their eyes temporarily turn blue.

On the third night of his drug infusion, a sudden back pain grew into an intense pressure in his chest that felt like he was being stabbed. A heart attack? An emergency CAT scan instead revealed two newly formed blood clots: one in his right leg and another in his right lung — not uncommon consequences of chemotherapy.

Over the next six months, Chris would need transfusions of blood-clotting platelets whenever his level of them dipped too low, and daily injections of a blood-thinning drug whenever it rose too high.

Thirteen days after being admitted into the hospital, he posted a more hopeful Facebook entry: “And I’m finally going home! Now the real adventure begins.”

New hope

Based on his leukemia classification, Chris was braced for multiple rounds of chemotherapy. He and his husband were overjoyed when a second bone marrow biopsy suggested that the leukemia had become undetectable after only a single round.

Because of his high-risk classification, however, Chris’s doctors said that the cancer was likely to return without a bone marrow transplant.

But Chris discovered that he had inherited an extremely rare set of cell-identifying protein tags. Only one bone marrow donor on the worldwide registry matched his genetic tags, and that person was unable to donate.

An umbilical cord blood transplant, Chris and his doctors agreed, was his best hope.

Like bone marrow, cord blood is unusually rich in hematopoietic stem cells — which can give rise to every type of blood cell — and their more developed descendants, progenitor cells, which are more limited in what they can become. But, unlike bone marrow, cord blood can be collected in advance and stored for decades in liquid nitrogen.

First, Chris would need to spend another five days in the hospital for a standard follow-up round of chemotherapy to pick off any hidden cancer cells. Chris marked the occasion with a Facebook post of himself in a grey felt Viking helmet and attached braids. “Round 2… And FIGHT!” This time, the chemo went off without a hitch.

He was a familiar face at the medical center, though, with three additional hospitalizations: twice for bacteremia, a bacterial blood infection marked by high fevers, and once so doctors could tame an allergic reaction to a transfusion of platelets, which always reminded Chris of chicken broth.

He had to steel himself again on Christmas Eve for the arrival of the “big guns”: two days of conditioning chemotherapy, headlined by a derivative of mustard gas. Its name is cyclophosphamide, and it works by sabotaging the machinery that copies DNA in rapidly dividing cells. As it does this, it breaks down to form toxic chemicals, including a pungent one called acrolein, which can destroy the lining of the bladder.

To neutralize its effects, patients must take another drug, called mesna, and drink plenty of water.

After a day of rest, Chris began a radiation therapy regimen so intense that it would have killed him if delivered in a single dose. Instead, his radiologists used a particle accelerator to fire X-rays at him in multiple bursts during morning and evening sessions over four days.

“You basically get into a tanning booth made out of clear Plexiglas,” he said.

Wearing nothing but a paper gown, Chris had to stay completely still behind two metal shielding blocks, each the size of a brick, positioned to protect his lungs from irreversible radiation-induced scarring. He did get a mild tan, he says, along with damaged skin that still resembles crepe paper.

Another absurdity still makes him laugh: while he requested punk rock for one of the sessions, he was instead blasted with the tune of Prince’s ‘Erotic City’.

When he finished the final round of total body irradiation on 30 December, the radiology team gathered for a final tribute and let Chris hit a small ceremonial gong.

Help from newborns

The morning of New Year’s Eve, Chris wrote on Facebook, “I’m as nervous as an expectant father!” An hour and a half later, he marked the delivery of his “zero birthday” with a small chocolate cake and a decorative “0” candle: the day when his own bone marrow cells, erased by radiation and chemotherapy, were replaced by roughly four tablespoons of a life-granting elixir from the cord blood of two baby girls.

Even with some of the best help that medicine can offer, transplant recipients face a daunting few weeks without functional bone marrow when nearly anything can kill them.

Chris and Bill have nicknamed the donors Amelia and Olivia based on their blood types, A-negative and O-positive. In a later post, Chris marveled at the new arrivals reseeding his bone marrow: “I use more vanilla flavoring creamer in my coffee than the volume of cells that are rebuilding my entire blood and immune system.”

Four hours after the initial infusions, he received his protective bridge of blood-forming stem cells, collected and expanded from the cord blood of a third baby, a boy he and Bill have nicknamed Eddie.

Less than three weeks after the transplant, Chris’s neutrophils had fully engrafted and genetic tests suggested that Amelia had decisively won the fight to form his new blood and bone marrow. He progressed so rapidly, in fact, that he had to stay in the hospital for two days after he was fit to leave, so that Bill could finish preparing the apartment.

28 January: discharge day. As his family packed up his hospital room, Chris was taking a shower when a wall of exhaustion hit him. He could no longer stand or even dry himself off and sat dripping on the shower bench until Bill heard his calls for help.

He had survived, but life had fundamentally changed.

At home, every surface had to be disinfected daily with a bleach solution. At first, Chris couldn’t walk 100 feet down the apartment hallway without leaning on his brother. Until he hit the 100-day milestone after his transplant, the end of the most vulnerable period for recipients, he returned to the Seattle Cancer Care Alliance every other day for blood tests and checkups.

On the 97th day, Chris and his family celebrated a hard-fought victory when he was officially declared cancer-free: a leukemia survivor.

Cord blood today

Despite dozens of studies documenting its curative powers, cord blood is saved after only 5 per cent of all US births. The rest is simply thrown away.

Michael Boo, chief strategy officer for the National Marrow Donor Program, estimates that only one in ten of those retained units passes the required screening tests and has enough volume to merit long-term storage.

Cord blood is also notoriously expensive, ranging from $22,000 to $45,000 per unit. Due to the relatively low demand from doctors, Boo says, public banks — at least in the US — are collecting as much as they can afford to keep. Beyond persuading new parents to donate, then, lowering the cost of cord blood transplants may depend upon persuading more doctors to use the cells and more insurers to cover them.

One potential use has attracted the avid interest of the Biomedical Advanced Research and Development Authority, part of the US Department of Health and Human Services. As part of Project BioShield, the federal agency has been on the lookout for medical interventions that could treat acute radiation syndrome after a dirty bomb or nuclear disaster.

Keeping people alive

Cord blood transplants in adults, still an option of last resort in the early 2000s, nearly slammed to a halt over the quandary of how to keep patients alive until their new bone marrow cells could kick in.

Some researchers reasoned that they could boost the transplant volume by giving adults two cord blood units instead of one. John Wagner and colleagues at the University of Minnesota performed the first double transplant in 2000, using cells from two infant donors.

The tactic dramatically reduced the rate of graft failure, in which the recipient’s body rejects the new cells. But it barely changed the time needed to regenerate the bone marrow, and some critics have questioned whether a double cord blood transplant offers any significant benefits.

Wagner says his research suggested that transplanting enough blood-forming cells was necessary − but likely not sufficient − for better results. Improved patient survival, in fact, seemed to depend more upon a revised roster of drugs given pre-transplant.

Blood is extracted from an Umbilical cord at UCLH in London.

Blood is extracted from an Umbilical cord at UCLH in London.

Blood is extracted from an Umbilical cord at UCLH in London.

To their surprise, researchers also discovered that the donors in a double cord blood transplant seem to battle for dominance, a curious “graft-versus-graft” phenomenon that almost always results in the victor dominating the recipient’s new bone marrow and blood cells.

Filippo Milano, associate director of the Cord Blood Program at the Fred Hutchinson Cancer Research Center in Seattle, compares it to a pivotal scene in the 1986 movie Highlander, when the antagonist exclaims, “There can be only one!”

On a sunny morning nearly a year after Chris’s transplant, he and I meet the Italian-born doctor in his lab so he can greet one of his star patients and explain the science behind the therapy that saved Chris’s life. Milano is passionate about coaching soccer and cooking. On the side, he jokes, he conducts research on cord blood transplants.

Upon his arrival to “The Hutch” in 2009, Milano teamed up with Colleen Delaney, founder and director of the Cord Blood Program, to test and refine a treatment strategy that may yet prove a better option than a bone marrow transplant for people with leukemia who are at high risk of relapsing.

