Christie will advise Trump panel on addiction

President Donald Trump made the announcement at a meeting at the White House Wednesday, with Christie sitting by his side. Trump introduced him as a “very effective guy” and said the governor will work with representatives in state and local government, as well as law enforcement, medical professionals, and victims to figure out the best ways to deal with this epidemic.

Since 1999, the number of overdose deaths involving opioids quadrupled. From 2000 to 2015, more than 500,000 people died from drug overdoses, and opioids account for the majority of those deaths. It’s estimated 91 Americans die every day from this addiction, according to the Centers for Disease Control and Prevention, and for every death, more than 30 others are admitted to the emergency room.
The Trump administration has said opioid addiction and treatment are priorities. On the campaign trail, Donald Trump spoke about expanding incentives for states to use drug courts and mandate treatment. He also vowed to expand access to treatment slots.
The proposed Trump budget (PDF) released this month highlighted a $500 million increase from above 2016 levels to expand opioid misuse prevention efforts and to increase drug treatment. It is unclear if that increase would be from additional funds, or if it would be from money made available through the 21st Century Cures Act, which President Barack Obama signed in December. That legislation provides $1 billion for drug treatment for fiscal years 2017 and 2018.
Christie has spoken at length about his efforts to end the opioid epidemic. His state has had its share of problems. There has been a significant 16.4% increase in drug overdose deaths in New Jersey from 2014 to 2015, according to the CDC. There were 1,600 lives lost in 2015 alone, which is four times the number of homicides in the state and three times the number of fatalities in accidents that year.

In response, Christie has signed Senate Bill 3, a bipartisan initiative that requires health insurance to cover treatment and substance abuse without delay. “Now, with this legislation, people seeking treatment cannot be denied access in their time of need,” Christie said when signing the bill last month.

The law also creates what Christie called some of the country’s strongest maximum limits on initial opioid prescriptions. That means doctors can only give their patients a five-day prescription for opioid pain pills. Other states, including New York, Massachusetts and Maine, have enacted laws that limit prescriptions, but those limits are typically seven days.

These pain pills can become a gateway to addiction and to heroin use, studies show. New Jersey already had a law that requires doctors to consult with a prescription monitoring database before they prescribe opioid painkillers. It’s one of 29 states to make that requirement.
New Jersey has also created commercials featuring the governor telling people where they can go to get help. The state set up a hotline and created a website.
“As I’ve said before addiction is not a moral failing, it is a disease and the more that we talk about it as a disease, treat it as a disease, regulate it as a disease, the more people will finally get the idea that asking for help is not a sign of weakness, but it is in fact a sign of strength,” Christie said at a press conference last month.

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At a CNN town hall meeting with Health and Human Services Secretary Tom Price this month, addiction recovery specialist and former addict John Brogan credited Christie in part with saving lives in the state. “If it were not for Gov. Christie, there would be 100 more people on top of the 1,600 that we lost last year for this epidemic,” Brogan said.
Christie met with Trump in February at a White House lunch in which the governor said they spent a “good amount of time” talking about the problem and other ways they could fight the epidemic on a “much broader level.

At Wednesday’s White House meeting, Christie said he is honored to take on this task.

“Every life is an individual life from God and no one life is irredeemable, and people make mistakes we all have, and when people make mistakes of drug use, and it is a mistake, we can’t throw their life away,” Christie said.

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.

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.

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.

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.

Luxury getaways for younger travelers

From perks like organic baby food and child-sized bathrobes to larger hotel suites and more kid-focused activities, the luxury travel market is catering to much younger travelers.

In the past year, the St. Regis has seen a 20% increase in families staying at its properties.

Older parents with more money are helping to fuel the trend, said Paul James, global brand leader for the St. Regis, The Luxury Collection, and W Hotels.

“We are seeing people in their 40s with young children,” James said. “By the time you are 40 and made money, you don’t want to stay at the cheap motel down the road. You don’t compromise your lifestyle.”

He added that seeing kids at the front of a plane is becoming more common. “I flew back in January, and everyone in the business cabin had a child with them.”

As more travelers bring their families along, experts said demand for larger suites and villas at hotels has increased. For instance, at the St. Regis in Bali, villa suites sell out 10 times faster than the main hotel suites, James said.

Related: Bored of your superyacht? Try a submarine

Luxury hotels are also stepping up their child-focused amenities and activities.

“Parents want to go and have adult experiences, but also want to make sure their kids will be catered to,” said Kara Slater, a travel agent with SmartFlyer California who specializes in family travel.

At the Four Seasons Resort in Orlando, children are normally welcomed with chocolate alligators or organic baby food and receive child-size bathrobes.

