YCLOAK

Alarmed by yet another jump in syphilis cases in newborns, U.S. health officials are calling for stepped-up prevention measures, including encouraging millions of women of childbearing age and their partners to get tested for the sexually transmitted disease.

More than 3,700 babies were born with congenital syphilis in 2022 — 10 times more than a decade before and a 32% increase from 2021, the Centers for Disease Control and Prevention said Tuesday. Syphilis caused 282 stillbirth and infant deaths, nearly 16 times more than the 2012 deaths.

The 2022 count was the most in more than 30 years, CDC officials said, and in more than half of the congenital syphilis cases, the mothers tested positive during pregnancy but did not get properly treated.

The rise in congenital syphilis comes despite repeated warnings by public health agencies, and it’s tied to the surge in primary and secondary cases of syphilis in adults, CDC officials said. It’s also been increasingly difficult for medical providers to get benzathine penicillin injections — the main medical weapon against congenital syphilis — because of supply shortages.

“It is clear that something is not working here, that something has to change,” the CDC’s Dr. Laura Bachmann said. “That’s why we’re calling for exceptional measures to address this heartbreaking epidemic.”

The federal agency wants medical providers to start syphilis treatment when a pregnant woman first tests positive, rather than waiting for confirmatory testing, and to expand access to transportation so the women can get treatment. The CDC also called for rapid tests to be made available beyond doctors’ offices and STD clinics to places such as emergency rooms, needle-exchange programs and prisons and jails.

Federal officials again advised sexually active women of childbearing age and their partners to get tested for syphilis at least once if they live in a county with high rates. According to a new CDC map and definition, 70% of U.S. adults live in a county with high rates. That’s likely tens of millions of people, according to an Associated Press estimate based on federal data.

The CDC’s recommendations are just that; there is no new federal money going out to state and local health departments to bolster testing or access. Some state health departments have already said they’re stretched thin when it comes to treatment and prevention, although Illinois announced last week it was starting a phone line for health care providers to help with record searching, consultation and assistance with mandatory reporting.

Syphilis is a bacterial infection that for centuries was a common but feared sexually transmitted disease. New infections plummeted in the U.S. starting in the 1940s when antibiotics became widely available and fell to their lowest mark in the late 1990s. By 2002, cases began rising again, with men who have sex with other men being disproportionately affected, although the STD is spreading among several demographics.

In congenital syphilis, mothers pass the disease on to their babies, potentially leading to the death of the child or health problems for the child such as deafness, blindness and malformed bones. Case rates have been rising across racial and ethnic groups.

Dr. Mike Saag, an infectious diseases expert at the University of Alabama at Birmingham, said syphilis can be “a silent infection” in women because it’s tricky to diagnose without a blood test — not everyone gets painless sores, wart-like lesions or other visible symptoms.

The CDC has long recommended that all pregnant women should be tested for syphilis at their first prenatal visit, but poor access to prenatal care — largely in rural areas of the U.S. — can make that difficult. Nearly 40% of last year’s congenital syphilis cases involved mothers who didn’t have prenatal care, the CDC said.

If syphilis is diagnosed early in a pregnancy, the threat of passing it to the baby can be removed by a single penicillin shot. But experts say the later one gets into pregnancy, the more likely one will need multiple shots, and they have to be completed at least 30 days before delivery.

“I have had patients who have been on (a three-shot) regimen who then miss a shot,” said Dr. Nina Ragunanthan, an OB/GYN at the Delta Health Center in Mound Bayou, Mississippi. “So they are trying to get their shots, but if they don’t get the three in a row, because of transportation issues, because of job issues, child care issues, any number of reasons that prevent them from coming back, they don’t complete their treatment.”

Plus, the shortage of shots makes the task of getting syphilis numbers down difficult, health officials across the U.S. told the AP. Patients who are not pregnant can use the antibiotic doxycycline to treat syphilis, but health officials are concerned that the 14- to 28-day timeline of treatment is difficult to complete, leaving infected people uncured.

Pfizer is the nation’s sole supplier of penicillin shots. Earlier this year, company officials said penicillin was in short supply because of increased demand. Pfizer also said the shortage may not be resolved until next year.

The CDC said the shortage didn’t affect the 2022 congenital syphilis case numbers and that, despite the shortage, it isn’t aware of patients not getting their needed shots.
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European astronomers on Tuesday released the first images from the newly launched Euclid space telescope, designed to unlock the secrets of dark matter and dark energy — hidden forces thought to make up 95% of the universe.

The European Space Agency, which leads the six-year mission with NASA as a partner, said the images were the sharpest of their kind, showcasing the telescope’s ability to monitor billions of galaxies up to 10 billion light years away.

The images spanned four areas of the relatively nearby universe, including 1,000 galaxies belonging to the massive Perseus cluster just 240 million light years away, and more than 100,000 galaxies spread out in the background, ESA said.

Scientists believe vast, seemingly organized structures such as Perseus could have formed only if dark matter exists.

“We think we understand only 5% of the universe. That’s the matter that we can see,” ESA’s science director Carole Mundell told Reuters.

“The rest of the universe we call dark because it doesn’t produce light in the normal electromagnetic spectrum,” she said. “But we know its effect because we see the effect on visible matter.”

Tell-tale signs of the hidden force exerted by dark matter include galaxies rotating more quickly than scientists would expect from the amount of visible matter that can be detected.

Its influence is also implicated in pulling together some of the most massive structures in the universe, such as clusters of galaxies, Mundell said.

Dark energy is even more enigmatic.

Its hypothetical existence was established only in the 1990s by studying exploding stars called supernovas, resulting in a 2011 Nobel prize shared between three U.S.-born scientists.

Thanks in part to observations from the earlier Hubble Space Telescope, they concluded that the universe was not only expanding but that the pace of expansion was accelerating — a stunning discovery attributed to the new concept of dark energy.

After initial commissioning and technical teething problems, including stray light and guidance issues, Euclid will now start piecing together a 3D map encompassing about a third of the sky to detect tiny variations attributable to the dark universe.

