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The next generation hypersonic space plane just took a big step toward reality as the Defense Advanced Research Projects Agency (DARPA) announced Boeing will “complete advanced design work” for the Experimental Spaceplane, XS-1.

The goal of the project is to offer quicker access to low Earth orbit, decreasing the preparation time to launch from months to days. For example, in the case of the loss of a military or commercial satellite, the unmanned, reusable XS-1 could quickly be used to launch a replacement.

“The XS-1 would be neither a traditional airplane nor a conventional launch vehicle, but rather a combination of the two, with the goal of lowering launch costs by a factor of 10 and replacing today’s frustratingly long wait time with launch on demand,” said Jess Sponable, DARPA program manager.

According to DARPA, the XS-1 will be about the size of a business jet and take off vertically, propelled not by external boosters but by “self contained cryogenic propellants.” After reaching a suborbital altitude, the plane would launch an expendable upper stage that would be able to push a satellite into orbit. The plane would then return to Earth, landing like a plane.

DARPA said the plane could then be reused “potentially within hours.”

The XS-1 could fly as fast as Mach 10, DARPA said.

The XS-1 is still years away from reality, with DARPA saying testing the plane’s engines on the ground slated for 2019.
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Tony Chhim, a first-generation Cambodian-American, needs a kidney.

Until a few weeks ago, his family thought a yearlong search among relatives in Cambodia and in Khmer communities throughout the United States had been fruitless. Then Taylor Tagg, an American friend of Tony’s dad, Tim, surprised everyone by turning out to be a match.

The euphoria lasted until a few days ago, when doctors at the Westchester Medical Center in Valhalla, New York, discovered a complication. That dashed what had been a feel-good, one-in-a-million, happy-ending kind of saga that transcended race, religion and national origin, as Tagg prepared to be the first American to donate a kidney to the son of Cambodian refugees.

Painful dialysis 3 times a week

Tony Chhim, 31, is Tim’s only son. Born in the United States, Tony is a football player and roots for the North Rockland Red Raiders football team in Thiells, New York. With only one functioning kidney, he’s in dialysis.

“It’s painful. Imagine you go [for treatment] four to five hours every other day for the rest of your life,” Tony said. “How much of that is your life?”

Now, once again, Taylor Tagg and Tim Chhim are supporting Tony during another search for a kidney match. Julie Kimbrough, senior director of marketing and communications for the National Kidney Foundation, told VOA Khmer the numbers are grim: About 19,000 people receive a transplant every year, and there are 120,000 people waiting for a kidney transplant.

“Every year there are over 4,000 people who die waiting” for help, she said.

A ‘special’ connection

Tagg and the older Chhim met in 2012 when they joined the same self-help group. A shared history of overcoming the kind of life trials that would stop many others — Tim escaped execution by the Khmer Rouge three times — grew into a friendship and a business partnership.

Neither of them cared that Tagg is a white Christian American and Chhim is an Asian Buddhist immigrant.

Tagg, a life coach who teaches forgiveness, lives in Germantown, Tennessee. The 46-year-old’s motto is: “Life gets better when you let go of the bitters.”

Chhim owns an Allstate Insurance agency in Nanuet, New York, and also is a motivational speaker.

His positive message dovetails with Tagg’s message of self-empowerment to survivors, especially refugees: “Don’t become victims forever. You were a victim, but not now. Now you are a victor.”

Tagg says they have a “special” connection.

In 2015, the two men co-wrote a book, Adversity to Advantage: 3 Epic Stories of Transforming Life’s Obstacles into Opportunity.

A hero’s gift

“We both felt through our meeting through the Napoleon Hill Foundation,  then writing a book together, a higher power placed us in our paths so that we can come together for Tony’s needs to help him with his kidney,” Tagg said. “Tim is one of my living heroes, and so when the opportunity presented itself, he asked for a blood test. Those with O blood type stepped up to get tested. Of course, I did that and turned out to be a match for Tony.”

Chhim has the same feeling about Tagg: “Taylor, you are my hero, not the other way around. How many people out there are willing to give a part of their body, their organ for someone else who’s not related to you?”

Not many. But Neang Chhim, 59, Tony’s mother, understands this sacrifice. In 2010, she gave one of her kidneys to her son.