Based on collaborations and discussions with other experts in the field, Delaney pioneered a method to minimize the risk of infection and bleeding after a cord blood transplant by reducing the time needed for the new blood cells to kick in. The strategy relies on what she and Milano call an “expanded” blood unit.

Starting with an extra batch of cord blood, they separate out the minuscule fraction of blood-forming stem cells and their early descendants and expand that population in the lab.

The hundreds of millions — even billions — of resulting stem and progenitor cells can jump start the generation of protective blood cells in the recipient. When infused along with a more traditional transplant, they can act like a temporary bridge until the replacement bone marrow takes over. “The net gain was that you didn’t have those very prolonged periods of recovery,” Wagner said.

Blood extracted from an umbilical cord and placenta by a member of the Cord Bank Team at NHS Blood and Transplant.

Blood extracted from an umbilical cord and placenta by a member of the Cord Bank Team at NHS Blood and Transplant.

Blood extracted from an umbilical cord and placenta by a member of the Cord Bank Team at NHS Blood and Transplant.

One crucial component, Delaney discovered, is a protein called Notch ligand.

When added to the blood-forming stem cells, Notch ligand lets them divide quickly in the lab but temporarily pauses their development by preventing them from maturing into the normal range of cell types. Critically, they never give rise to T or B immune cells, which would seek out and destroy any perceived threats lacking the proper “self” ID tags.

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Putting a donor’s T cells into an unmatched recipient, Delaney says, would trigger fatal graft-versus-host disease. “That’s the key: we get rid of all those bad parts of the immune system that need to be matched or they can kill you.”

The “bridge of recovery” lasts only so long before the full contingents of other donor cells begin attacking and dismantling it. But, with no cells checking IDs initially, the early flood of blood-forming stem cells need not be matched to the recipient at all, meaning that the “expanded” cord blood unit could be created well ahead of time and used whenever needed as a universal donor.

Other researchers are working on strategies toward the same end, and Mary Laughlin describes the overall progress as “very exciting”.

Delaney’s work, she says, “is very important, saving lives and improving the tolerability of these transplants and the success of these transplants”.

This is an edited extract from an article first published by Wellcome on Mosaic. It is republished here under a Creative Commons license.

Five things you didn’t know about Jesus

You may hear revelations from new books that purport to tell the “real story” about Jesus, opinions from friends who have discovered a “secret” on the Web about the son of God, and airtight arguments from co-workers who can prove he never existed.

Beware of most of these revelations; many are based on pure speculation and wishful thinking. Much of what we know about Jesus has been known for the last 2,000 years.

Still, even for devout Christian there are surprises to be found hidden within the Gospels, and thanks to advances in historical research and archaeological discoveries, more is known about his life and times.

With that in mind, here are five things you probably didn’t know about Jesus.

1.) Jesus came from a nowhere little town.

Nearly all modern-day archaeologists agree the town of Nazareth had only 200 to 400 people. Jesus’ hometown is mentioned nowhere in either the Old Testament or the Talmud, which notes dozens of other towns in the area.

In fact, in the New Testament it is literally a joke.

In the Gospel of John, when a man named Nathanael hears the messiah is “Jesus of Nazareth,” he asks, “Can anything good come from Nazareth?” He’s dissing Jesus’ crummy backwater town.

2.) Jesus probably didn’t know everything.

This is a thorny theological question. If Jesus is divine, wouldn’t he know all things? (Indeed, on several occasions Jesus predicts his death and resurrection.)

On the other hand, if he had a human consciousness, he needed to be taught something before he could know it. The Gospel of Luke says that when Jesus was a young man he “progressed” in wisdom. That means he learned things. (Otherwise how would he “progress”?)

In the Gospel of Mark, Jesus initially refuses to heal the daughter of a non-Jewish woman, saying rather sharply, “It is not fair to take the children’s food and throw it to the dogs.”

But when she replies that even the dogs get the crumbs from the table, Jesus softens, and he heals her daughter. He seems to be learning that his ministry extends beyond the Jewish people.

3.) Jesus was tough.

From age 12 to 30, Jesus worked in Nazareth as a carpenter. “Is not this the carpenter?” say the astonished crowds when he begins to preach.

The word used for Jesus’ profession in the original Greek is tekton. The traditional translation is “carpenter.” But most contemporary scholars say it’s more likely a general craftsman; some even translate it as “day laborer.”

A tekton would have made doors, tables, lamp stands and plows. But he probably also built stone walls and helped with house construction.

It was tough work that meant lugging tools, wood and stones all over Galilee. Jesus doesn’t simply stride onto the world stage after having dreamily examined a piece of wood when the mood suited him. For 18 years, he worked—and worked hard.

4.) Jesus needed “me time.”

The Gospels frequently speak of Jesus’ need to “withdraw” from the crowds, and even his disciples.

Today by the Sea of Galilee, where Jesus carried out much of his ministry, you can see how close the towns were, and how natural it would have been for the enthusiastic crowds to “press” in on him, as the Gospels describe.

There’s even a cave on the shoreline, not far from Capernaum, his base of operations, where he may have prayed.

It’s called the “Eremos Cave,” from the word for “desolate” or “solitary,” from which we get the word “hermit.” Even though Jesus was the son of God, he needed time alone in prayer with the father.

5.) Jesus didn’t want to die.

As he approaches his death, and prays hard in the garden of Gethsemane, Jesus says, “Remove this cup.” It’s a blunt prayer addressed to the father, whom he affectionately calls Abba. He doesn’t want to die.

Unlike the way some Christians portray Jesus as courting death, and even desiring it, like any human being, the idea of death is terrifying. “My soul is sorrowful even unto death,” he says.

In other words, “I’m so sad that it feels like I’m going to die.” But once Jesus realizes that this is somehow the will of the father, he assents to death, even on a cross.

It’s natural to want to know as much as we can about Jesus; that’s one reason I wrote my new book. But beware of the more outlandish claims about the son of God (he fathered children, he was married to Mary Magdalene, he spent time in India and so on.)

Many of these claims tend to project our own desires on a man who will always remain somewhat elusive, hard to fully understand and impossible to pin down.

In the end, as theologians like to say, Jesus is not so much a problem to be solved as a mystery to be pondered.

Iceland’s Blue Lagoon unveils cool new luxury hotel

Iceland’s Blue Lagoon to get new luxury hotel

Blue Lagoon: A man-made series of pools filled with geothermal mineral water, the Blue Lagoon is one of the prime tourist destinations in Iceland. Now it’s set to open a new luxury hotel.

Iceland’s Blue Lagoon to get new luxury hotel

Private pools: The expansion of Blue Lagoon will include an underground spa, a signature restaurant and 62 guest rooms.

Iceland’s Blue Lagoon to get new luxury hotel

Breaking boundaries: The folks at the Blue Lagoon say the expansion will attempt to “erase the boundary between nature, wellness, hospitality and affluence.”

Iceland’s Blue Lagoon to get new luxury hotel

Icelandic eats: The Moss Restaurant aims to deliver a luxury dining experience with a menu based on Iceland’s culinary traditions.

Iceland’s Blue Lagoon to get new luxury hotel

Steamy windows: The hotel’s rooms will have views of the lagoon.

Iceland’s Blue Lagoon to get new luxury hotel

Hot facilities: As well as a spa using geothermally heated seawater, the Blue Lagoon also includes a sauna, steam room, waterfall, and in-water silica bar.

Iceland’s Blue Lagoon to get new luxury hotel

Perfect stopover: Located just 20 minutes from Keflavík International Airport and 50 minutes from Reykjavík, Blue Lagoon is conveniently placed for visitors.

Iceland’s Blue Lagoon to get new luxury hotel

Misty marvel: Created in 1976 as a byproduct of a a nearby geothermal power plant, the water in the lagoon is rich in minerals such as silica and sulfur.

Iceland’s Blue Lagoon to get new luxury hotel

Big bath: The Blue Lagoon covers an area of 8,700 square meters and holds nine million liters of geothermal water.

Iceland’s Blue Lagoon to get new luxury hotel

Light show: From the waters of the lagoon, visitors can see the Northern Lights when conditions are right.