By gaining new insights into dark energy and matter, scientists hope to better grasp the formation and distribution of galaxies across the so-called cosmic web of the universe.

The release of the images in Darmstadt, Germany, coincided with the second of two days of European space talks in Spain dominated by Europe’s continued dependency on foreign launches.
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Sweden is poised to become Europe’s first smoke-free country largely thanks to the popularity of snus, a kind of moist snuff which is placed under the upper lip.   

But some are worried the tobacco industry is peddling a “fairytale” that is too good to be true.    

Used by one in seven Swedes, snus has, according to the government, helped slash the number of smokers from 15% of the population in 2005 to 5.2% last year, a record low in Europe.  

A country is considered smoke-free when less than 5% of its population are daily smokers.     

Snus has been banned in the European Union since 1992. But Sweden negotiated an exemption when it joined the bloc three years later.   

At the Swedish Match factory in the western city of Gothenburg, thousands of doses of snus wend their way through a complex web of machinery producing the sachets.   

The company sold 277 million boxes of snus in Sweden and Norway in 2021.   

“We have used it for 200 years in Sweden. [It’s] part of the Swedish culture, just like many other European countries have their wine culture,” Swedish Match spokesman Patrik Hildingsson told AFP.   

 

Clad in a white lab coat, he described the manufacturing process.   

“Tobacco comes from India or the United States. It goes through this silo and is then packed inside the pouches like tea bags and then into these boxes.”    

There are two types: traditional brown snus, which contains tobacco, and white snus, which is made of synthetic nicotine and often flavored.   

Conquering the young

Traditional snus is mostly sold in Sweden, Norway and the U.S.   

White snus, introduced about 15 years ago, falls into a legal void in the EU since it doesn’t contain tobacco. It was banned this year in both Belgium and the Netherlands.   

But it is hugely popular with young people in Sweden, with its use quadrupling among women aged 16 to 29 in four years.   

Fifteen percent of people in Sweden say they use some form of snus daily, a figure that has risen slightly in recent years.   

At the same time, the country has seen a sharp drop in smokers even though cigarettes are less than half the price they are in Ireland.   

Just 5% of Swedes say they smoke regularly, according to 2022 data from the Public Health Agency, putting Sweden 27 years ahead of the EU’s 2050 smoke-free target.   

“It’s very positive,” Swedish Health Minister Jakob Forssmed told AFP.   

“A very important decision was the smoking ban in restaurants from 2005, and then at outdoor restaurants and public places in 2019,” he said.   

“Many Swedes also say that switching to snus helped them stop smoking.”   

The government has also backed the snus industry, hiking taxes recently on cigarettes by nine percent while cutting those on traditional snus by 20%.  

“With all these regulations it’s almost impossible to smoke. Snus doesn’t smell, and the nicotine rush is much stronger than with a cigarette,” said Thorbjorn Thoors, a 67-year-old window repairman who has used snus since his teens and quit smoking decades ago.   

Linked to cancer?

But the decision to lower taxes on snus does not sit well with Ulrika Arehed Kagstrom, head of the Swedish Cancer Society.   

“It came as a complete surprise and I was really disappointed,” she said.   

“It shows that they really completely bought the fairytale from the tobacco industry, [which is] trying to find a new market for these products and saying that these are harm reduction products.

“We don’t have enough research yet,” she insisted.   

“We know that snus and these kinds of nicotine products cause changes in your blood pressure and there is a risk of long-term cardiovascular disease.”   

Arehed Kagstrom fears that just like with smoking it will take years to show “to what extent these products were harmful.”   

A June 2023 study by the Norwegian Institute of Public Health showed that the risk of throat and pancreatic cancer was three and two times greater, respectively, among frequent snus users.  

However, in 2017, a study in the International Journal of Cancer concluded there was no link between cancer and snus. 

 
…

When Hurricane Michael hit the Florida Panhandle five years ago, it left boats, cars and trucks piled up to the windows of Bonny Paulson’s home in the tiny coastal community of Mexico Beach, Florida, even though the house rests on pillars 14 feet above the ground. But Paulson’s home, with a rounded shape that looks something like a ship, shrugged off Category 5 winds that might otherwise have collapsed it. 

“I wasn’t nervous at all,” Paulson said, recalling the warning to evacuate. Her house lost only a few shingles, with photos taken after the storm showing it standing whole amid the wreckage of almost all the surrounding homes.

Some developers are building homes like Paulson’s with an eye toward making them more resilient to the extreme weather that’s increasing with climate change, and friendlier to the environment at the same time. Solar panels, for example, installed so snugly that high winds can’t get underneath them, mean clean power that can survive a storm. Preserved wetlands and native vegetation that trap carbon in the ground and reduce flooding vulnerability, too. Recycled or advanced construction materials that reduce energy use as well as the need to make new material.

A person’s home is one of the biggest ways they can reduce their individual carbon footprint. Buildings release about 38% of all energy-related greenhouse gas emissions each year. Some of the carbon pollution comes from powering things like lights and air conditioners and some of it from making the construction materials, like concrete and steel.

Deltec, the company that built Paulson’s home, says that only one of the nearly 1,400 homes it’s built over the last three decades has suffered structural damage from hurricane-force winds. But the company puts as much emphasis on building green, with higher-quality insulation that reduces the need for air conditioning, heat pumps for more efficient heating and cooling, energy-efficient appliances, and of course solar.

“The real magic here is that we’re doing both,” chief executive Steve Linton. “I think a lot of times resilience is sort of the afterthought when you talk about sustainable construction, where it’s just kind of this is a feature on a list … we believe that resilience is really a fundamental part of sustainability.”

Other companies are developing entire neighborhoods that are both resistant to hurricanes and contribute less than average to climate change.

Pearl Homes’ Mirabella community in Bradenton, Florida, consists of 160 houses that are all LEED-certified platinum, the highest level of one of the most-used green building rating systems.

To reduce vulnerability to flooding, home sites are raised 3 feet above code. Roads are raised, too, and designed to direct accumulating rainfall away and onto ground where it may be absorbed. Steel roofs with seams allow solar panels to be attached so closely it’s difficult for high winds to get under them, and the homes have batteries that kick in when power is knocked out.