Guests ages 4-12 at The Resort at Pelican Hill in California can attend Camp Pelican where each day’s supervised activities have a different theme like Treasure Island Tuesdays or Space Exploration Fridays. The clubhouse has digital microscopes, video games and computer stations. A full day at the club runs $90 and $60 for a half day.

Parents looking for some alone time in the evening can send their travel companions to Kid’s Night Out, which includes dinner, movie and popcorn for $60.

Latitude, a program for teens, runs $15 an hour ($50 for a half day) has daily activities including surf and kayak camp. And the lounge has Netflix-connected TVs, video games and a special food menu.

The resort also offers a three-hour Children’s Resort Etiquette Class for guests ages 7-12 that teaches travel and social etiquette.

The room service menu includes “ants on a log” (celery with peanut butter and raisins on top) and veggies and hummus, according to Kate Starr, spokeswoman for the resort.

Related: The river cruise craze goes high-end

Families aren’t just heading to the traditionally kid-friendly spots, but are seeking out more exotic locations. Hawaii and Europe are popular, according to Slater.

Authentic experiences are also a priority for people traveling with kids, said Dan Austin, president of Austin Adventures.

“We see families often start out with a domestic vacation, like Yellowstone, and the next year they head to Alaska or the Canadian Rockies. By the third trip, they are looking at Peru, Belize and Costa Rica.”

CNNMoney (New York) First published February 26, 2015: 10:36 AM ET

A religion for society’s unwanted

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How paralyzed man regained hand movements

The early stage research has been tested in a lab with just one patient so far, yet someday it may change the lives of many with spinal cord injuries, said lead author Abidemi Bolu Ajiboye, an assistant professor at Case Western Reserve University.

Even though the system would not become immediately available to patients, Ajiboye believes that all the technical hurdles can be overcome within five to 10 years. “We actually have a handle on everything that we need. There are no significant novel discoveries we need to make for the system,” he said.

Ajiboye said that what makes this achievement unique is not the technology, but the patient. Unlike any previous experiments, a man who is nearly completely paralyzed — or tetraplegic — regained his ability to reach and grasp by virtue of a neuroprosthetic.

Cycling accident

Bill Kochevar, a resident of Cleveland, injured his spinal cord in 2006 prior to enrolling in the study.

“It was a bicycling accident,” said Ajiboye, who explained that Kochevar, 53, was doing a 150-mile bicycle ride on a rainy day. “He was following a mail truck and the mail truck stopped and he ended up running into the back of the truck,” said Ajiboye. As a result, Kochevar has paralysis below the shoulders.

“So he can’t walk, he can’t move his arms, he can’t move his hands,” said Ajiboye.

While the American Spinal Injury Association classifies him at the most disabled level of paralysis, Kochevar is capable of both speaking and moving his head. Prior to enrolling in the study, he often used head tracking software technology that relied on him moving his head to move a cursor on a screen. “But he had no ability to do any sort of functional activities,” said Ajiboye.

Kochevar underwent two surgeries fitting him with the neuroprosthetic. The first operation on December 1, 2014, implanted the brain computer interface, or BCI, in the region of Kochevar brain that is responsible for hand movement, called the motor cortex.

The BCI is an electrode array which penetrates the brain between one to one and a half millimeters, said Ajiboye.

Next, Kochevar underwent a second surgery to implant 36 muscle stimulating electrodes into his upper and lower arm. Known as functional electrical stimulation or FES, these electrodes are key to restoring movement in his finger and thumb, wrist, elbow and shoulders.

The Cleveland Functional Electrical Stimulation Center, of which Ajiboye is a part, first developed electrical stimulation technology for reanimating paralyzed function nearly 30 years ago. As Ajiboye explained, the technology is similar to a pacemaker in that it applies electrical stimulation to the muscles in order to stir movement.

After the separate technologies were implanted, the researchers connected Kochevar’s brain-computer interface to the electrical stimulators in his arm. At this point, Kochevar began learning how to use his neuroprosthetic and that process started with a virtual arm.

“We had him watch the virtual arm move, he attempted to move his arm in the same way, and that elicited some patterns of cortical activity — some patterns of electrical neural activity,” said Ajiboye.

This electrical activity was recorded and based on this recording, Ajiboye and his colleagues created a “neural decoder” — an algorithm specific to Kochevar — that could translate the patterns of Kochevar’s recorded brain signals into commands for the electrodes in his arm.

“Then we had him use our algorithm to control the virtual arm on the screen just using his brain signals,” said Ajiboye. “Very early on he could hit the target with 95 to 100% accuracy.” This ‘virtual’ step in the process helped Ajiboye and his colleagues refine the algorithm.