Study: Greatest rise in heroin use was among whites

More people die from drug overdoses than from guns or car accidents. At the peak of the AIDS epidemic in 1995, 43,115 people in the United States died from the disease.

Furthermore, since 1999, the number of overdoses from prescription opioids like oxycodone and hydrocodone, as well as illicit drugs like heroin, have quadrupled. In fact, heroin now accounts for one in four overdose deaths in the United States.

Now, a new study in the journal JAMA Psychiatry looks beyond the total number of overdose deaths to get a better picture of how heroin use patterns have changed since 2001. Since then, the number of people who have used heroin has increased almost five-fold, and the number of people who abuse heroin has approximately tripled.

The greatest increases in use occurred among white males.

Heroin use on the rise

The authors evaluated the responses of 79,402 individuals, as collected from the 2001-2002 and the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions, a longitudinal study conducted by the National Institutes of Health to evaluate alcohol and drug use and abuse. While heroin use between whites and non-whites was fairly similar in the 2001-2002 results, at 0.34% and 0.32% respectively, by 2012-2013 the percentage of whites who had used heroin jumped to 1.90%. Just 1.05% of non-whites in 2012-2013 used heroin. Heroin use also increased significantly among those with a high school education or less, as well as those who lived at less than 100% of the federal poverty line.

The authors of the new report write “these trends are concerning because increases in the prevalence of heroin use and use disorder have been occurring among vulnerable individuals who have few resources to overcome problems associated with use.”

According to a 2016 Surgeon General’s report on alcohol, drugs and health, only one in 10 of those with a substance use disorder receive any treatment.
“The good news is that among all drugs of abuse, heroin and opioids have by far the best treatment medications available. Methadone and buprenorphine have proven effectiveness data, they not only reduce the chances of dying from an opioid overdose by 50%, they support people being in recovery from their addiction and reduce health care costs and improve a wide array of other outcomes,” said Caleb Banta-Green, an associate professor of health services at the University of Washington. Banta-Green was not involved in the study.

Starting with prescription drugs

The study also confirmed the idea that many heroin users start by using prescription opioids like oxycodone and hydrocodone. Approximately one-third of all white heroin users reported using prescription drugs for non-medical purposes in 2001-2002. By 2013 more than half of all white heroin users started by initially using prescription drugs. For non-whites, the number of people who started by using prescription drugs before heroin actually dropped in the same time frame.

An accompanying editorial by Bertha Madras, a psychologist at McLean Hospital in Massachusetts and former deputy director in the White House’s Office of National Drug Control and Policy pointed to the shift in treating pain as a major factor in understanding the current crisis. She noted that in the past two decades, the number of opioid prescriptions has risen three-fold.

“This shift in practice norms was fueled by acceptance of low quality evidence that opioids are a relatively benign remedy for managing chronic pain,” she wrote. “These vast opioid supplies created a risk for diversion, opioid misuse and disorder, and overdose death.”

The study did not find any significant difference when looking at what age groups were using heroin, but heroin dependency and addiction was significantly higher for those below the age of 45 than those above. That should be a cause of concern, said Banta-Green, who noted that one of the costs of overdoses and abuse to society is lost productivity.

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A county-by-county study released Wednesday by the Robert Wood Johnson Foundation, calculated that drug overdose deaths resulted in a 778 years of potential life lost for every hundred thousand people. This report also found that most of the increase in premature deaths in 15- to 44-year-olds is due to drug overdoses. And while no community is immune to this crisis, suburbs, which used to have the lowest rates of premature deaths from drug overdoses now have the highest rates.

The authors of the longitudinal study note that “heroin use appears to have become more socially acceptable among suburban and rural white individuals, perhaps because its effects seem so similar to those of widely available [prescription opioids].”

The findings of these new reports are in line with earlier research over the past two decades about increasing heroin and opioid overdoses. “The trend isn’t a surprise — the takeaway is what matters. Heroin use disorder is a serious medical condition with which individuals are likely to struggle for the rest of their life. We need to give them the tools they need to survive and thrive,” said Banta-Green.

This skyscraper is out of this world

Clouds Architecture Office has unveiled plans for a futuristic skyscraper dubbed the “Analemma Tower.” The building would hover majestically above the ground because it would be attached — wait for it — to an actual asteroid, in space, that is forcibly put into orbit around the earth.

If that’s not enough to digest, consider that your exact address in this pendulous pad could be anywhere on Earth. The tower will be suspended via high-strength cabling from an asteroid and placed in “eccentric geosynchronous orbit”. In other words, it would be always moving — residents and visitors would take a daily journey between the northern and southern hemispheres with a prolonged visit over a main “home” point like New York City or Dubai (it’s always New York City or Dubai, isn’t it?)

In 2015 the European Space Agency’s Rosetta Mission successfully landed on the surface of the comet Churyumov-Geraismenko showing that it is possible to interact with such smaller bodies in space. NASA’s “Asteroid Redirect Mission” is scheduled to send a robot to collect a boulder off an asteroid and then place that boulder into a stable orbit around the moon.

In like fashion, CAO plans to use an asteroid harnessed with high strength cabling reaching towards earth to hold the skyscraper along its journey.

Analemma Tower’s designer Ostap Rudakevych told CNN that the tower could be made of durable and lightweight materials such as carbon fiber and aluminum. Advances in cable engineering would be needed to achieve the cable strength required to support the structure. Power would come from space based solar panels that have a constant exposure to sunlight. Water for the tower will be captured from clouds and rainwater and maintained in a semi-closed loop system.

As proposed the top of the tower sits at 32,000m and would be expected to reach speeds of 300mph as it travels through the sky.

How you would hang out

The design leaves some pretty important questions to be answered, like, “What do I do if I want to also have a life on the ground?” “Won’t my family and friends miss me because they will only have a finite window each day in which to see me, and even then, I will be floating above the earth, unable to make contact?”

The upper reaches of Analemma would extend beyond the troposphere

The upper reaches of Analemma would extend beyond the troposphere

The upper reaches of Analemma would extend beyond the troposphere

If you have to ask these questions then, we hate to say it, you are probably not ready to live in a huge mobile asteroid tower, but the designers have your back nonetheless.

Rudakevych said he envisions large passenger drones allowing people to move back and forth between the tower and earth’s surface along with cutting edge electro-magnetic elevators moving people throughout the this fantastic vision.

Currently the proposal calls for the tower to be mid-air over Dubai which has a long history of building tall and stylish skyscrapers at a fraction of the cost of U.S. based construction.

When asked what inspired such a project, Rudakevych said, “Since humans have emerged from caves our buildings have been growing ever taller and lighter. We believe that some day buildings will break free from earths surface, releasing us from harmful floods, earthquakes and tsunamis. Analemma Tower is a speculative idea for how this might be achieved some time in the future.”

American climate refugees: Tragedy of a village built on ice

Their bodies are buried in the cemetery, I’m sure of it. I’ve seen the obituaries.

But neither man is dead.

No one in Shishmaref dies, I’m told — not really.

It’s about 9 a.m. as I trudge through the snow, past the cemetery and to a neighboring house. The sky is frozen in pre-dawn twilight. The sun won’t rise for hours.

An elder answers the door and welcomes me into a living room that smells of sourdough and coffee. On the shelves, above a big-screen TV: dozens of figurines carved from walrus ivory, a tradition in this 560-person Inupiat village. How meta, I think. Walrus ivory carved back into the shape of a walrus, as if the animal were reincarnated from its own tusks.

Even walruses have a second life here, apparently.

The man offers me a seat and a coffee mug.

I’m here to ask him about Esau.

Yes, one of the men in the cemetery.

But also the 19-year-old born with the same name — the hoodie-wearing kid with the faint mustache. The one, among many, who’s trying to imagine another future for this village.

A future away from this island.

The blue house

Shelton and Clara Kokeok live in a blue house at the edge of the village.

Shelton and Clara Kokeok live in a blue house at the edge of the village.

Shelton and Clara Kokeok live in a blue house at the edge of the village.

Everyone knows Shishmaref isn’t expected to last long.

Residents of this barrier island, located just south of the Arctic Circle, some 600 miles from Anchorage and only 100 miles from Russia, have been saying so for years.