“You have to do what a mother has to do,” she said. “I checked the blood and it matched. You act quickly because you try to save your son’s life.”

Five years later, Tony’s body rejected Neang’s kidney, and that led to the tests that showed Tagg’s kidney was a match for the young man’s.

Tony says that kindness transcends any differences: “For me, it doesn’t matter if you’re non-Cambodian, black, and white. Just the fact that anybody that would step up that didn’t even know me, it really touched me. It made me happy inside knowing that there are people out there that do genuinely want to help.”

The kidney transplant surgery was scheduled for this week, but three weeks ago the medical team called it off because of complications that indicated it would not be a long-term solution to Tony’s problems.

Tony Chhim says his bond with Taylor Tagg is solid: “I still consider him my brother and he’s just as heartbroken as I am.”

Ever his father’s son, Tony vows to keep on fighting, “to find the good in the adversity.” And he hopes his story will inspire more organ donors.

“My main mission is to get people aware,” he said. “If one person besides me gets a kidney because I’m talking about it, then I’m more than happy just to stay on dialysis.”

This report originated on VOA Khmer.
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A new study suggests that probiotics, so-called “good” bacteria that aid in digestion, may also ease symptoms of depression. The finding adds to a growing body of evidence that what happens in the gut affects the brain. 

Some 300 to 500 bacterial species inhabit the human gut, many aiding in digestion and the proper functioning of the gastrointestinal tract.

Experts say some of these bacteria produce proteins that communicate with the brain. 

Your gut, your mood

The gut flora not only play a role in helping to orchestrate the neural responses that regulate digestion, scientists say, but evidence is emerging that gut bacteria can also affect a person’s mood.

Premysl Bercik, a gastroenterologist at Ontario Canada’s McMaster University, researches what he calls the microbiota-gut-brain axis, or the communication between the gut and the brain through the millions of bacteria that live in the gastrointestinal tract.

Bercik said between 40 and 90 percent of people with irritable bowel syndrome, a distressing intestinal disorder, also battle symptoms of anxiety and depression.

Research led by Bercik suggests the gut bacteria themselves may have an effect on mood.

In Bercik’s pilot study of 44 patients with irritable bowel syndrome and mild to moderate anxiety or depression, half of the patients received a daily probiotic — a beneficial gut bacterium called Bifidobacterium longum — and the other half were given a placebo. The participants were followed for 10 weeks.

“What we found was that the patients that were treated with this probiotic bacterium improved their gut symptoms but, also surprisingly, decreased their depression scores,” Bercik said. “That means their mood improved. And this was associated also with changes in the brain imaging.”

Depression, anxiety improve

At the beginning of the study, the patients’ levels of depression and anxiety were scored. The patients also underwent high-tech brain imaging to see which structures were activated in response to happy and sad images.

At six weeks, 64 percent of patients taking the probiotic had a decrease in their depression scores compared to 32 percent of the placebo patients. 

A second round of imaging showed changes in multiple brain areas involved with mood control in the patients who felt better. 

While the participants’ gut symptoms improved, Bercik said it was not to a statistically significant degree, suggesting the probiotic may have improved their anxiety and depression independent of symptom relief.

Results of the study were published in the journal Gastroenterology.

More study needed

Bercik says larger studies are needed to confirm the findings.

“However, I think that it shows a great promise,” he said. “I mean new treatments, not only for patients with functional bowel disorders like irritable bowel syndrome, but it may also offer some new treatments for patients with primary psychiatric disorders like depression or anxiety.”

B. longum was developed by Nestle, a Swiss food and drink company, which funded the study. It is not yet commercially available. 

However, Bercik says it’s possible other probiotics found in the gut have the potential to improve mood. And he doesn’t stop there. Bercik says he envisions a form of personalized medicine using genome sequencing techniques to create microbiome profiles of individuals, which can be tweaked with oral probiotics for maximum health.
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Tedros Adhanom Ghebreyesus, the World Health Organization’s newly elected director-general, says health as a human right is at the core of his vision for the organization he soon will lead.

The former Ethiopian health and foreign minister is the first African chosen to head the organization, which was created 69 years ago.  