“Then, finally, we basically do the same thing with his actual arm. We manually move his arm, and we have him imagine he’s doing it,” said Ajiboye. Kochevar is then able to move his arm on his own by thinking the command (and so generating once again the same brain pattern when he imagined moving his arm) and this is then actuated through electrical stimulation.

Essentially, the technology circumvents the spinal injury feeding the electrical stimulation of his brain through wires to the electrodes in his arm.

After mastering simple movements, Kochevar was tested on day-to-day tasks, including drinking a cup of coffee and feeding himself. In all of these, Kochevar was successful.

“There were no significant adverse events, the system is safe, so as far as the clinical trial endpoint goes, he has met those,” said Ajiboye.

“Now he has opted voluntarily to continue working as a participant in our study for at least another five years,” said Ajiboye. Kochevar hopes to experience the benefits of the technology for himself while also seeing it advance to the point of becoming available for other people with spinal cord injuries, according to Ajiboye.

CNN attempted to contact Kochevar for comment.

‘Encouraging’ results

A previous unrelated study showed paraplegic people with spinal cord injuries using brain-machine interfaces to gain control of their brain activity and stimulate movement in their legs. A separate study used a brain-spine interface to communicate nerve signals and helped paralyzed monkeys to regain movement.
According to Andrew Schwartz, a professor of neurobiology at the University of Pittsburgh, the new study “shows the potential that [a brain-machine interface] can be used to reanimate a limb.” Schwartz was uninvolved with the current study.

While the “generated movements were somewhat rudimentary” with a rather limited range of action, “the attempt to use multiple degrees of freedom was encouraging,” said Schwartz.

“I liked the idea that movements were decoded first and then transformed to muscle activations,” he added. “For real movements in the real world, this transformation will be very difficult to calculate and that is where real science will be needed.”

In an editorial published alongside the study, Steve I. Perlmutter, an associate professor at University of Washington in Seattle, said the research is “groundbreaking as the first report of a person executing functional, multijoint movements of a paralysed limb with a motor neuroprosthetic. However, this treatment is not nearly ready for use outside the lab.”

Similar to Schwartz, Perlmutter noted that Kochevar’s movements were “rough and slow” and had limited range due to the necessary motorized device.

“Stimulation of nerves or the spinal cord, rather than muscles, and more sophisticated stimulation technology may provide substantial improvements,” wrote Perlmutter.

“The algorithms for this type of brain computer interface are very important, but there are many other factors that are also critical, including the ability to measure brain signals reliably for long periods of time,” Perlmutter said in an email. He added another critical issue is execution of movement.

Hurdles that all motor neuroprostheses must overcome have yet to be addressed, noted Perlmutter, including “development of devices that are small enough, robust enough, and cheap enough to be fully mobile and widely available.”

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Ajiboye acknowledges the need for smaller technologies. Still, he said, his new study differs from previous work done in the field. Although other labs have worked with non-human primates or partially paralyzed participants, his study helped someone who is completely paralyzed.

“This is an exponentially harder problem,” said Ajiboye. “Our study is the first in the world, to my knowledge, to take someone paralyzed and give him the ability to both reach and grasp objects… so that he can regain the ability to perform functional activities of daily living.”

One other way the new study differs from previous research is Ajiboye and his colleagues built their neuroprosthetic from separate technologies, each of which had already been proven viable. This translates to the entire system, when refined, more easily gaining approval and becoming available to patients.

“The goal is to do much more than a cool science experiment,” said Ajiboye.

The world’s most beautiful island hotels

Whether you’re after a glitzy private island getaway or a low-key tropical escape, we’ve picked 15 of the world’s most stunning island hotels.

It’s built on its own 3,500-acre private island studded with lush coconut groves and ringed by pristine white sand beaches.

Each of its 25 villas — inspired by traditional Fijian bure — boast leafy tropical gardens and private infinity-edge pools.

As if that weren’t enough to keep you occupied, there’s also an equestrian center, five restaurants and countless coral reefs to be explored (via submarine, naturally).

Lacaula Island, Fiji; +679 888 0077

Anantara Medjumbe Island Resort (Mozambique)

Anantara: Understated castaway chic.
It doesn’t get much more far-flung than this resort, tucked away on a tiny private island in the Quirimbas Archipelago, off the northern coast of Mozambique.

But the views alone are worth the trek. Upon arrival, you’re greeted with miles of empty, powder-white sand and ocean so blue it barely looks real.

The resort itself is gorgeous, with its castaway-chic aesthetic and whimsical, Arabian Nights-inspired decor.

And though its wooden, thatched-roof villas may look simple, don’t be fooled: They’re decked out with luxe deep-soak tubs, roomy outdoor decks and plunge pools built just steps from the ocean.