To understand it, visit the tiny blue house at the edge of the land.

It’s the edge of the Earth, really. And it’s also the house where Norman grew up.

Norman, the second man in the cemetery.

Inside, an old woman sits in a wheelchair and an old man peers through the kitchen window at the Chukchi Sea. A cassette-radio buzzes with headlines from God-knows-where, but the man, Norman’s father, isn’t listening. Shelton Kokeok, a 72-year-old with palm-sized ears and a face that tragedy has worn into a grouper’s frown, is focused on the ocean. He scans it in a state of unease; creases etch his forehead. Shelton, who once was a light-hearted man, and whose kind eyes and infectious smile still hint at happier times, will be nervous until the water is frozen cement-hard. Today, in mid-December, it is the texture of a snow cone.

“It’s not really solid yet,” he tells me, forlorn. “Young ice, fresh ice, you know?”

These aren’t bored-old-man concerns.

The ice is disappearing.

And then there’s what happened to his son, Norman.

First, the ice.

Here, and across the Arctic, sea ice is forming later and thawing earlier.

That ice protects Shishmaref’s coast from erosion. Without it, punishing storms grab hunks of the land and pull it out to sea, shrinking and destabilizing the island.

Look at where the coast was in 2004 — and where it’s expected to be in 2053.

Shelton’s blue house is right on the edge of the receding coastline.

He worries it could fall in.

That happened to one of his neighbors.

A house fell off the edge of the land in 2006. The Kokeok home is shown in the background.

A house fell off the edge of the land in 2006. The Kokeok home is shown in the background.

A house fell off the edge of the land in 2006. The Kokeok home is shown in the background.

As the world warms — thanks largely to the 1,200 metric tons of carbon dioxide we humans are pumping into the atmosphere each second — the ice is disappearing. The planet has warmed about 1 degree Celsius since the Industrial Revolution, when people started burning fossil fuels for heat and electricity, creating a blanket of heat-trapping gases in the atmosphere. But scientists say the Arctic, the far-north, is warming twice as fast as the rest of Earth.

“I miss that cold, cold weather,” says Hazel Fernandez. I meet her in a community hall; she’d rather be fishing on the ice but says it’s still too thin. “It’s too weird. It’s too warm.”

Outside, thermometers show temperatures in the mid-20s Fahrenheit, or about minus 4 Celsius. That’s freakishly warm for December, everyone tells me. I’m wearing two coats and ski pants, and residents of Shishmaref seem to find that hilarious. This isn’t cold, they say. Their sealskin hats and mittens, the fur-lined hooded parkas — those mostly stay at home.

Fernandez, in her early 60s, fondly remembers temperatures of 30- and 40-below Fahrenheit.

But mean air surface temperatures increased more than 2 degrees Celsius (3.6 degrees Fahrenheit) in the Arctic region between 1960 and 2011, according to the US National Snow & Ice Data Center. Arctic sea ice, measured since 1979, was at a monthly record low in January. And the September sea ice minimum is decreasing at a rate of 13.3% per decade.

The scientific consensus is that human pollution is driving these changes.

But it’s not the science or the charts that matter most to Shelton.

It’s not his blue house, either, perched precariously on the edge.

It’s his son, Norman.

It’s that day: June 2, 2007.

The day Norman fell through the ice and died.

Esau

The stories about Esau are easy to unearth.

Like people here, they never truly die.

“What was Esau like?” I ask the elder whose home is next to the white crosses and the cemetery, in the heart of this village of wooden homes and metal-sided buildings, a place where the winter landscape is an infinity of white, where there’s no running water or sewage service, where a shower costs $3.50 at the holiday rate, a 12-pack of Sprite $12.75. Most people prefer to live off the land, hunting seal, walrus and ptarmigan and fishing tomcod as their ancestors did.

The elder replies in a tone that is airy and patient, a voice measured through time.

Esau Weyiouanna was something of a renegade in Shishmaref, he tells me. He was an individual in a place that prides itself on community — an opinionated, outspoken man in a village where many would prefer to blend with the environment. In a photo that hangs on a friend’s wall today, Esau wears purple-and-green plaid and Napoleon-Dynamite bifocals, a knowing, understanding smile on his lips. His eyebrows are angled and inquisitive, like an owl’s.

The local church in Shishmaref, Alaska.

The local church in Shishmaref, Alaska.

The local church in Shishmaref, Alaska.

Allow the elder to share one story.

Decades ago, the Christian church decided to ban some of the village’s Inupiat traditions, which had been passed from one generation to the next for centuries, if not longer. The church believed some of these traditions defied the will of God and were incompatible with its teachings. Dancing, in particular, was banned. Children of Shishmaref no longer could gather with drums made of stretched walrus stomach to move their bodies in the same artful patterns their parents, grandparents and great-grandparents always had, the elder tells me.

Esau was the rare man who could see both sides of this dispute, the kind of man who straddled worlds both modern and ancient. He served on the church board, the elder says. But he also loved the Inupiat cultural traditions — particularly the dance. So he took a stand. Esau danced boldly and in public, the elder tells me, to remind the community of the value of culture.

Today, the elder says, children are taught this dance in the local school.

This portal to the past remains open because of Esau.

Renegade, reborn

Decades later, and nearing death, Esau tried to ensure his story would continue.

He walked up to a pregnant woman and touched her stomach.

How am I doing in there? he asked.

It was a startling question, but up here in a world of ice, where no one really dies, or not for long, the meaning was clear to the mother. She knew Esau’s body soon would be laid to rest in the cemetery, and that he would be reincarnated as the child still growing inside her.

Esau Weyiouanna was declared dead on October 29, 1997.

On November 16, the woman’s child was born.

The family, following tradition, named him Esau.

Esau Sinnok.

A village renegade, reborn.

Norman

Shelton and Clara Kokeok, with a photo of their deceased son, Norman, who fell through the ice in 2007.

Shelton and Clara Kokeok, with a photo of their deceased son, Norman, who fell through the ice in 2007.

Shelton and Clara Kokeok, with a photo of their deceased son, Norman, who fell through the ice in 2007.

Elders say the ice should have been safe that day in 2007.

Norman had been on a hunting trip and was heading back into town in the early morning of late spring, when lower latitudes would still be shrouded in darkness but when this village sees nearly eternal sunshine, the tilt of the Earth making it possible to hunt through the night.

Village elders and family members tell me he was crossing a narrow part of the lagoon that separates Shishmaref and its barrier island from mainland Alaska. It may sound strange to drive a snowmobile across ice-covered water in June. But elders tell me the ice should have been frozen solid that time of year — that there was no indication Norman would be in danger.

Now, everyone is less trusting.

Some haven’t gone hunting on the ice since.

Norman’s death was particularly hard on his father, Shelton, who keeps a photo of the young man, wearing a buzz cut and Reno-911 mustache, on his coffee table, facing the door for all to see. Norman was a second-chance child, one he taught to hunt seal and follow traditions Inupiat people had followed here for at least four centuries, if not many more. Yet, from birth, the boy had an air of tragedy about him, even if no one in the family dared say so aloud.

It was in the name: Norman.

Norman was named after Shelton’s brother, who died in a plane crash.

The tragedy brought Shelton together with Clara, who was married to his brother.

In the wake of the accident, the two mourners decided to marry. Love was at the heart of it, to be sure, but Shelton also felt a sense of duty — duty to occupy the loving, supportive station his brother had left vacant in Clara’s life.

When one man leaves, another stands in his place.

‘Like an old soul’

Esau Sinnok, 19, was adopted by his aunt, Bessi Sinnok.

Esau Sinnok, 19, was adopted by his aunt, Bessi Sinnok.

Esau Sinnok, 19, was adopted by his aunt, Bessi Sinnok.

The boy always seemed to possess knowledge from another life.

As a toddler, Esau Sinnok spouted off phrases in Inupiaq, the local language, even though no one had taught him to do so. Then, as a young boy, Esau was traveling with his birth mother across the empty landscape that surrounds Shishmaref. “That’s where I used to camp,” he told her. It was the very spot where his namesake, Esau Weyiouanna, used to stay.