After a long, bruising campaign that began in 2015, Tedros beat out two other contenders, David Nabarro of Britain and Pakistani physician Sania Nishtar, for the post by winning 133 of the votes cast by 185 WHO member states.

“The outcome of the voting was very, very clear,” said Tedros.  “Having confidence from the majority of member states gives me legitimacy to really implement the vision that I have already outlined.”

Tedros’ goals

That vision included five promises, which Tedros made to the World Health Assembly during a final campaign pitch preceding Tuesday’s secret ballot vote.

He said that he would “work tirelessly” to fulfill the WHO promise of universal coverage and would ensure “a robust response for emergencies to come.”

He promised to strengthen the frontlines of health, transform the World Health Organization into a world class force and lastly “place accountability, transparency and continuous improvement at the heart of WHOs culture.”

At a news conference in Geneva, he said the concept of health as a human right would be at the heart of whatever he did.

“Half of our population does not have access to health care,” he said.  That, he said, could and should be remedied through universal health care coverage, which would address the issue of health as a human right and act as a spur to development.  

“All roads should lead to universal health coverage and it should be the center of gravity of our movement,” he said.  

Tedros begins his five-year term as director-general on July 1, succeeding Margaret Chan, who has headed the WHO for the past 10 years.  

The newly elected director general said he wants to reform and transform the World Health Organization into a better, more responsive agency.    

As Ethiopia’s minister of health, Tedros led a comprehensive reform of the country’s health system, including the expansion of the country’s health infrastructure and health insurance coverage.

Resources a constant priority

As WHO leader, Tedros said one of his first orders of business would be to strengthen the organization’s ability to respond swiftly and effectively to emergencies because “epidemics can strike at any time” and the WHO must be prepared.

“The campaign has ended, as you know, officially, but I think the work begins actually now.  I know it is very difficult.  It is going to be tough,” he said.  

One of the major difficulties is that of money.  Reform, tackling emerging and ancient diseases take a lot of money, something the World Health Organization, which reportedly is struggling to close a $2.2 billion gap, does not have.

The problem is likely to be made even worse given the Trump administration announced budget cuts to global health programs, including a 32 percent cut to USAID (U.S. Agency for International Development) and between 20 percent and 30 percent cuts for scientific research institutes.

The United States is the biggest WHO donor.  U.S. President Donald Trump has suggested funding cuts to the organization might be in the offing.

Tedros observed that it is the poor that are the most affected by big financial cuts.

“I hope this will be understood before finalizing the proposal.  I believe this will be taken into consideration,” he said.

He can take heart in that a congratulatory statement on his election from Tim Price, U.S. Health and Human Services Secretary did not threaten any funding cuts.  Instead, he told Tedros the United States looked forward to working with him on changing the World Health Organization for the better.

“The United States is committed to helping advance reforms and cultivating greater global health security,” he said.
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The positive impact of exercise is old news. There really is no downside, mentally or physically, to getting up and moving around in any form from taking walks to lifting weights. But what if a pill could give you all those benefits. VOA’s Kevin Enochs reports.
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Children younger than one should drink breast milk or formula, and should only drink fruit juice if advised by a doctor, according to the American Academy of Pediatrics. The organization made the recommendation in the journal Pediatrics amid concerns about rising childhood obesity and tooth decay.

This is the first time since 2001 that the doctors’ group has reviewed its recommendation on fruit juice, which is a leading source of dietary sugar.

Between the ages of one and four, young children should consume no more than 118 milliliters of fruit juice, the doctors’ group says. The academy recommends that children between the ages of four and six restrict their juice intake to no more than 177 milliliters a day, while children between seven and 18 should limit their fruit juice consumption to 236 milliliters.

The new guidelines recognize that 100 percent natural and reconstituted juice can be a healthy part of a child’s diet. However, the group said juice should count for no more than one of the two to two-and-a-half recommended servings of fruit per day.

If fruit juice is given to young children, the academy discourages parents from putting it in a bottle or “sippy” cup, which may be in a child’s mouth all day, promoting cavities. Instead, it’s recommended that the juice be consumed all at once in a cup.

The group had previously recommended that parents wait until a child is six months old before introducing fruit juice to the diet. However, in light of the growing rates of obesity and other negative health effects, the American Academy of Pediatrics revisited the recommendation.