Anantara Medjumbe Island Resort, Medjumbe Island, Quirimbas Archipelago, Cabo Delgado Province, Mozambique; +27 10 003 8979

Southern Ocean Lodge (Australia)

Built atop scrub-covered bluffs on the southwest tip of Australia’s Kangaroo Island, this unique resort is another spot offering incredible views.

Each of its 21 glass-fronted suites feature floor-to-ceiling windows and are cantilevered to ensure jaw-dropping panoramas over Hanson Bay.

In contrast to its rugged coastal landscape, the lodge is sleek and ultramodern, built from sustainable materials like recycled gumtrees and local limestone.

It’s also luxurious: Each suite has its own private terrace, sunken lounge and standalone bathtubs, perfectly positioned to soak in the glorious views.

Southern Ocean Lodge, Hanson Bay Road, Kingscote, Australia; +61 08 8559 7347

Cap Juluca (Anguilla)

This intimate boutique hotel, situated on Anguilla’s turquoise-blue Maundays Bay, is a Caribbean classic.

Its domed, Moorish-style villas are cheerful and stylish, decorated with colorful batiks, rattan furniture and coconut wood accents.

Though the vibe is beachy and relaxed, rooms abound with posh amenities like plush Frette linens and Hermès bath products.

Added bonus: Every room is beachfront and has an ocean-facing patio.

Cap Juluca, Maundays Bay, Anguilla; +1 264 497 6666

Belmond Villa Sant’Andrea (Sicily, Italy)

Belmond Villa Sant'Andrea: Sicilian charm and jaw-dropping views.

Though you’d be hard pressed to find a hotel in Sicily that’s not picture-perfect, there’s something especially dreamy about this one.

Built as a villa in 1830, the beautifully renovated Belmond has retained the laid-back charm of a private family residence (think homemade Sicilian pastries upon check-in and fresh flowers in every room).

Suites are huge and indulgent, outfitted with enormous marble bathrooms and furnished French balconies that offer sweeping views over the Bay of Mazzarò.

Added bonus: It even has its own private stretch of beachfront, fringed by lush subtropical gardens.

Belmond Villa Sant’Andrea, Via Nazionale, 137, Taormina, Italy; +39 0942 627 1200

Four Seasons Resort Oahu at Ko Olina (Hawaii)

Opened in the summer of 2016, Oahu’s newest resort — located on the quiet western side of the island — might also be its most beautiful.

The property is sleek yet earthy, and takes advantage of its gorgeous oceanfront setting with plenty of sun-drenched, indoor-outdoor spaces.

All 371 rooms are decorated in a modern Hawaiiana style, with banana-leaf wall coverings, banana leaf-printed pillows and local wood accents.

But the hotel’s pièce de résistance is its blissful adults-only infinity pool, which is tucked away from the main pool and beach area and overlooks the Pacific Ocean.

Four Seasons Resort Oahu at Ko Olina, 92-1001 Olani St, Kapolei, Hawaii; +1 808 679 0079

Secret Bay (Dominica)

Perched on a clifftop on the island of Dominica, this uber-luxe hotel remains relatively undiscovered compared to other Caribbean resorts of the same caliber.

But therein lies its charm: Unlike the crowded, all-inclusive resorts of Bermuda and the Bahamas, this low-key boutique property feels like your own secret Caribbean hideaway.

Its eight treehouse-style bungalows are hidden amidst thick, jungle-like foliage and equipped with so many luxe features — hammocks, plunge pools, sundecks, personal libraries — that you won’t ever want to leave.

But you must, if only to walk down to its two stunning beaches or watch the sun set over the Caribbean Ocean from the gorgeous Vetiver Sunset Deck.

Secret Bay, Ross Boulevard, Portsmouth, Dominica; +1 767 445 4444

Soneva Jani (Maldives)

With 24 over-water villas and one sprawling island villa set on a private lagoon in the Maldives, the newest Soneva resort is one of the world’s most beautiful hotels, period.

Each of the resort’s multi-level water villas — made out of renewable plantation wood — has its own private pool and a retractable roof that allows guests to sleep beneath the stars.

Many villas also have slides that transport guests directly from the top level into the lagoon below.

Other hotel highlights include an observatory — home to the largest telescope in the Indian Ocean — and an outdoor floating cinema.

Soneva Jani, Medhufaru Island, Noonu Atoll, Republic of Maldives; +960 656 6666

The Naka Island, A Luxury Collection Resort & Spa (Phuket, Thailand)

The Naka Island: Splendid isolation.
Nestled on the northwest tip of Naka Yai island, off the coast of the larger island of Phuket, this Thai resort feels blissfully isolated.

It’s not a private island resort, but it feels that way, with just 67 villas draped along miles of deserted, unspoiled beachfront.