Pearl Homes CEO Marshall Gobuty said his team approached the University of Central Florida with a plan to build a community that doesn’t contribute to climate change. “I wanted them to be not just sustainable, but resilient, I wanted them to be so unlike everything else that goes on in Florida,” Gobuty said. “I see homes that are newly built, half a mile away, that are underwater … we are in a crisis with how the weather is changing.”

That resonates with Paulson, in Mexico Beach, who said she didn’t want to “live day to day worried about tracking something in the Atlantic.” Besides greater peace of mind, she says, she’s now enjoying energy costs of about $32 per month, far below the roughly $250 she said she paid in a previous home.

“I don’t really feel that the population is taking into effect the environmental catastrophes, and adjusting for it,” she said. “We’re building the same old stuff that got blown away.”

Babcock Ranch is another sustainable, hurricane-resilient community in South Florida. It calls itself the first solar-powered town in the U.S., generating 150 megawatts of electricity with 680,000 panels on 870 acres. The community was also one of the first in the country to have large batteries on site to store extra solar power to use at night or when the power is out.

Syd Kitson founded Babcock Ranch in 2006. The homes are better able to withstand hurricane winds because the roofs are strapped to a system that connects down to the foundation. Power lines are buried underground so they can’t blow over. The doors swing outward in some homes so when pressure builds up from the wind, they don’t blast open, and vents help balance the pressure in garages.

In 2022 Hurricane Ian churned over Babcock Ranch as a Category 4 storm. It left little to no damage, Kitson said.

“We set out to prove that a new town and the environment can work hand-in-hand, and I think we’ve proven that,” said Kitson. “Unless you build in a very resilient way, you’re just going to constantly be repairing or demolishing the home.”

The development sold some 73,000 acres of its site to the state for wetland preservation, and on the land where it was built, a team studied how water naturally flows through the local environment and incorporated it into its water management system.

“That water is going to go where it wants to go, if you’re going to try and challenge Mother Nature, you’re going to lose every single time,” said Kitson. The wetlands, retention ponds, and native vegetation are better able to manage water during extreme rainfall, reducing the risk of flooded homes.

In the Florida Keys, Natalia Padalino and her husband, Alan Klingler, plan to finish building a Deltec home by December. The couple was concerned about the future impacts global warming and hurricanes would have on the Florida Keys and researched homes that were both sustainable and designed to withstand these storms.

“We believe we’re building something that’s going to be a phenomenal investment and reduce our risk of any major catastrophic situation,” Klingler said.

“People have been really open and receptive. They tell us if a hurricane comes, they’re going to be staying in our place,” Padalino said.
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Prince William arrived Sunday in Singapore for the annual Earthshot Prize awards, the first to be held in Asia, to support environmental innovators with solutions to battle climate change and save the planet. 

Upon his arrival, dozens of people waving British flags welcomed him with loud cheers. William, 41, shook hands, signed autographs and sportingly took selfies with many of them during a walkabout. 

“It’s fantastic to be back in Singapore for this year’s Earthshot Prize ceremony, after 11 years,” he said in a statement upon landing. “Singapore’s bold vision to be a leader for environmental innovation sets the standard for others to follow.” 

“He has this charm,” said Johanes Mario, a Singaporean welcoming William at the airport. “He really fights for … the climate. I believe this is really a good cause for the future of our generation.”

At Singapore’s Changi Airport and before greeting the crowd, William stood on an upper floor for a stunning view of the 40-meter (131-foot) Rain Vortex, the world’s largest indoor waterfall, which was illuminated green to mark his arrival. He was also shown a tree planted in his honor in the indoor garden at the foot of the waterfall. 

The heir to the British throne last visited Singapore with his wife, Princess Catherine, in 2012. Traveling solo this time, William’s focus is on the Earthshot Prize that he and his Royal Foundation charity launched in 2020 to promote innovative solutions and technologies to combat global warming and mitigate its impact on the environment. 

15 finalists

Five winners will be named at an award ceremony Tuesday. Each will get a million pounds ($1.2 million) to help them scale up their projects for a wider global reach. Fifteen finalists representing six continents were selected from 1,300 nominees this year. The winners are from five categories: nature protection, clean air, ocean revival, waste elimination and climate change. 

William will address the star-studded ceremony, to be hosted by English actress Hannah Waddingham. Renowned wildlife conservationist Robert Irwing and celebrities including Oscar-winner Cate Blanchett and actresses Lana Condor and Nomzamo Mbatha are expected to attend the event. 

The inaugural ceremony was held in London in 2021, followed by Boston last year. The prize’s name refers to the late President John F. Kennedy’s 1962 “moonshot” speech, which challenged Americans to reach the moon by the end of that decade. That inspired the prince and his partners to set a similar goal for finding solutions to pressing environmental problems by 2030. 

Singapore’s Foreign Ministry said William will call on Singapore President Tharman Shanmugaratnam and meet Prime Minister Lee Hsien Loon at The Istana palace — one of Singapore’s oldest heritage sites — during his four-day trip. 

William, a keen sportsman, will also try his hand at dragon boating, a popular sport in Singapore and many parts of the world. He will also meet Singaporeans to see how local organizations are working to protect and restore the planet. 

William’s office at Kensington Palace has said that Singapore was chosen to host this year’s awards ceremony because of its role as a “hub for innovation” in Southeast Asia. 

William will also attend the United for Wildlife global summit, featuring representatives of law enforcement agencies, conservation groups and corporations working to combat trade in illegal wildlife products, estimated at $20 billion annually. 
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Building a robot that’s both humanlike and useful is a decadesold engineering dream inspired by popular science fiction. 

While the latest artificial intelligence craze has sparked another wave of investments in the quest to build a humanoid, most of the current prototypes are clumsy and impractical, looking better in staged performances than in real life. That hasn’t stopped a handful of startups from keeping at it. 