It was as if the renegade elder were speaking through the boy.

A voice carried on the wind from one generation to the next.

People in the village treat it this way.

For many, it’s not just that young Esau reminds them of his namesake. It’s that Esau is the namesake elder, returned from the grave and walking among them. They sometimes call him “father” or “brother” or “cousin,” referencing their relationships with the elder who passed away.

Esau inherited the elder’s respected status, too. “He’s like an old soul,” says his adoptive mother, Bessi Sinnok. “He’s very outspoken, like his namesake. His namesake was very respected by lots of people and because of that he had already earned respect as he was growing up.”

Teenage Esau never knew this when he was young. Bessi Sinnok told me the village hid the history from him. She wanted her son to form his own identity.

Yet she watched as the elder’s personality seemed to emerge from the boy. Esau, who was nearly mute as a child, they say, bookish and reserved, grew to be an outspoken and free-thinking young man, much like the elder Esau — and much to the surprise of his family.

Two events helped encourage the shift.

One was a storm in 2006.

Esau remembers the waves crashing over his grandparent’s roof.

The small blue house at the edge of the land once seemed like it might stand forever.

After the storm, he tells me, “We thought the house would collapse.”

The other was the death of his uncle, Norman, the man who feel through the ice.

Esau was only 9.

“It really hurts,” Esau tells me. He’s now a 19-year-old college student with heavy eyes and mussy hair. “It really made me cry and wonder why he left so early. And there’s not a day that goes by that I do not think of him. He’s always on my mind. He’s always in my heart.”

‘Climate change is happening real fast’

Local meats, including seal, hang from drying racks in the village. Seal oil, made from blubber, is a staple.

Local meats, including seal, hang from drying racks in the village. Seal oil, made from blubber, is a staple.

Local meats, including seal, hang from drying racks in the village. Seal oil, made from blubber, is a staple.

A few years after Norman’s death, Esau moved into Shelton and Clara Kokeok’s blue house at the edge of the Earth. Esau tells me he wanted to help his grandparents with chores his uncle might have performed, which would have included things like getting ice for drinking water from the lake, washing clothes in the local “Washateria” and emptying the “honey bucket” toilet.

Shelton remembers telling his grandson how much the village had changed over the years, how the weather wasn’t cold like it used to be, how these storms seemed bigger now, how much of the land, including the neighbor’s house, had already disappeared — and how he might be next.

“When I built this house, there was still more ground out there,” Shelton says. “We’re right on the edge of the beach now … Climate change is happening real fast.”

But none of this made sense to Esau — not really — until his senior year of high school.

That’s when he took Ken Stenek’s science class.

Stenek, an affable, big-smiling guy with a wiry beard and a kettlebell figure, told the students about the greenhouse effect — how pollution, mostly from fossil fuels, hangs around in the atmosphere and acts like a blanket, heating the planet. They watched “An Inconvenient Truth,” the high-profile documentary featuring former Vice President Al Gore and a graph often called the “hockey stick.” That now-famous chart shows that levels of carbon dioxide in the atmosphere haven’t been this high in hundreds of thousands of years.

Esau learned that a consensus of climate scientists — at least 97% — agree humans are causing rapid warming, and that continuing to pollute at current rates would be catastrophic, contributing to mass extinction, searing droughts, deadlier heat waves and more.

They also talked about the consequences for Shishmaref.

The “erosion” everyone in town was discussing?

That was related to the melting sea ice, the thawing of permafrost, the frequency of damaging storms. In short: By burning fossil fuels, people were helping destroy this village.

If you’d asked him the year before what he wanted to do with his professional life, Esau would have told you he wanted to be a petroleum engineer, like his brother. Good money, he’d say, unaware that extracting and burning fossil fuels like oil is contributing to the problem.

Now, however, Esau was learning the science.

He thought about his grandfather’s house.

His uncle’s death.

He believes that climate change had a hand in both.

‘Imminent’ threats

This education took him all the way to Paris.

Through Ken Stenek’s science class, Esau met researchers who were studying climate change and its consequences. And through those connections he became an Arctic Youth Ambassador, which is a program of two federal agencies and Alaska Geographic, a nonprofit. He learned that Shishmaref is not alone — that 31 villages in Alaska face “imminent” threats from erosion and other issues related to climate change, according to a Government Accountability Office report; and that 12 of them were exploring relocation options because of warming.

Esau started to wonder: Could Shishmaref actually survive the melting of the Arctic?

Was his village’s life nearing its end?

Or the start of a new beginning?

Those questions never occurred to Esau before, although they had been on the lips of older people in Shishmaref for years. They’re questions kept from young people, hoping to protect them, wanting them to grow up with a sense that the world is more certain than it is.

The Obama White House named Esau a Champion of Change for Climate Equity. He got to go to Washington. Then, he said, with help from the Sierra Club, an environmental group, he got to attend international climate change negotiations in Paris in December 2015. It was that meeting — which is often called “COP21,” since that’s simpler than “the 21st meeting of the conference of parties to the UN Framework Convention on Climate Change” — where world leaders agreed, after decades of failure, to work together to end the fossil fuel era.

The target: Limit global temperature increases to no more than 2 degrees Celsius.

Basically, that means eliminating fossil fuels this century.

In Paris, hope filled the air — hope for a cleaner, safer future.

Esau, meanwhile, arrived in the French capital terrified.

It was just so different from Shishmaref.

“It felt a little claustrophobic to me, being in a big city for the first time,” he says. “It felt like I just can’t take a walk or go outside and walk without thinking of being threatened or beat up. When you walk around here, you don’t feel that. Everyone here is family. You get a sense of trust.” He was so afraid of Paris — its clustered buildings, sidewalks thick with people, streets clogged with smoking cars — that he did not dare leave the hotel without an escort.

The scale of the place got to him in other ways, too.

How much pollution are all these people creating?

How do you get all of them to change?

In a word: overwhelming.

Yet amid this chaos, Esau made another leap of understanding.

‘Before it completely erodes away’

Percy Nayokpuk owns one of two stores in town. "Climate change is happening," he says.

Percy Nayokpuk owns one of two stores in town. "Climate change is happening," he says.

Percy Nayokpuk owns one of two stores in town. “Climate change is happening,” he says.

Rae Bainteiti comes from Kiribati, a tropical island nation that could not be more geographically dissimilar from Shishmaref. Sun and sand vs. ice and snow. The two places are thousands of miles apart, separated by the vast Pacific Ocean and a half-world of latitude, with Shishmaref near the Arctic Circle and Kiribati near the equator. Yet when an interviewer sat Rae down with Esau in Paris, the two young men discussed the perils of a common threat.

Both may have to relocate because of climate change.

“My future generation of kids will be the last ones that will actually be on the island of Shishmaref before it completely erodes away,” Esau tells Rae in the Paris interview, which is posted on YouTube.

He looks directly at the other young man.

“It’s just really sad knowing that you probably have to relocate and migrate, too,” Esau says.

“Your country has to be stopped from melting so we don’t see water rising,” Rae replies.

The two share a laugh at the irony of the situation: As Arctic ice melts and oceans warm, sea levels around the world are rising. A host of locations, from Pacific islands like Kiribati to low-lying countries like Bangladesh and cities from New York to Shanghai will be threatened with coastal flooding — and possibly relocation, too — as people continue to pump greenhouse gases into the atmosphere. Already, Miami Beach, Florida, is installing pumps and raising street levels to try to hold the water back. That work is only the beginning of a $400-million-plus project. In 2016, the community of Isle de Jean Charles, Louisiana, got a $48 million federal grant to relocate, in part because of rising seas. But this is the exception rather than the rule. Most local governments don’t have the money for infrastructure to hold rising tides back.

Experts say there are no programs — in the United States or internationally — designed specifically to plan and fund climate-driven relocations. Only a few moves have been funded with money designated for climate adaptation projects, said Elizabeth Ferris, research professor at Georgetown University’s Institute for the Study of International Migration.

“Governments are reluctant to think about planned relocations because everyone wants to stay where they are,” she told me. But “if it isn’t planned well, it just doesn’t work. It leaves people much worse off.”