Villas are earthy yet luxurious, made entirely of wood, stone and clay, and equipped with private pools and steam rooms.

If you can manage to drag yourself from your villa, make a beeline for the beachfront Z Bar, which serves up potent cocktails and epic sunset views.

The Naka Island, 32 Moo 5, Tambol Paklok, Amphur Thalang, Naka Yai Island, Phuket, Thailand; +66 (76) 371 400

The Cliff Hotel (Jamaica)

Though it sits directly on the ocean, this new boutique hotel isn’t your typical beach getaway.

For starters, there’s no beach: True to its name, the hotel is perched on low, jagged cliffs that jut out dramatically onto the ocean.

Unlike its colorful, kitschy neighbors, The Cliff opts for a neutral-toned, minimalist vibe that allows its striking natural setting to steal the show.

Still, its 33 rooms are as luxe as they come, outfitted with stylish hammocks, roomy balconies and, in some cases, private plunge pools.

The Cliff Hotel, West End Road, Negril, Jamaica; US 1 800 213 0583; UK 020 3002 0927

Cavo Tagoo (Mykonos, Greece)

Hugging a cliff high above the Aegean Sea, Cavo Tagoo remains a haven of peace and serenity on Greece’s most touristed island.

The vibe is refreshingly modern and minimalist: whitewashed surfaces, exposed wood and stone, and sleek, clean furnishings.

Rooms come with with whirlpool baths, ocean-facing balconies and, in some cases, private plunge pools.

No pool? No worries: The resort’s communal infinity saltwater pool has an aquarium bar and the best sunset views on the island.

Cavo Tagoo Mykonos, Aegean Coasts S.A., Mykonos, Greece; +30 22890 20100

Belmond La Samanna (St. Martin)

La Samanna: Unspoilt beaches and killer cocktails.
Easily the best resort in St. Martin, La Samanna brings tranquility and a touch of glamor to a fairly tourist-clogged island.

Its 83 lavish rooms and eight Mediterranean-style villas are hidden behind 55 lush tropical acres on the unspoilt shores of Baie Longue.

Property highlights include two infinity pools, a heavenly spa, two French-Caribbean restaurants and a 12,000-bottle wine cave.

But what you’re really here for is the Moroccan-themed beach bar, which serves up potent cocktails and killer ocean views to match.

Belmond La Samanna, 97064 St Martin, CEDEX, French West Indies; +590 590 87 6400

Nihiwatu (Sumba Island, Indonesia)

Though it’s just an hour’s flight from Bali, Nihiwatu feels worlds away: It sits on a private 1.5-mile beach backed by 560 acres of tropical jungle.

Its 28 thatched-roof villas are rugged yet luxurious, decorated with teak furnishings, traditional ikat-print fabrics and local Sumban art.

Though every villa is impressive, the Marrangga villas — which feature beds elevated on cliffside platforms overlooking the ocean — are where you want to be.

Nihiwatu, Sumba Island, Indonesia; +62 361 757 149

North Island (Seychelles)

North Island: A celebrity favorite.
Breathtaking natural beauty and innovative design come together on this heavenly private island resort in the heart of the Seychelles.

Its 11 newly renovated villas feature a glamorous, castaway-meets-Colonial vibe that blends seamlessly into its jungle-like natural surroundings.

Of course, there are five-star amenities to boot: indoor-outdoor bathrooms, deep-soak tubs and personal plunge pools, to name a few.

It’s no wonder that the resort’s guest list includes the likes of Angeline Jolie and Brad Pitt, George and Amal Clooney and the Duke and Duchess of Cambridge.

North Island, Victoria, Mahé Seychelles; +248 4293 100

CéBlue Villas and Beach Resort (Anguilla)

Opened in 2014, CéBlue is one of Anguilla’s newest and most luxurious resorts.

It has just eight eco-friendly hideaways built into the verdant hills above tranquil Crocus Bay on the island’s northwest coast.

Lodgings are sleek and modern, and equipped with large saltwater swimming pools, 3,000-square-foot sun decks and frangipani-filled private gardens.

Thanks to the resort’s linear, terraced design, guests can enjoy panoramic views over the Caribbean Sea from every single window.

CéBlue Villas and Beach Resort, Valley Road, 1264 The Valley, Crocus Bay, Anguilla; +1 264 462 1000

Krisanne Fordham has written for Conde Nast Traveler, Fodor’s Travel, Departures and Travel + Leisure. She grew up in Sydney and now splits time between Umbria, Italy and New York.

GOP may be working on health care plan B

President Donald Trump and Vice President Mike Pence spoke with several House members over the weekend to discuss a path forward, a senior administration official and Republican official with knowledge of the discussions told CNN. And House Speaker Paul Ryan — despite saying Friday that “Obamacare is the law of the land” — appears ready to keep going as well.