“The intention is not to start from the beginning and say, ‘Hey, we’re trying to make a robot look like a person,'” said Jonathan Hurst, co-founder and chief robot officer at Agility Robotics. “We’re trying to make robots that can operate in human spaces.” 

Do we even need humanoids? Hurst makes a point of describing Agility’s warehouse robot Digit as human-centric, not humanoid, a distinction meant to emphasize what it does over what it’s trying to be. 

What it does, for now, is pick up tote bins and move them. Amazon announced in October it would begin testing Digits for use in its warehouses, and Agility opened an Oregon factory in September to mass-produce them. 

Digit has a head containing cameras, other sensors and animated eyes, and a torso that essentially works as its engine. It has two arms and two legs, but its legs are more birdlike than human, with an inverted knees appearance that resembles so-called digitigrade animals such as birds, cats and dogs that walk on their toes rather than on flat feet. 

Rival robot-makers, like Figure AI, are taking a more purist approach on the idea that only true humanoids can effectively navigate workplaces, homes and a society built for humans. Figure also plans to start with a relatively simple use case, such as in a retail warehouse, but aims for a commercial robot that can be “iterated on like an iPhone” to perform multiple tasks to take up the work of humans as birth rates decline around the world. 

“There’s not enough people doing these jobs, so the market’s massive,” said Figure AI CEO Brett Adcock. “If we can just get humanoids to do work that humans are not wanting to do because there’s a shortfall of humans, we can sell millions of humanoids, billions maybe.” 

At the moment, however, Adcock’s firm doesn’t have a prototype that’s ready for market. Founded just over a year ago and after having raised tens of millions of dollars, it recently revealed a 38-second video of Figure walking through its test facility in Sunnyvale, California. 

Tesla CEO Elon Musk is also trying to build a humanoid, called Optimus, through the car company’s robotics division, but a hyped-up live demonstration last year of the robot’s awkwardly halting steps didn’t impress experts in the robotics field. Seemingly farther along is Tesla’s Austin, Texas-based neighbor Apptronik, which unveiled its Apollo humanoid in an August video demonstration. 

All the attention — and money — poured into making ungainly humanoid machines might make the whole enterprise seem like a futile hobby for wealthy technologists, but for some pioneers of legged robots, it’s all about what you learn along the way. 

“Not only about their design and operation, but also about how people respond to them, and about the critical underlying technologies for mobility, dexterity, perception and intelligence,” said Marc Raibert, the co-founder of Boston Dynamics, best known for its dog-like robots named Spot. 

Raibert said sometimes the path of development is not along a straight line. Boston Dynamics, now a subsidiary of carmaker Hyundai, experimented with building a humanoid that could handle boxes. 

“That led to development of a new robot that was not really a humanoid, but had several characteristics of a humanoid,” he said via email. “But the changes resulted in a new robot that could handle boxes faster, could work longer hours and could operate in tight spaces, such as a truck. So humanoid research led to a useful nonhumanoid robot.” 

Some startups aiming for humanlike machines focused on improving the dexterity of robotic fingers before trying to get their robots to walk. 

Walking is “not the hardest problem to solve in humanoid robotics,” said Geordie Rose, co-founder and CEO of British Columbia, Canada-based startup Sanctuary AI. “The hardest problem is the problem of understanding the world and being able to manipulate it with your hands.” 

Sanctuary’s newest and first bipedal robot, Phoenix, can stock shelves, unload delivery vehicles and operate a checkout, early steps toward what Rose sees as a much longer-term goal of getting robots to perceive the physical world to be able to reason about it in a way that resembles intelligence. Like other humanoids, it’s meant to look endearing, because how it interacts with real people is a big part of its function. 

“We want to be able to provide labor to the world, not just for one thing, but for everybody who needs it,” Rose said. “The systems have to be able to think like people. So we could call that artificial general intelligence if you’d like. But what I mean more specifically is the systems have to be able to understand speech and they need to be able to convert the understanding of speech into action, which will satisfy job roles across the entire economy.” 
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Using sidewalks as exam rooms and heavy red duffle bags as medical supply closets, volunteer medics spend their Saturdays caring for the growing number of migrants arriving in Chicago without a place to live.

Mostly students in training, they go to police stations where migrants are first housed, prescribing antibiotics, distributing prenatal vitamins and assessing for serious health issues. These student doctors, nurses and physician assistants are the front line of health care for asylum-seekers in the nation’s third-largest city, filling a gap in Chicago’s haphazard response.

“My team is a team that shouldn’t have to exist, but it does out of necessity,” said Sara Izquierdo, a University of Illinois Chicago medical student who helped found the group. “Because if we’re not doing this, I’m not sure anyone will.”

More than 19,600 migrants have come to Chicago over the last year since Texas Gov. Greg Abbott began sending buses to so-called sanctuary cities. The migrants wait at police stations and airports, sometimes for months, until there’s space at a longer-term shelter, like park district buildings.

Once in shelter, they can access a county clinic exclusively for migrants. But the currently 3,300 people in limbo at police stations and airports must rely on a mishmash of volunteers and social service groups that provide food, clothes and medicine.

Izquierdo noted the medical care gap months ago, consulted experienced doctors and designed a street-medicine model tailored to migrants’ medical needs. Her group makes weekly visits to police stations, operating on a shoestring budget of $30,000, mostly used for medication.

On a recent Saturday, she was among dozens of medics at a South Side station where migrants sleep in the lobby, on sidewalks and an outdoor basketball court. Officers didn’t allow the volunteers in the station so when one patient requested privacy, their doctor used his car.

Abrahan Belizario saw a doctor for the first time in five months.

The 28-year-old had a headache, toothache and chest pain. He recently arrived from Peru, where he worked as a driver and at a laundromat but couldn’t survive. He wasn’t used to the brisk Chicago weather and believed sleeping outdoors exacerbated his symptoms.

“It is very cold,” he said. “We’re almost freezing.”

The volunteers booked him a dental appointment and gave him a bus pass.

Many migrants who land in Chicago and other U.S. cities come from Venezuela where a social, political and economic crisis has pushed millions into poverty. More than 7 million have left, often risking a dangerous route by foot to the U.S. border.