“There’s no federal or state law — no institution in the United States — with a mandate for how are we going to manage relocation internally,” said Alice Thomas, the climate displacement program manager at Refugees International, a non-profit group. “It’s going to be enormously expensive. It’s going to be very vulnerable people … people who aren’t going to be able to cut their losses on their home when they can’t get flood insurance. Where will they go?”

In Shishmaref, the answer remains unclear.

Relocation

Local officials in Shishmaref discuss the possibility of climate relocation. They do not have the money to move.

Local officials in Shishmaref discuss the possibility of climate relocation. They do not have the money to move.

Local officials in Shishmaref discuss the possibility of climate relocation. They do not have the money to move.

August 2016.

Globally, it tied for the hottest month of the hottest year on record. In Shishmaref, residents went to the polls to decide whether they would relocate because of warming.

The answer: Yes, by a margin of 89 to 78, according to local officials.

But the August 16 vote did not solve Shishmaref’s trouble. Far from it.

Annie Weyiouanna, local coordinator for the Native Village of Shishmaref, tells me the tribe has no money to fund the move. And this isn’t the first time the village has held a relocation vote. They did so in 2002, as well. Nothing changed. No one in the village today is packing. And Weyiouanna has tried to stop using the word “relocation” — or uses it minimally, sometimes correcting herself — because she worries it will signal to funding agencies in the state and federal governments that the village will be gone soon and doesn’t need help with grants or infrastructure. The reality is that no one knows how long the village will be stuck.

Perhaps forever, some worry, or until the island is gone.

“They are not safe right now, and their lives are in danger because of the storms that are coming in,” said Robin Bronen, executive director of the Alaska Institute for Justice and a senior research scientist at the University of Alaska Fairbanks. She was referring to Shishmaref as well as Newtok and Kivalina, Alaska, which face similar circumstances. “(T)hey just need a large sum of money to get them to the places that they’ve chosen so they can be safe.”

Shishmaref has identified two potential sites for a new version of the community. Both are inland, meaning hunters and fishers would not be able to access the sea as easily. Some people in the community — particularly elders — believe the move threatens the tribe’s Inupiat identity.

Away from the coast, are they still the same people?

Why should they move when others are driving climate change?

Esau has wrestled with these questions, too. His grandparents, Shelton and Clara, the couple in the blue house at the edge of the Earth, who lost their son to the ice, do not want to leave. They want to stay in their home — in the community they know so well — no matter the risks.

Esau worries about them.

“If you ask the older generations like my grandfather, their views are totally different,” he tells me. “They want to stay on this island forever and ever. And I respect that decision. They’re my elders.

“But, to me, I think we have to relocate so that our future generations can still be alive.”

Norman, age 7

In the winter, the skies in Shishmaref appear to be frozen in twilight.

In the winter, the skies in Shishmaref appear to be frozen in twilight.

In the winter, the skies in Shishmaref appear to be frozen in twilight.

On my last day in Shishmaref, Esau and I paid his old science teacher a visit.

We found Ken Stenek in a cream-colored house with Christmas lights on the roofline. He lives on a part of the island where houses are newer. Some were moved from the side where Esau’s grandparents live, and where coastal erosion is more threatening.

Standing in his home, I couldn’t help but think about the cemetery.

About the two men — Esau and Norman — who are buried there.

Two young people, bearing those names, were standing in the room with me.

There was Esau Sinnok, standing in the entryway, of course.

But also Norman, sitting on the sofa in the living room.

Norman Stenek, age 7.

The boy was named after Esau’s uncle, the one who fell through the ice.

When I visited, young Norman seemed more interested in a tablet computer than a conversation with a random reporter, and I can’t blame him for that. Still, the encounter sticks with me.

It made me wonder: What will his life be like?

His name — Norman — carries a tragic legacy. The death in the plane crash. The fall through the ice. Will this 7-year-old live to see the rest of the village drown beneath the waves, too?

Will the same happen to millions of coastal residents during his lifetime?

And what about Esau?

Sometimes I think the weight of this tragedy falls on his young shoulders. His namesake was a local agitator and his uncle’s death drove him into activism. The strength of his voice — his power to command attention — has surprised a village where few care to stand out from the crowd. He speaks out against fossil fuels, saying that the world must rush to a future with 100% renewable, clean energy. It may be too late for Shishmaref, he says, but what about other communities in similar straits? How many people will pollution force from their homes?

“I don’t blame it on one person, or a group of people. It’s all our fault,” Esau tells me. “It’s not the 1940s anymore. We can’t use fossil fuels anymore to heat our homes and use for our energy.

“We can transition from dirty fossil fuels to renewable energies.”

But how much weight can a 19-year-old bear?

The rest of us must realize our role in this tragedy.

Responsibility for Shishmaref’s plight falls on those in the industrialized world who continue to pollute the atmosphere with carbon, knowing it will warm the climate, melt the ice and make it less likely Shishmaref will survive. It falls on the Trump administration, which has moved to defund and upend climate change initiatives instead of planning for a transition to cleaner power sources, like wind and solar. It falls on politicians who know the scope of the impending climate relocation crisis but have done little to make adequate plans or secure appropriate funding.

Shishmaref is part of America, even if it’s rarely treated that way.

It is a place where people never really die, where the cemetery on that hilltop in the center of the island is full of people like Norman and Esau who are kept alive by names and stories. The question now is whether villages, like people, can be reincarnated.

Can Shishmaref be reborn?

Sadly, it’s a question the village cannot answer on its own.

12 of the best canalside hotels in Amsterdam

But one thing beats, and links, them all: Amsterdam’s canals.

Not only do these 17th-century transport routes lend the Dutch capital a certain grandeur, they also provide locals and visitors with a great place to soak up the city’s atmosphere.

Staying in a hotel that overlooks one of these elegant canals is one of the best ways to enjoy these waterways.

Here are 12 of the best luxury five-star canalside hotels Amsterdam has to offer.

Grand Hotel Amrâth Amsterdam

Few hotels in the city can beat the Grand Hotel Amrâth Amsterdam for both location and looks.

The five-star venue, which originally opened in 1916 as offices, sits within the Scheepvaarthuis, or shipping house, a classic building sitting right next to the city’s Central Station.

The Scheepvaarthuis’s radical expressionist design — Art Nouveau with a Dutch twist — went on to define the Amsterdam School of architecture, heavily influencing the look of subsequent modern buildings.

The Amrâth, recently extended to 40 rooms, offers sublime views over the spacious IJ, Amsterdam’s main waterfront, and the romantic Waalseilandsgracht canal.

Grand Hotel Amrâth Amsterdam, Prins Hendrikkade 108, Amsterdam; +31 20 552 0000

InterContinental Amstel Amsterdam

InterContinental Amstel Amsterdam: The city's "grande dame."

Located on the banks of the River Amstel, the InterContinental is known as the city’s grande dame, thanks to its longevity and rather formal appearance.

In 2017, the hotel is celebrating its 150th anniversary with festivities and a complete restoration of its palatial exterior.

The Royal Afternoon Tea provides the perfect chance to relax while staring out over the river.

InterContinental Amstel Amsterdam, Professor Tulpplein 1, Amsterdam; +31 20 622 6060

Waldorf Astoria Amsterdam

The classically beautiful Waldorf Astoria Amsterdam is made up of six traditional canalside palaces from the 17th century.

It sits on the Herengracht, and though it’s relatively new, it’s earned TripAdvisor’s 2017 Travelers’ Choice Award for the luxury category of The Netherlands.

The luxurious but modern decor feels airy, and the tulips in the private gardens add to the Dutch feel.

One of its restaurants, the Librije’s Zusje, has two Michelin stars.

An extra bonus: the honey served at breakfast comes from the hotel’s rooftop beehives.

Waldorf Astoria Amsterdam, Herengracht 542-556, Amsterdam; +31 20 718 4600

The Dylan Amsterdam

The Dylan is small and chic, a renovated boutique hotel dating back to the 17th century.

Heavy wooden joists give many of the rooms an original feel, but the decor and ambiance are very much modern and sleek.