Trump himself isn’t giving up.

“I know we’re going to make a deal on health care, that’s such an easy one,” Trump told a bipartisan group of senators and spouses at a White House reception Tuesday night.

The fact remains, however, that House Republicans aren’t in a different position than they were on Friday. The math is the same. Republican leaders are still struggling to satisfy two diametrically opposed forces: moderates who want to see to government lend more support to middle and low-income people to buy health insurance and conservatives who want to see Obamacare repealed more fully so that even popular regulations like the one requiring insurers to cover people with pre-existing conditions disappear.

“At the end of the day, I don’t know that the weekend did much to change anything. I think it was a missed opportunity. I think it was an unforced error,” said Arkansas Republican Rep. Steve Womack.

“We’re mending our wounds right now,” Rep. Chris Collins, a Republican from New York told reporters Tuesday.

But Republicans can’t go back to their voters and say they’ve given up. Moving on from repealing Obamacare would mean Republicans may have to admit defeat and face a sobering new reality, in which, they were not able to deliver on the policy goal that united them and catapulted them to victory in the House in 2010, the Senate in 2014 and the White House in 2016.

“Opposition to government run health care has been a foundation of the Republican party for three or four generations now, so it is difficult to see House Republicans walk away from efforts to protect the American people from this awful law,” said Michael Steel, former spokesman for ex-House Speaker John Boehner. “At the same time, after last week, it’s difficult to see how the entire conference can find a unified position.”

“I think the divisions that have existed for some time look and feel particularly acute now that we have a Republican President,” Steel added.

White House downplaying role

Those divisions came out perhaps most dramatically when Trump got involved in the negotiations. Now, the White House is keeping its role much lower key than it did during the final push last week and insisting it is letting rank-and-file members of Congress drive discussions on health care, which are ongoing between a small group of House Freedom Caucus members and members of the moderate Tuesday Group.

The senior administration official told CNN that the White House believes its threats to move past health care have helped jolt House GOP members into action.

“All last week he was calling them. Now they’re calling him,” the official said.

White House press secretary Sean Spice publicly downplayed Tuesday any suggestion that there was a concerted effort to resurrect health care, only going as far as saying that there were continued conversations and exchanging of ideas.

“Have we had some discussions and listened to ideas? Yes,” Spicer told reporters in the briefing room. “Are we actively planning an Immediate strategy? Not at this time.”

On Tuesday, House GOP leaders also projected more optimism that something could still be done to dismantle the Affordable Care Act even as the political dynamics remained unchanged.

“I think we’re closer today to repealing Obamacare than we’ve ever been before, and are surely even closer than we were Friday,” House Majority Whip Steve Scalise said Tuesday morning.

Ryan vowed members would continue working although he didn’t offer any specific timeline.

In the Senate, Majority Leader Mitch McConnell was more frank that it was time to get to other issues.

“It’s pretty obvious we were not able, in the House, to pass a replacement. Our Democratic friends ought to be pretty happy about that because we have the existing law in place, and I think we are just going to have to see how that works out,” McConnell said. “We believe it will not work out well, but we’ll see. They have an opportunity now to have the status quo, regretfully.”

McConnell complemented Trump’s and Ryan’s efforts and then concluded his remarks on the debacle with four words: “Sorry that didn’t work.”

GOP base doesn’t want to give up

The concept of giving up is hard for many Republican rank-and-file members to swallow. Those who would have voted yes wish they could have gotten their colleagues there too. Members of the House Freedom Caucus, meanwhile, who were opposed to the bill, are grappling now with public admonishment from their new President.

“We’re gonna get a ‘yes,’ we’re gonna get to ‘yes.’ It will be a better bill and I think everybody is going to be very happy in the end,” said Rep. David Brat, a Republican from Virginia and a member of the Freedom Caucus.

“I think we have plenty of time. We can fix this,” said Idaho Republican Rep. Raul Labrador, another House Freedom Caucus member.

Texas Republican Rep. Randy Weber, a member of the House Freedom Caucus who opposed the GOP health care bill said Tuesday he thought that the GOP conference could find a way to get a revised Obamacare bill through the House if they all got in a room and put their heads together.

“We need to stay here on the weekend and have an all-day conference,” Weber said, noting that the one-hour weekly meetings weren’t enough time to work through the sticking points.

Weber, who didn’t vote for Ryan for speaker in January, even complimented Ryan and said that he texted the speaker over the weekend when some conservative media figures pushed for him to step down and told him “don’t even think about it. You’re doing a good job. My prayers and my support are with you.”

Still hard to govern

Womack said Republicans need to keep moving and show they can govern with their majorities in the House and Senate and Trump in the White House.