The migrants’ health problems tend to be related to their journey or living in crowded conditions. Back and leg injuries from walking are common. Infections spread easily. Hygiene is an issue. There are few indoor bathrooms and outdoor portable toilets lack handwashing stations. Not many people carry their medical records.

Most also have trauma, either from their homeland or from the journey itself.

“You can understand the language, but it doesn’t mean you understand the situation,” said Miriam Guzman, one of organizers and a fourth-year medical student at UIC.

The doctors refer patients to organizations that help with mental health but there are limitations. The fluid nature of the shelter system makes it difficult to follow-up; people are often moved without warning.

Chicago’s goal is to provide permanent homes, which could help alleviate health issues. But the city has struggled to manage the growing population as buses and planes arrive daily at all hours. Mayor Brandon Johnson, who took office in May, calls it an inherited issue and proposed winterized tents.

His administration has acknowledged the heavy reliance on volunteers.

“We weren’t ready for this,” said Rey Wences Najera, first deputy of immigrant, migrant and refugee rights. “We are building this plane as we are flying it and the plane is on fire.”

The volunteer doctors also are limited in what they can do: Their duffle bags have medications for children, bandages and even ear plugs after some migrants wanted to block out sirens. But they cannot offer X-rays or address chronic issues.

“You’re not going to tell a person who has gone through this journey to stop smoking,” said Ruben Santos, a Rush University medical student. “You change your way of trying to connect to that person to make sure that you can help them with their most pressing needs while not doing some of the traditional things that you would do in the office or a big academic hospital.”

The volunteers explain to each patient that the service is free but that they’re students. Experienced doctors, who are part of the effort, approve treatment plans and prescribe medications.

Getting people those medications is another challenge. One station visit prompted 15 prescriptions. Working from laptops on the floor — near dozens of sleeping families — the doctors mapped out which medics would pick up medications the following day and how they’d find the recipients.

Sometimes the volunteers must call for emergency help.

Thirty-year-old Moises Hidalgo said he had trouble breathing. Doctors heard a concerning “crackling” sound, suspected pneumonia and called an ambulance.

Hidalgo, who came from Peru after having left his native Venezuela more than a decade ago, once worked as a chef. He’s been walking around Chicago looking for jobs, but has been turned away without a work permit.

“I’ve been trying to find work, at least so that I can pay to sleep somewhere, because if this isn’t solved, I can’t keep waiting,” he said.

To stay warm while sleeping outside, he wore four layers of clothing; his loose pants cinched with a shoelace.

The medics hope Chicago can formalize their approach. And they say they’ll continue to keep at it — for some, it’s personal.

Dr. Muftawu-Deen Iddrisu, who works Advocate Illinois Masonic Medical Center, said he wanted to give back. Originally from Ghana, he attended medical school in Cuba.

“I come from a very humble background,” he said. “I know how it feels. I know once sometime back someone did the same for me.” 
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One of modern climate science’s pioneers is warning that the world isn’t just steadily warming but is dangerously accelerating, according to a study that some other scientists call a bit overheated.

The work from former NASA top scientist James Hansen, who since leaving the space agency has become a prominent protester against the use of fossil fuels, which cause climate change, illustrates a recently surfaced division among scientists about whether global warming has kicked into a new and even more dangerous gear.

Hansen, who alerted much of the United States to the harms of climate change in dramatic congressional testimony in 1988, said Thursday that since 2010, the rate of warming has jumped by 50%. Hansen argues that since 2010 there is more sun energy in the atmosphere, and less of the particles that can reflect it back into space thanks to efforts to cut pollution. The loss of those particles means there’s less of the cooling effect that they can have.

Hansen said a key calculation used in figuring out how much the world will warm in response to carbon pollution shows much faster warming than the United Nations’ Intergovernmental Panel on Climate Change estimates. He called the international goal of limiting warming to 1.5 degrees Celsius since pre-industrial times “deader than a doornail” and said a less stringent goal of 2 degrees Celsius is on its deathbed. That matters because increases in average global temperatures lead to more frequent and intense extreme weather events.

“The next few years will show that we indeed do have an acceleration in the global warming rate,” Hansen said in a press briefing. “And it’s based on simple good physics.”

“The planet is now out of (energy) balance by an incredible amount, more than it ever has been,” said Hansen, who has been nicknamed the Godfather of Global Warming.

Several climate scientists contacted by The Associated Press expressed skepticism about Hansen’s study, tinged with respect for his long-term work.

Hansen’s study in Thursday’s journal Oxford Open Climate Change is broad-ranging “but has little by way of analytical depth or consistency checks when making claims quite far outside the norm,” said Robin Lamboll, a climate scientist at the Imperial College of London. “It seems primarily aimed at convincing policymakers rather than scientists.”

University of Pennsylvania climate scientist Michael Mann, who insisted that warming is steadily increasing but not accelerated, posted a rebuttal to Hansen’s claims and said climate change right now is bad enough and there’s no need to overstate the case. Mann said “it has always been risky to ignore (Hansen’s) warnings and admonitions” but when claims are made so out of the mainstream the standard for evidence is high, and he said Hansen hasn’t met them.

Yet a check of National Oceanic and Atmospheric Administration data lends support to Hansen’s modeling.

Hansen’s study said from 1970 to 2010, the world warmed at a rate of 0.18 degrees Celsius per decade, but projected that would increase to a rate of at least 0.27 degrees Celsius per decade after 2010. NOAA data shows that 0.27 degrees is the rate since September 2010.

That starting date is key because that’s when scientists could start to see the effect of clean air regulations that reduced aerosol pollution and the amount of sulfur in fuel used by ocean shipping, Hansen said. That type of more traditional sooty air pollution has a cooling effect that masks a fraction of the warming from the burning of coal, oil and natural gas, Hansen and many other scientists said.

When scientists try to figure out future and past warming one of the crucial variables is climate sensitivity, which is how much the world warms when carbon dioxide levels in the air double. These calculations have had a wide range and scientists have yet to settle on it, but the latest U.N. climate panel said it is within a range of 2 degrees Celsius to 5 degrees Celsius, with the likely range between 2.5 and 4 degrees and 3 degrees being a good midpoint.