Juice is a frequent beverage of choice among U.S. teenagers and children, who experts say would rather drink it than water.

Dr. Steven A. Abrams, chairman of the Department of Pediatrics at the Dell Medical School at the University of Texas, and co-author of the policy statement, said there was nothing “magical” about the academy’s revised recommendation. 

Dell said the group simply saw no need or beneficial role for juice in very young children.
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Gender confirmation surgeries jumped by 20 percent in the United States from 2015 to 2016, according to a new survey.

The American Society of Plastic Surgeons (ASPS) survey says there were more than 3,200 “transfeminine” and “transmasculine” surgeries in 2016. Included in this number is everything from body contouring to full gender reassignment.

“There is no one-size-fits-all approach to gender confirmation,” said Loren Schechter, MD, a board-certified plastic surgeon based in Chicago. “There’s a wide spectrum of surgeries that someone may choose to treat gender dysphoria, which is a disconnect between how an individual feels and what that person’s anatomic characteristics are.”

The survey is the first ever done by the ASPS and includes data from 2015 to 2016.

One driver is that insurance companies are increasingly covering some of the procedures, making them more accessible and affordable.

“In the past several years, the number of transgender patients I’ve seen has grown exponentially,” said Schechter. “Access to care has allowed more people to explore their options, and more doctors understand the needs of transgender patients.”

Changing attitude is also behind the increase.

‘It’s only in the last couple of years that we’ve seen this dramatic increase in demand for procedures, it’s certainly a subject that’s more talked about,’ Schechter told Daily Mail Online.

Schechter added that until recently, there were just six U.S. surgeons who were certified to do both male-to-female and female-to-male genital surgery.

“The numbers are increasing, but one of the barriers is that there’s been no formal training program,” he told the Daily Mail.

For those undergoing sex change procedure, surgery is usually just a part of the process.

“Surgical therapy is one component of the overall care of the individual,” said Schechter. “It takes a team of experts across different disciplines working together to provide comprehensive care. I often partner with doctors who may prescribe treatments such as hormone therapy and mental health professionals who help patients through their transitions.”
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Ethiopia is battling an outbreak of acute watery diarrhea (AWD) that has affected more than 32,000 people.  At the same time, Ethiopia’s former minister of health, Tedros Adhanom Ghebreyesus, is a candidate to lead the World Health Organization.

The two facts are linked in that critics of Tedros say he has tried to minimize the outbreak by refusing to classify it as cholera, a label that could harm Ethiopia’s economic growth.

The WHO’s 194 member states will gather in Geneva for a 10-day assembly starting Monday. One of their first tasks is to choose the organization’s next director-general.

Tedros is one of three top contenders for the position, along with candidates from Britain and Pakistan.

Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The New York Times that Ethiopia has a long history of downplaying cholera outbreaks, and the WHO could “lose its legitimacy” if Tedros, who is also a former Ethiopian minister of foreign affairs, takes over the leadership of the organization.

“Dr. Tedros is a compassionate and highly competent public health official,” he told the Times. “But he had a duty to speak truth to power and to honestly identify and report verified cholera outbreaks over an extended period.”

But others have risen to Tedros’ defense. Tom Frieden, the former director of the Centers for Disease Control and Prevention, said the controversy over naming the outbreak is overblown. “During the time that Tedros was health minister, it would have not made any difference,” Frieden told VOA.

Cholera vs. acute watery diarrhea

Ethiopia has been accused of covering up three cholera outbreaks during Tedros’ tenure as health minister.

Declaring cholera would not have changed Ethiopia’s response to past AWD outbreaks, according to Frieden.  In fact, he says, avoiding the cholera label has not been irresponsible but rather a necessary compromise.

“It allowed public health to respond rapidly,” Frieden said.

The literature on AWD and cholera shows that treatment is the same. It calls for hydrating the patient, chlorinating water and improving sanitation. In fact, the WHO uses the terms interchangeably in their teaching materials on how to deal with an outbreak.

Lately, the development of cholera vaccines has brought the value of identifying the bacterial disease to the fore, said Frieden. “At this time, all African countries that report acute watery diarrhea should be rapidly doing lab confirmation and, if it’s cholera, considering the use of cholera vaccine in the response,” he said.