“The people who were ‘yes’ on the health care bill were reminding Paul this is something we promised and we got to push in that direction,” Womack said. “It’s more a reflection of the need to show that we can do something with our governing majority, but again it comes back to numbers. If you don’t have the votes, you don’t have the votes.”

But Trump and Ryan say they want to go to tax reform next, but that’s not going to be any easier.

“How do you move forward?” said Rep. Mario Diaz-Balart, a Republican from Florida. “If you can’t do this, can you then do tax reform? If you think this is complicated and controversial, wait ’til we get into tax reform.”

Neverending success? Olive Garden sales boom

Darden Restaurants announced late Monday that it was buying Cheddar’s Scratch Kitchen, a casual dining chain with 165 restaurants in 28 states, for $780 million cash. The company also announced earnings and sales that topped forecasts.

Shares of Darden (DRI) rose 7% in early trading on the news and hit an all-time high.

The Cheddar’s deal gives Darden another brand that is regionally popular but does not have a national footprint. Most Cheddar’s locations are in Texas and the Southeast.

Cheddar’s focuses on American comfort food classics like chicken-fried steak, ribs, and macaroni and cheese. This is the first acquisition for Darden since it bought the Yard House chain in 2012. Darden sold Red Lobster to private equity firms in 2014.

In addition to Olive Garden and Yard House, Darden owns the LongHorn Steakhouse, The Capital Grille, Seasons 52, Bahama Breeze and Eddie V’s chains.

The good news for Darden is the latest in a stunning turnaround since the company was essentially taken over by the activist investor group Starboard in 2014.

Starboard successfully led a shareholder revolt that caused then-CEO Clarence Otis to step down and the company’s COO at the time, Gene Lee, to replace him — with Starboard’s blessing.

Related: Olive Garden unveils its latest all-you-can-eat deal

Starboard attacked Darden in a scathing slide presentation that detailed all the culinary sins that the investment firm thought were ruining the company and keeping investors away, such as too much sauce and a menu that had strayed from its Italian-American roots.

My colleague Cristina Alesci and I did our own taste test in 2014 after Starboard unleashed its attack on the company — and we concurred with Starboard. We did not find Olive Garden’s food to our liking.

But since Starboard took over, the company has been in growth mode again. And the investment has been such a success that Starboard leader Jeffrey Smith decided to step down as Darden chairman last year, citing the progress the company had made in its turnaround.

Olive Garden sales have picked up, largely because of a changing menu mix and higher prices. One problem the company is still having is that it has been unable to dramatically expand its customer base.

The chain’s traffic fell slightly again in the quarter and is lower for the fiscal year as well. But Darden has held up well in an environment that has been tough for some other restaurant chains lately.

Lower prices for many agricultural commodities have led people to take advantage of cheaper groceries and dine in more instead of eating out.

And as long as Olive Garden keeps offering its famous breadsticks and neverending pasta passes, it looks like investors will be just as satisfied with Darden’s stock as Olive Garden loyalists are with its food.

CNNMoney (New York) First published March 28, 2017: 11:42 AM ET

Other celebrities battling lupus

Celebrities battling lupus

Celebrities battling Lupus – Selena Gomez’s struggle with lupus has interrupted two of her concert tours and forced her to undergo chemotherapy to control the disease.

Celebrities battling lupus

Celebrities battling lupus

Celebrities battling lupus

Singer Toni Braxton has been hospitalized several times to bring her lupus under control. She told the world about her condition in 2010 and in 2014 wrote “Unbreak My Heart,” a memoir in which she revealed that her uncle died from the disease.

Celebrities battling lupus

“Third Rock from the Sun” star Kristen Johnston had to take a break from work in 2013 when she developed a rare form of lupus that attacks the spinal cord. After chemotherapy, she has said she’s in remission.

Celebrities battling lupus

Soccer star Shannon Boxx has been battling lupus since she was 30 years old. She went public with her condition in 2012, continuing to play for the U.S. women’s soccer team and working with lupus organizations to spread awareness of the disease.

Celebrities battling lupus

The scars of a skin form of lupus left a distinctive pattern on British singer Seal’s face. The singer has battled the disease since he was a child.

Celebrities battling lupus

Former model and “Extra” correspondent Terri Seymour says she nearly lost her life to lupus in her early 20s, and has struggled with flares since.

Celebrities battling lupus

Actress Mary Elizabeth McDonough, best known for her work on “The Waltons,” has been advocating for those with lupus since that time. She struggled with many typical symptoms of the disease for years before getting a diagnosis.