Hansen’s study has it at 4.8 degrees Celsius. That’s within the widest range, but barely.

It’s that high because past research was based on wrong calculations of how fast the world warmed between glacial periods, Hansen said.

Past calculations were based on plant and animal fossil data, figuring microbiotic organisms wouldn’t adapt to warming, but would move to their preferred temperature range. Hansen said recent research shows that the organisms adapt and stay put, and when his team calculated past temperature changes based on chemical, not biological markers, it showed much faster warming for when carbon dioxide doubled in Earth’s ancient history.

Studies on climate sensitivity vary widely and are inconsistent, with another recent study showing 2.8 degrees not 4.8, said climate scientist Zeke Hausfather of Berkeley Earth and the tech company Stripe. He said Hansen’s calculations are “not implausible but not particularly well supported by the literature.”

Stanford University climate scientist Rob Jackson, however, said “I tend to trust Hansen, despite his advocacy. I think his contention that the IPCC has underestimated climate sensitivity will prove out.”

Hansen said a more recent climate model — downplayed by the U.N. climate panel for running too hot – is actually more accurate than the ones mainstream climate scientists prefer based on cloud conditions in the southern ocean.

With a strong natural El Nino, which tends to temporarily warm the globe, and record heat in the air and in the deep oceans, scientists in the past month have split about what’s happening to the globe.

Mann said the warming the world is seeing is what has long been predicted and is not the indication of something unusual or acceleration. The increases reported, he said, are statistically insignificant.

Hausfather said the world is warming faster, but he calculated the rate at 0.24 degrees Celsius per decade instead of Hansen’s 0.27 degrees.
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The cancellation of two large offshore wind projects in New Jersey is the latest in a series of setbacks for the nascent U.S. offshore wind industry, jeopardizing the Biden administration’s goals of powering 10 million homes from towering ocean-based turbines by 2030 and establishing a carbon-free electric grid five years later.

The Danish wind energy developer Ørsted said this week it’s scrapping its Ocean Wind I and II projects off southern New Jersey due to problems with supply chains, higher interest rates and a failure to obtain the amount of tax credits the company wanted.

Together, the projects were supposed to deliver over 2.2 gigawatts of power.

The news comes after developers in New England canceled power contracts for three projects that would have provided another 3.2 gigawatts of wind power to Massachusetts and Connecticut. They said their projects were no longer financially feasible.

In total, the cancellations equate to nearly one-fifth of President Joe Biden’s goal of 30 gigawatts of offshore wind power by 2030.

Despite the setbacks, offshore wind continues to move forward, the White House said, citing recent investments by New York state and approval by the Interior Department of the nation’s largest planned offshore wind farm in Virginia. Interior’s Bureau of Ocean Energy Management also announced new offshore wind lease areas in the Gulf of Mexico.

“While macroeconomic headwinds are creating challenges for some projects, momentum remains on the side of an expanding U.S. offshore wind industry — creating good-paying union jobs in manufacturing, shipbuilding and construction,” while strengthening the power grid and providing new clean energy resources for American families and businesses, the White House said in a statement Thursday.

Industry experts now say that while the U.S. likely won’t hit 30 gigawatts by 2030, a significant amount of offshore wind power is still attainable by then, roughly 20 to 22 gigawatts or more. That’s far more than the nation has today, with just two small demonstration projects that provide a small fraction of a single gigawatt of power.

Large, ocean-based wind farms are the linchpin of government plans to shift to renewable energy, particularly in populous East Coast states with limited land for wind turbines or solar arrays. Eight East Coast states have offshore wind mandates set by legislation or executive actions that commit them to adding a combined capacity of more than 45 gigawatts, according to ClearView Energy Partners, a Washington-based research firm.

“I think very few people would argue that the U.S. will have the gigawatts the Biden administration wants” by 2030, said Timothy Fox, a ClearView vice president. “But I do think eventually we will have it and will likely exceed it.”

Offshore wind developers have publicly lamented the global economic gales they’re facing. Molly Morris, president of U.S. offshore wind for the Norwegian company Equinor, said the industry is facing a “perfect storm.”

High inflation, supply chain disruptions and the rising cost of capital and building materials are making projects more expensive while developers are trying to get the first large U.S. offshore wind farms opened. Ørsted is writing off $4 billion, due largely to cancellation of the two New Jersey projects.

David Hardy, group executive vice president and CEO Americas at Ørsted, said it’s crucial to lower the levelized cost of offshore wind in the United States so Americans aren’t debating between affordability and clean energy. Hardy spoke at the American Clean Power industry group’s offshore wind conference in Boston last month on a panel with Morris.

“We’re probably a little bit too ambitious,” he said. “We came in hot; we came in fast, we thought we could build projects that were inexpensive, large projects right out of the gate. And it turns out that we probably still need to go through the same learning curve that Europe did, with higher prices in the beginning and a little slower pace.”

In May, there were 27 U.S. offshore wind projects that had negotiated agreements with states to provide power before the brunt of the cost increases hit, according to Walt Musial, offshore wind chief engineer at the National Renewable Energy Laboratory, an arm of the Energy Department. The delay between signing purchase agreements and getting final approval to build allowed unexpected cost increases to render many projects economically unfeasible, he said.

Musial called Ørsted’s announcement a setback for the industry but “not a fatal blow by any means.”

On Tuesday, the Biden administration announced approval of the nation’s largest offshore wind project. The Coastal Virginia Offshore Wind project will be a 2.6 gigawatt wind farm off Virginia Beach to power 900,000 homes. And even as Ørsted announced the New Jersey cancellations, it said it was investing with utility Eversource to move forward with construction of Revolution Wind, Rhode Island and Connecticut’s first utility-scale offshore wind farm, a 704-megawatt project.

The current outlook from S&P Global Commodity Insights is 22 gigawatts by 2030, though that will be revised due to the recent industry announcements.