In the current outbreak, Ethiopia’s Somali region has been hit the hardest, with 768 deaths since January, according to a WHO report published May 12.  Almost 99 percent of the deaths and 91 percent of cases are in the same region.

The WHO representative to Ethiopia, Dr. Akpaka Kalu, says the government is right to call it AWD because regional health centers do not have the capacity to test every case.

If all cases are treated as cholera, the disease has the potential to spread more quickly when children who do not have it are brought into cholera treatment centers, Kalu said.

“We know, biologically, malnutrition causes diarrhea. Now, if you admit that child into a cholera treatment center, you’ve actually turned that center into a cholera transmission center,” he said, speaking by phone from Addis Ababa.

Current response

Over the past six weeks, the response to AWD in Ethiopia appears to have been effective.

Kalu said his team, along with regional leadership and government officials, have focused on prevention and intervention. They have instituted community-based surveillance to monitor the regional drought in general and AWD in particular, and there has been a drop in reported cases.

“We have evidence the average number of cases [dropped] from over 600 a day to about 54 a day,” he said.

Kalu argues that early interventions are getting results and doesn’t think that vaccinating 6 million people in the Somali region is feasible.

He says Ethiopia is now preparing to prevent outbreaks from spreading to other parts of the country such as the Afar and Amhara regions as the rainy season approaches.

“We need to enhance preparedness because, as the rains come, usually what happens is the rains wash and enter the water bodies including where there is open defecation,” he said. “That’s how water bodies get contaminated and people use the water and become sick. So there is a need, our focus is to build capacity to be able to detect and contain so that it doesn’t spread.”
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Minutes matter when it comes to treating sepsis, the killer condition that most Americans probably have never heard of, and new research shows it’s time they learn.

Sepsis is the body’s out-of-control reaction to an infection. By the time patients realize they’re in trouble, their organs could be shutting down.

New York became the first state to require that hospitals follow aggressive steps when they suspect sepsis is brewing. Researchers examined patients treated there in the past two years and reported Sunday that faster care really is better.

Every additional hour it takes to give antibiotics and perform other key steps increases the odds of death by 4 percent, according to the study reported at an American Thoracic Society meeting and in the New England Journal of Medicine.

That’s not just news for doctors or for other states considering similar rules. Patients also have to reach the hospital in time.

“Know when to ask for help,” said Dr. Christopher Seymour, a critical care specialist at the University of Pittsburgh School of Medicine who led the study. “If they’re not aware of sepsis or know they need help, we can’t save lives.”

The U.S. Centers for Disease Control and Prevention last year began a major campaign to teach people that while sepsis starts with vague symptoms, it’s a medical emergency.

To make sure the doctor doesn’t overlook the possibility, “Ask, ‘Could this be sepsis?'” advised the CDC’s Dr. Lauren Epstein.

Sepsis is more than an infection

Once misleadingly called blood poisoning or a bloodstream infection, sepsis occurs when the body goes into overdrive while fighting an infection, injuring its own tissue. The cascade of inflammation and other damage can lead to shock, amputations, organ failure or death.

It strikes more than 1.5 million people in the United States a year and kills more than 250,000.

Even a minor infection can be the trigger. A recent CDC study found nearly 80 percent of sepsis cases began outside of the hospital, not in patients already hospitalized because they were super-sick or recovering from surgery.

There’s no single symptom

In addition to symptoms of infection, worrisome signs can include shivering, a fever or feeling very cold; clammy or sweaty skin; confusion or disorientation; a rapid heartbeat or pulse; confusion or disorientation; shortness of breath; or simply extreme pain or discomfort.

If you think you have an infection that’s getting worse, seek care immediately, Epstein said.

What’s the recommended care?

Doctors have long known that rapidly treating sepsis is important. But there’s been debate over how fast. New York mandated in 2013 that hospitals follow “protocols,” or checklists, of certain steps within three hours, including performing a blood test for infection, checking blood levels of a sepsis marker called lactate, and beginning antibiotics.