The hotel sits on the “grachtengordel,” or Amsterdam’s central canal belt.

Shopping enthusiasts will happily stumble upon the Nine Streets upscale area just around the corner, full of boutiques and cute canalside cafes.

Dinner is served in the hotel at the brasserie Occo or the Michelin-starred Vinkeles.

The Dylan Amsterdam, Keizersgracht 384, Amsterdam; +31 20 530 2010

Pulitzer Amsterdam

Twenty-five connecting 17th- and 18th-century aristocratic canal houses make up the Pulitzer, resulting in a dazzling maze on the inside with a tranquil inner garden.

One of the best features of this stylish hotel is the possibility to walk around the city with one of the concierges, allowing guests to see Amsterdam through a local’s eyes.

Another option is to cruise the canals in the hotel’s stylish boat built in 1909.

Pulitzer Amsterdam, Prinsengracht 315 — 331, Amsterdam; +31 20 523 5235

Sofitel Legend The Grand Amsterdam

The entrance gate of The Grand will be covered with tulips from April to mid-May.

The Grand was first a 15th-century convent, then housed royals before becoming the City Hall of Amsterdam.

Princess Beatrix, the former queen of The Netherlands, married Prince Claus in 1966 in the former council chamber here.

Though the hotel, which opened in 1992, is situated near the Red Light District, where sex workers legally ply their trade, it’s a quiet oasis away from the tourists.

Planning to visit Amsterdam in spring? The entrance gate will be covered with orange flowers for the Tulip Festival which runs from April 1 to May 14.

Sofitel Legend The Grand Amsterdam, Oudezijds Voorburgwal 197; +31 20 555 3111

Luxury Suites

Newcomer Luxury Suites combines the services of a hotel with the independence of an apartment.

Order food or cook a homemade meal in the suite’s private kitchen.

The large and fully equipped suites overlook the Oudeschans, a wide canal at the east side of the city center, and are surrounded by typical Amsterdam warehouses.

The hotel offers packages including one for romance and another for diamond lovers.

Luxury Suites, Oudeschans 75, Amsterdam; +31 20 723 8300

Andaz Amsterdam

Andaz is located in a former library and designed by the renowned Dutch designer Marcel Wanders.

The hotel made no effort to make the interior traditional — more than 50 pieces of video art are on display, giving the place a modern feel splashed with Delft blue pottery and vases.

Andaz offers complimentary wine for a couple hours daily, as well as free bikes.

Rooms come with a choice of a view of the tranquil inner garden or the mesmerizing canal.

Andaz Amsterdam, Prinsengracht 587, Amsterdam, +31 20 523 1234

Hilton Amsterdam

Hilton Amsterdam throws one of the best herring parties in the country.
John and Yoko Ono held their famous “bed-in for peace” in one of the rooms here in 1969, the aptly named John and Yoko suite.
The hotel is within walking distance of the Amsterdam’s Museum Square where the Van Gogh Museum and the famous Dutch national museum Rijksmuseum are located.

The Dutch love their salted herring, and they also like to launch the season with a good party.

One of the most renowned ones is the private, invite-only, VIP, glamorous party held every year at the waterside garden in the Hilton Amsterdam.

Hilton Amsterdam, Apollolaan 138, Amsterdam; +31 20 710 6000

De L’Europe

Central as it comes, this hotel is near shopping, tourist attractions, the Red Light District, the Canal Ring and Amsterdam’s Central Station.

Built as an inn in 1636, the hotel has welcomed guests ever since.

The hotel’s Michelin-starred restaurant Bord’Eau offers a great, reasonably priced three-course lunch menu.

This not only gives guests somewhere decent to eat, but also helps the ongoing campaign to convince locals that there’s more to lunch than just a sandwich.

De L’Europe, Nieuwe Doelenstraat 2-14, Amsterdam; +31 20 531 1777

NH Collection Amsterdam Doelen

NH Collection Amsterdam Doelen: Outstanding river views.

Rembrandt painted the famous Nachtwacht (The Night Watch) originally to be exhibited in the De Doelen, as the hotel was called in the 17th century.

After that, many VIPs booked rooms at the Doelen, such as Empress Elisabeth of Austria and The Beatles.

Stunning views over the River Amstel can be seen through the hotel’s grand windows.

All the rooms were renovated in 2016, giving it a grand but modern feeling.

NH Collection Amsterdam Doelen, Nieuwe Doelenstraat 26, Amsterdam; +31 20 554 0600

Hyatt Regency Amsterdam

Amsterdam’s newest five-star hotel officially opens in April 2017.

If a quieter stay is desired, the Hyatt — located near Amsterdam’s trendy and leafy east district — may suit.

Guest can take a stroll down to the nearby Oosterpark, have a drink at one of the many hip cafés in the neighborhood or visit the Tropenmuseum nearby, the museum about humans.

Indonesian dinner is available at the hotel bar and restaurant called Mama Makan.

Hyatt Regency Amsterdam, Sarphatistraat 104, Amsterdam; +31 20 554 1234

Katja Brokke is a freelance journalist and editor from Amsterdam specializing in food, travel and media. Follow her on Twitter at @KatjaSchrijft or take a look at katjaschrijft.nl.

Greatest rise in heroin use was among white people, study says

More people die from drug overdoses than from guns or car accidents. At the peak of the AIDS epidemic in 1995, 43,115 people in the United States died from the disease.

Furthermore, since 1999, the number of overdoses from prescription opioids like oxycodone and hydrocodone, as well as illicit drugs like heroin, have quadrupled. In fact, heroin now accounts for one in four overdose deaths in the United States.

Now, a new study in the journal JAMA Psychiatry looks beyond the total number of overdose deaths to get a better picture of how heroin use patterns have changed since 2001. Since then, the number of people who have used heroin has increased almost five-fold, and the number of people who abuse heroin has approximately tripled.

The greatest increases in use occurred among white males.

Heroin use on the rise

The authors evaluated the responses of 79,402 individuals, as collected from the 2001-2002 and the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions, a longitudinal study conducted by the National Institutes of Health to evaluate alcohol and drug use and abuse. While heroin use between whites and non-whites was fairly similar in the 2001-2002 results, at 0.34% and 0.32% respectively, by 2012-2013 the percentage of whites who had used heroin jumped to 1.90%. Just 1.05% of non-whites in 2012-2013 used heroin. Heroin use also increased significantly among those with a high school education or less, as well as those who lived at less than 100% of the federal poverty line.

The authors of the new report write “these trends are concerning because increases in the prevalence of heroin use and use disorder have been occurring among vulnerable individuals who have few resources to overcome problems associated with use.”

According to a 2016 Surgeon General’s report on alcohol, drugs and health, only one in 10 of those with a substance use disorder receive any treatment.
“The good news is that among all drugs of abuse, heroin and opioids have by far the best treatment medications available. Methadone and buprenorphine have proven effectiveness data, they not only reduce the chances of dying from an opioid overdose by 50%, they support people being in recovery from their addiction and reduce health care costs and improve a wide array of other outcomes,” said Caleb Banta-Green, an associate professor of health services at the University of Washington. Banta-Green was not involved in the study.

Starting with prescription drugs

The study also confirmed the idea that many heroin users start by using prescription opioids like oxycodone and hydrocodone. Approximately one-third of all white heroin users reported using prescription drugs for non-medical purposes in 2001-2002. By 2013 more than half of all white heroin users started by initially using prescription drugs. For non-whites, the number of people who started by using prescription drugs before heroin actually dropped in the same time frame.

An accompanying editorial by Bertha Madras, a psychologist at McLean Hospital in Massachusetts and former deputy director in the White House’s Office of National Drug Control and Policy pointed to the shift in treating pain as a major factor in understanding the current crisis. She noted that in the past two decades, the number of opioid prescriptions has risen three-fold.

“This shift in practice norms was fueled by acceptance of low quality evidence that opioids are a relatively benign remedy for managing chronic pain,” she wrote. “These vast opioid supplies created a risk for diversion, opioid misuse and disorder, and overdose death.”