Celebrities battling lupus

John Wayne’s oldest son Michael suffered from lupus for years before dying of complications of the disease at age 68. Michael collaborated with his famous father on several well-known films, such as “The Green Berets” and “The Train Robbers.”

Tennessee kidnapping law could work in teacher’s favor

District Attorney Brent Cooper of the 22nd Judicial Circuit wants to change that, and he hopes state lawmakers consider Elizabeth’s case when they convene next year, he told CNN on Tuesday. Through an attorney, Elizabeth’s father, Anthony Thomas, said he wants the law changed immediately.
The way it’s written now, the statute lets children older than 12 decide whether to leave their families, unless their removal or confinement “is accomplished by force, threat or fraud.”
Police say 50-year-old Tad Cummins, who taught Elizabeth in a forensics class at Culleoka Unit School, absconded with the freshman March 13, weeks after a student claimed to see the two kissing in Cummins’ classroom.

The investigation led authorities to Decatur, Alabama, later that day before the two vanished.

As it stands, to prove the kidnapping of a victim who is 12 or older, Cooper said, he’d have to prove that Elizabeth was unlawfully removed or had her freedom restricted.

Further, to prove that Elizabeth was unlawfully removed, he’d need to demonstrate to a jury that Cummins employed “force, coercion, fraud or something to that effect,” the prosecutor said.

“What we run into here, of course, is this child is 15 and, according to reports, at least initially, she left of her own free will,” he said.

The issue was especially concerning at the outset of the investigation, Cooper said. Cummins was charged only with sexual contact with a minor by an authority figure, a misdemeanor. Investigators worried that if police stopped the pair out of state, they’d be released because authorities couldn’t detain them, let alone extradite Cummins, on a misdemeanor warrant.

Cooper ultimately felt comfortable adding the aggravated kidnapping charge after deciding that Cummins allegedly groomed his victim and was armed, the latter being a prerequisite for aggravated kidnapping. (Grooming is the act of establishing a connection with a child with the goal of defusing her or his inhibitions toward sexual abuse.)

The prosecutor says the present law could pose obstacles once he has Cummins in a courtroom.

“Under current law, it’s really going to depend what the testimony of Ms. Thomas is,” Cooper said, explaining that if she claims she left on her own volition, the defense will argue Cummins is not guilty of kidnapping.

Cooper will then have to introduce circumstantial evidence that Elizabeth was coerced. The district attorney is confident the communications between Elizabeth and Cummins show “he was definitely trying to influence her in his favor,” he said.

“This grown man was using his knowledge and life experience to basically attract her and to convince her to be with him,” he said.

In discouraging anyone who might blame Elizabeth for her plight, Tennessee Bureau of Investigation Director Mark Gwyn, too, discounted the notion that there was a mutual romance.

“She is 15, a child. He is 50, a grown man. This is and was not a romance. This was manipulation solely to the benefit of Tad Cummins,” Gwyn said.

Attorney Jason Whatley, who is representing Elizabeth’s father, told CNN the kidnapping statute might not matter in Cummins’ case, especially if he crossed state lines with Elizabeth. He predicted the ex-teacher would face “scores of charges once we find him.”

“I think Tad Cummins will have violated so many laws, I think he’s finished,” Whatley said.

Elizabeth Thomas: The 15-year-old has light brown or blond hair and hazel eyes. She is 5 feet 5 inches tall and weighs 120 pounds. She was last seen wearing a flannel shirt and black leggings.

Tad Cummins: The 50-year-old has brown hair, brown eyes and a gray goatee. He is 6 feet tall and weighs about 200 pounds. He is believed to be armed.

Vehicle: Silver Nissan Rogue, Tennessee tag 976-ZPT

Reward: $1,000

Who to call: 1-800-TBI-FIND

Source: Tennessee Bureau of Investigation

The Tennessee Legislature is already in session, and the deadline for introducing legislation has passed, Cooper said. Before lawmakers convene again in January, the prosecutor intends to meet individually with legislators to convince them the law needs changing, he said.

An ideal law, he said, would presume that if the victim were younger than 18, she or he could not leave on their own accord. It would be similar to statutory rape laws that place the onus on adults not to break the law, he said.

Whatley says he concurs the law needs to be changed, but as a lawyer who also does defense work, he has reservations about the age limit. He’d hate seeing an 18-year-old accused of kidnapping for taking a 17-year-old on a date after the 17-year-old’s parents forbade it, he said.

Perhaps the correct age is 16 and above, he said, suggesting that the amendment be called “Elizabeth’s Law.”

Amending the law makes sense, Cooper said, when you consider that, in Tennessee, children younger than 18 can’t consent to sex, rent cars or enter into legal contracts.

“This is a much bigger life choice than trying to buy a car,” he said of Elizabeth’s case. “I think it would be a simple fix.”