Do the steps make a difference? Seymour’s team examined records of nearly 50,000 patients treated at New York hospitals over two years. About 8 in 10 hospitals met the three-hour deadline; some got them done in about an hour. Having those three main steps performed faster was better — a finding that families could use in asking what care a loved one is receiving for suspected sepsis.

Who’s at risk?

Sepsis is most common among people 65 and older, babies, and people with chronic health problems.

But even healthy people can get sepsis, even from minor infections. New York’s rules, known as “Rory’s Regulations,” were enacted after the death of a healthy 12-year-old, Rory Staunton, whose sepsis stemmed from an infected scrape and was initially dismissed by one hospital as a virus.

What’s next?

Illinois last year enacted a similar sepsis mandate. Hospitals in other states, including Ohio and Wisconsin, have formed sepsis care collaborations. Nationally, hospitals are supposed to report to Medicare certain sepsis care steps. In New York, Rory’s parents set up a foundation to push for standard sepsis care in all states.

“Every family or loved one who goes into a hospital, no matter what state, needs to know it’s not the luck of the draw” whether they’ll receive evidence-based care, said Rory’s father, Ciaran Staunton.

 
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The World Health Organization’s regional chief for Africa reports prospects for rapidly controlling the spread of the deadly Ebola virus in the Democratic Republic of Congo are good.

While not underestimating the difficulties that lie ahead in bringing this latest outbreak of Ebola to an end, Matshidiso Moeti told VOA she is “very encouraged” by the speed with which the government and its national and international partners have responded to this crisis.

“I am quite optimistic because this is a government that is experienced at this, and which has got off to a very quick start and we are already on the ground with the partners.  

“We are getting logistic support from WFP (World Food Program) and from the U.N. mission.  So, I am quite optimistic,” Moeti said.

WHO has reported 29 suspected cases, including three deaths since Ebola was discovered in a remote region of DRC on April 22.   This deadly virus causes fever, bleeding, vomiting and diarrhea.  It spreads easily through bodily fluids and can kill more than 50 percent of its victims.

This is the eighth recorded outbreak of Ebola in DRC since 1976.  The outbreak was first detected in Bas-Uele Province, a densely-forested area in northeastern Congo near the border with the Central African Republic.

Outbreak isolated

Moeti calls the remoteness of the area “a mixed blessing.”

She said that there was little likelihood of a “rapid expansion of the outbreak to other localities due to population movement as happened in West Africa.  Although, we are keeping a close eye on the Central African Republic … where we are concerned that there is insecurity there.”

She said it was difficult to operate and carry out surveillance or investigations in this area because the road network leading there was not very well developed and “we have to drive long distances, not in a car, but have to use a motorbike.”

To remedy this, she said the government had fixed up a landing strip to enable helicopters to fly in the experts and material needed to deal with this crisis.

Moeti, a South African physician, replaced Luis Gomez Sambo of Angola as WHO regional head for Africa in January 2015 after he was criticized for his lackluster leadership in handling the 2014 Ebola outbreak in West Africa.  

The World Health Organization has come under scathing criticism by the international community for its slow and inept response to that unprecedented epidemic.  By the time WHO declared the Ebola epidemic at an end in January 2016, the deadly virus had killed 11,315 people in Liberia, Sierra Leone, and Guinea.

Experience put to use

During a recent visit to Kinshasa, Matshidiso Moeti said she saw how the hard lessons that have been learned from this tragic experience were being applied in DRC.

“What I observed was that the government itself was very quick in getting out to this remote area from the central level.  

“So, they sent a team from Kinshasa within a day or two of getting this alert to go and investigate and from the provincial level very rapidly, the government got down into this local area,” she said.

Moeti is leading a reform process to transform the WHO in the African Region into what she called a “more responsive, accountable, effective and transparent organization.”

She told VOA that this process was a component of WHO’s global reform effort and she would be rolling out the plan during a side-event on May 22, the opening day of this year’s World Health Assembly.

She said the reform program focused largely on how to improve measures for more quickly and efficiently tackling emergencies and communicable diseases.

“Clearly, as we saw very starkly with the Ebola outbreak, an outbreak can quickly transform into a big humanitarian crisis with all sorts of impacts.”

While the job of health reform is far from complete, Moeti said, “I am really pleased to say that we are starting to see how those changes that we have made are making a difference in how we operate.”

 
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