The study did not find any significant difference when looking at what age groups were using heroin, but heroin dependency and addiction was significantly higher for those below the age of 45 than those above. That should be a cause of concern, said Banta-Green, who noted that one of the costs of overdoses and abuse to society is lost productivity.

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A county-by-county study released Wednesday by the Robert Wood Johnson Foundation, calculated that drug overdose deaths resulted in a 778 years of potential life lost for every hundred thousand people. This report also found that most of the increase in premature deaths in 15- to 44-year-olds is due to drug overdoses. And while no community is immune to this crisis, suburbs, which used to have the lowest rates of premature deaths from drug overdoses now have the highest rates.

The authors of the longitudinal study note that “heroin use appears to have become more socially acceptable among suburban and rural white individuals, perhaps because its effects seem so similar to those of widely available [prescription opioids].”

The findings of these new reports are in line with earlier research over the past two decades about increasing heroin and opioid overdoses. “The trend isn’t a surprise — the takeaway is what matters. Heroin use disorder is a serious medical condition with which individuals are likely to struggle for the rest of their life. We need to give them the tools they need to survive and thrive,” said Banta-Green.

What caused deadly outbreak at these hospitals

UPMC informed the Allegheny County Health Department, Pennsylvania Department of Health, and U.S. Centers for Disease Control and Prevention that its independent testing led UPMC officials to believe the linens were the likely source of the outbreak, according to the emails.

The new emails reveal additional testing seeking to pinpoint the source of the outbreak.

An email sent May 5, 2016, by Jeff Miller, a field epidemiologist for the CDC, said that environmental samples were taken on February 21, 22 and April 21, 2016, at UPMC Presbyterian and Montefiore hospitals and Paris Co. laundry facilities. The testing was requested by UPMC and conducted by an independent contractor.

A whole genome sequencing report by an independent laboratory based on these specimens “[suggests] that fungi from Paris have been brought into the [Presbyterian University Hospital] laundry,” according to the report provided in the email.

“It is looking more likely than ever, that the linen vendor is the more likely potential source of mucor as you can see by the reports,” said an email sent by Allegheny County Health Department Chief Epidemiologist LuAnn Brink on June 21, 2016, in which she shared “notes from UPMC.” It is unknown who from UPMC sent Brink the notes. Mucor is a species of mucormycosis, which are fungal spores commonly found outdoors. However, they can cause a rare and sometimes fatal fungal infection in patients who are immunocompromised, according to the CDC.

A whole genome sequencing report compares environmental samples from which the DNA has been extracted and sequenced to show the fingerprint of the sample at a high resolution, according to Dr. Barun Mathema, an assistant professor of epidemiology at Columbia’s Mailman School of Public Health who CNN contacted independently on Monday.

“Nobody is a 100% sure, if you read carefully, there will always be a bit of a wiggle room caveat,” said Mathema, who was not involved in testing the samples from Pittsburgh. In general, it is rare that epidemiological testing comes to an absolutely conclusive result because of variables that come into play when epidemiologists attempt to replicate the exact environment in which the case occurred.

Additional testing

This isn’t the first report to link the mold outbreak to hospital linens. In a separate, UPMC-contracted internal report, testing conducted on February 1, 2016 by hospital environmental specialists Andrew Streifel and Michael Buck found a heavy buildup of lint and mold near the Paris Co. linen facility vent through which unfiltered air dried the linens.

When Streifel and Buck went to the hospitals and tested linen from Paris Co., a cart of wet sheets delivered to the Montefiore laundry storage area bore “heavy fungal growth of Mucor and rhizopus,” according to their report, which was not made public until early 2017.

“Our hospitals are safe, and our ongoing monitoring and testing show no evidence of a mold outbreak. We and the nation’s top health regulators have found no definitive or unifying cause of the previous infections, which are known to occur on occasion at most major medical centers,” UPMC spokeswoman Allison Hydzik said in a statement to CNN when asked to respond to the contents of these emails.

UPMC “will address specific allegations in court and not in the media,” Hydzik said.

The Allegheny County Health Department provided CNN with the emails, which were incorrectly redacted to reveal more information than intended. The emails were provided in response to an open records request under the state’s Right to Know Law. The county records department withheld several other emails on the grounds of privacy for patients’ information.

“While we were made aware of all steps that UPMC was taking to identify potential sources, including looking at linens, there was no identification of the linens as the source of the outbreak. Similarly, as has already been stated by the department, ACHD was an observer in this process, not the regulatory agency looking into this,” Allegheny County Health Department spokeswoman Melissa Wade said in a statement to CNN when asked about the emails.

“Our products are safe. We have nothing to hide. We have followed and continue to follow protocols of the Healthcare Laundry Accreditation Council by providing hygienically clean linens to our customers,” Paris Co. CEO Dave Stern said in a statement to CNN when asked about the content of the emails.

CDC and state officials respond

In a phone interview this week, Sharon Watkins, director of the bureau of epidemiology for the Pennsylvania Department of Health said the mold investigation is continuing. At no time has the state or the CDC determined that linens were the most likely cause of the UPMC mold outbreak, she said.

“I don’t know why anyone would say that,” Watkins said, referring to the email that said “the linen vendor is the more likely potential source of mucor.”

UPMC is required to provide the Pennsylvania Department of Health with regular updates concerning the investigation, Pennsylvania Department of Health spokeswoman April Hutcheson said.

Since May 2016, the Pennsylvania health department has been “in constant consultation with the CDC on this issue, including epidemiological evaluation of new information, a site visit, and current review of system-wide UPMC data,” Hutcheson told CNN in a statement when asked about the emails.

“There is no evidence to indicate an ongoing outbreak at this time; however, the state health department is in the process of reviewing additional information as part of the ongoing investigation.”

The UPMC hospital system mold outbreak began in October 2014. By September 2015, four patients had died of fungal infections at UPMC Presbyterian and Montefiore hospitals. By that time, the transplant ICU at Presbyterian had temporarily closed.

In September 2015, while the Presbyterian transplant ICU was closed, the CDC investigated possible sources of the mold outbreak. The results of the investigation were published in the May 2016 Morbidity and Mortality Weekly Report. Investigators said that the fatal infections were not attributed to the mold-covered linens, but rather to ventilation that may have allowed dust and mold spores to enter the hospital rooms.

The CDC maintains that conclusion despite what the newly uncovered emails say, Skinner said. The CDC findings were not addressed in the recently released emails.

In May 2016, Pennsylvania Governor Tom Wolf again requested the CDC consult with the state health department and UPMC because a fifth fungal infection recipient had been identified in the Presbyterian ICU, CDC spokesperson Tom Skinner told CNN when asked about the content of the emails. Wolf’s press secretary, J.J. Abbott, confirmed the request in an email to CNN.

That additional patient was Daniel Krieg, a kidney transplant patient who died in July 2016. UPMC medical reports show Krieg had fungal pneumonia and that fungal-infected sections of his left lung were removed. A CDC representative returned to UPMC on June 22, 2016, with officials from the state and county departments of health to discuss the outbreak and Krieg’s case, Skinner told CNN on Monday.

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An agenda in the newly revealed emails said health officials were to discuss laundry processes at Presbyterian, Montefiore, and Shadyside hospitals at the June 22, 2016 CDC visit.

The day before that visit, an June 21, 2016, email sent by Brink also said that UPMC was working with the linen vendor to “improve their product.” The email also said the hospital system was “aggressively pursuing” an alternative linen solution for all transplant patients in the ICU at Presbyterian hospital.

UPMC said in a January 2016 statement that high-risk transplant patients would receive linens with a lower bacterial count going forward. Hospital linens are required to be “hygienically clean,” according to the Healthcare Laundry Accreditation Council. (PDF) That means linens are not sterile, but in a clean state, free of pathogens in sufficient numbers to minimize risk of infection, and the clean textiles are not inadvertently contaminated before use, according to the CDC.

“Despite the lack of a definitive source, UPMC still went above and beyond state and federal recommendations in order to implement changes to protect our patients. One of the many changes includes the provision of specially treated bioburden-reduced linens to our highest risk transplant patients,” UPMC spokeswoman Hydzik told CNN previously.

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