New York state, meanwhile, recently announced the award of 4 gigawatts of offshore wind capacity as it seeks to obtain 70% of its electricity from renewable sources by 2030 and 9 gigawatts of offshore wind by 2035. That announcement came shortly after New York regulators rejected a request for bigger payments for four offshore wind projects worth a combined 4.2 gigawatts of power.

Any delay in offshore wind means continued reliance on fossil fuel-burning power plants, according to environmental advocates. “The quicker they come online, the quicker our air quality improves,” said Conor Bambrick, director of policy for Environmental Advocates NY.

New Jersey, under Democratic Gov. Phil Murphy, has established increasingly stringent clean energy goals, moving from 100% clean energy by 2050 to 100% by 2035. Murphy cast Ørsted’s decision as “outrageous” and an abandonment of its commitments, but the two-term Democrat said New Jersey plans to move forward with offshore wind.

The first U.S. commercial-scale offshore wind farms are currently under construction: Vineyard Wind off Massachusetts and South Fork Wind off Rhode Island and New York. 
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Countries moved a step closer Saturday to getting a fund off the ground to help poor states damaged by climate disasters, despite reservations from developing nations and the United States.  

The deal to create a “loss and damage” fund was hailed as a breakthrough for developing country negotiators at United Nations climate talks in Egypt last year, overcoming years of resistance from wealthy nations.  

But in the past 11 months, governments have struggled to reach consensus on the details of the fund, such as who will pay and where the fund will be located.  

A special U.N. committee tasked with implementing the fund met for a fifth time in Abu Dhabi this week — following a deadlock in Egypt last month — to finalize recommendations that will be put to governments when they meet for the annual climate summit COP28 in Dubai in less than four weeks. The goal is to get the fund up and running by 2024.  

The committee, representing a geographically diverse group of countries, resolved to recommend the World Bank serve as trustee and host of the fund — a tension point that has fueled divisions between developed and developing nations. 

Housing a fund at the World Bank, whose presidents are appointed by the U.S., would give donor countries outsized influence over the fund and result in high fees for recipient countries, developing countries have argued. 

To get all countries on board, it was agreed the World Bank would serve as interim trustee and host of the fund for a four-year period. 

Jennifer Morgan, Germany’s special climate envoy, said in a post on X that Berlin “stands ready to fulfill its responsibility — we’re actively working towards contributing to the new fund and assessing options for more structural sources of financing.” 

Others were less optimistic. 

“It is a somber day for climate justice, as rich countries turn their backs on vulnerable communities,” said Harjeet Singh, head of global political strategy at nonprofit Climate Action Network International.  

“Rich countries … have not only coerced developing nations into accepting the World Bank as the host of the Loss and Damage Fund but have also evaded their duty to lead in providing financial assistance to those communities and countries.” 

The committee also recommended that developed countries be urged to continue to provide support to the fund, but failed to resolve whether wealthy nations would be under strict financial obligation to chip in. 

“We regret that the text does not reflect consensus concerning the need for clarity on the voluntary nature of contributions,” a U.S. State Department official told Reuters. 

The U.S. attempted to include a footnote clarifying that any contributions to the fund would be voluntary, but the committee chair did not allow it. The U.S. objected to that denial. 

Sultan al-Jaber, who will preside over the COP28 talks, said he welcomed the committee’s recommendations and that they would pave the way for an agreement at COP28.  
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Called cover crops, they top the list of tasks U.S. farmers are told will build healthy soil, help the environment and fight climate change.

Yet after years of incentives and encouragement, Midwest farmers planted cover crops on only about 7% of their land in 2021.

That percentage has increased over the years but remains small in part because even as farmers receive extra payments and can see numerous benefits from cover crops, they remain wary. Many worry the practice will hurt their bottom line — and a study last year indicates they could be right.

Researchers who used satellite data to examine over 90,000 fields in six Corn Belt states found cover crops can reduce yields of cash crops — the bushels per acre. The smaller the yield, the less money farmers make.

“I don’t want to abandon it, but as far as just going whole-hog with planting cover crops, that’s a tough thing for me to do,” said Illinois farmer Doug Downs, who plants cover crops only on a sliver of his land in a relatively flat region of east-central Illinois.

Cover crops are plants grown on farmland that otherwise would be bare. While crops like corn and soybeans are growing or soon after harvest, farmers can sow species such as rye or red clover that will grow through winter and into spring. They stabilize soil, reduce fertilizer runoff, store carbon in plant roots and potentially add nutrients to the dirt.

The practice is key to government efforts to sequester carbon in farmland to help reduce climate change, since there’s general agreement planting the right off-season crops can pull carbon from the air and keep it underground in plant roots.

The U.S. Department of Agriculture promotes cover crops through several programs, starting with $44 million in payments during the 2023 fiscal year from the agency’s Natural Resources Conservation Service for over 4,700 contracts to plant them on more than 344,000 hectares. Additional funding was available for conservation practices, including cover crops, through the Inflation Reduction Act. Another program provided $100 million in extra benefits through federal crop insurance coverage to farmers who plant cover crops.

There’s heightened interest in cover crops for carbon storage, though the effectiveness depends on the soil, plant variety, temperature and other factors.

The Natural Resources Defense Council has put so much stock in cover crops that it recently launched a social media campaign with Nick Offerman, featuring the Parks and Recreation TV show actor buried in dirt while promoting the practice. The environmental group has encouraged Congress to give farmers more lucrative financial incentives to plant the crops.

The NRDC points to studies that have found cover crops don’t necessarily reduce cash crop yields and can boost growth. And Lara Bryant, the group’s deputy director of water and agriculture, notes that while the overall percentage of farmers planting cover crops is small, acreage increased by 50% to about 5% of U.S. cropland from 2012 to 2017, the most recent year USDA data is available.

“We have a long way to go but we’ve come a long way in a short amount of time,” Bryant said.

However, the 2022 satellite study found yields declined by an average of 5.5% on corn fields where cover crops were used for three or more years. For soybean fields, the decline was 3.5%. The declines varied depending on factors such as cover crop type, soil moisture and soil quality.

“I was surprised it was so negative,” said David Lobell, a Stanford University agricultural ecologist who worked on the study published in the journal Global Change Biology with researchers from Illinois and North Carolina. “We rechecked everything and were a little bit surprised.”

The study found that rye, the most frequently used cover crop, is especially prone to reducing yields, Lobell said. Rye is less expensive than many cover crops and grows well in many kinds of soil.

The study examined farm fields in Illinois, Iowa, Indiana, Michigan, Missouri and Ohio, using satellite images. Lobell said details from an individual field are less precise than on-the-ground study, but by examining thousands of fields, researchers can reach accurate conclusions.

The researchers said farmers need more technical help choosing and maintaining cover crops as well as more government or food industry payments to offset potential yield losses. The federal government and at least 22 states provide financial incentives to farmers — and food companies such as General Mills and PepsiCo pay more to farmers who plant cover crops.

Terry Cosby, chief of the USDA’s Natural Resources Conservation Service, acknowledged establishing effective cover crops can take time and some experimenting but said farmers who stick with them should see significant benefits. He noted the Biden administration’s allocation of $19.5 billion for climate smart programs over five years and that federal, state and university outreach services can provide technical advice.

“It’s going to take some trials and errors,” Cosby said. “It might fail but over the long term … it has been proven that you can be very successful with some type of cover crop.”

Downs, the Illinois farmer, has tried to incorporate cover crops into some of his operations, especially to control weeds. But he says it hasn’t been easy.

In 2019, Downs planted rye in one field but didn’t plant it on an identical field across a road. The spring was wet and the rye field was so soggy, he couldn’t get in for weeks to kill the cover crop and plant his soybeans, resulting in a smaller crop.

“Growing a cover crop cost me $250 an acre, and I spent $50 an acre doing it,” Downs said.

Farmers don’t typically harvest and sell cover crops; they frequently use herbicides to kill them before planting their principle crop. 

Less than 32 kilometers away, fourth-generation farmer Curt Elmore has been “dabbling” in cover crops for a decade, planting varieties like oats and rye on parts of the 809 hectares he farms.

Elmore seeds cover crops by plane before harvesting his cash crop, but cover crop growth has been spotty, not worth the cost.

Elmore said he’ll keep trying, but it seems that in his area of Illinois, it will take more payments from governments or companies to convince many additional farmers to take up the practice.

“If this is an imperative, then somebody is going to have to pay for it,” he said.

Joe McClure, Iowa Soybean Association research director, said the Stanford study largely confirms his organization’s research, though he thought the university researchers should do field study to verify their satellite-based analysis.

McClure said more more financial support would help farmers avoid having to choose between planting cover crops and losing money.

J. Arbuckle, a professor in Iowa State University’s sustainable agriculture program, said it’s important to be open with farmers about possible yield reductions and how they can be mitigated over longer periods, such as six or seven years.

Even then, Arbuckle said, it can be hard to convince farmers to give cover crops a try because, despite the significant environmental benefits, a small drop in cash crop yield can mean a big cost.

“Even a one bushel hit, if you’re talking about a bushel an acre over a thousand acres, that’s a lot of money,” he said.
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A thick layer of toxic haze choked Indian capital New Delhi on Friday, and some schools were ordered closed as the air quality index plummeted to the “severe” category.

New Delhi again topped a real-time list of the world’s most polluted cities compiled by Swiss group IQAir, which put the Indian capital’s air quality index, or AQI, at 640, which is in the “hazardous” category, followed by 335 in the Pakistani city of Lahore.

Regional officials said a seasonal combination of lower temperatures, a lack of wind and crop stubble burning in neighboring farm states caused a spike in air pollutants.

Many of New Delhi’s 20 million residents complained of irritation in the eyes and itchy throats with the air turning a dense gray.

An AQI of 0-50 is considered good while anything between 400-500 affects healthy people and is a danger to those with existing diseases.

“In my last 24 hours duty, I saw babies coughing, children coming with distress and rapid breathing,” Aheed Khan, a Delhi-based doctor, said on social media platform X.

Fewer people came to the city’s parks, such as Lodhi Garden and India Gate, popular with joggers.

Residents snapped up air purifiers. One service center for the appliances said there was a shortage of new filters and fresh stocks were expected Monday.

Officials said they did not expect an immediate improvement in the air quality.

“This pollution level is here to stay for the next two to three weeks, aggravated by incidents of stubble burning, slow wind speed and cooling temperatures,” said Ashwani Kumar, chairman of the Delhi Pollution Control Committee.

Farmers in the northern states of Punjab, Haryana and Uttar Pradesh typically burn crop waste after harvesting in October to clear their fields before sowing winter crops a few weeks later.

This year, attention on the worsening air quality has cast a shadow over the cricket World Cup hosted by India, with financial capital Mumbai also suffering from a spike in pollution levels.

Delhi hosts a World Cup match Monday between Bangladesh and Sri Lanka.

A concentration of toxic PM2.5 particles, which are less than 2.5 microns in diameter and can cause deadly illness, was 53.4 times the World Health Organization’s annual air quality guideline value in New Delhi on Friday, according to IQAir.

While junior schools in the capital were ordered shut for Friday and Saturday, they were open in the suburbs and children boarding school buses were forced to wear masks that had been put away since the end of the COVID-19 pandemic.

Poor air quality also caused respiratory problems, irritation in the eyes and restlessness in pets.

“Breathing trouble can develop into pneumonia or other ailments in younger animals. If possible, avoid taking pets out on morning walks for a few days till the air improves,” said Prabhat Gangwar, a veterinarian at animal welfare NGO Friendicoes.
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The little asteroid visited by NASA’s Lucy spacecraft this week had a big surprise for scientists.

It turns out that the asteroid Dinkinesh has a dinky sidekick — a mini moon.

The discovery was made during Wednesday’s flyby of Dinkinesh, 480 million kilometers (300 million miles) away in the main asteroid belt beyond Mars. The spacecraft snapped a picture of the pair when it was about 435 kilometers (270 miles) out.

In data and images beamed back to Earth, the spacecraft confirmed that Dinkinesh is barely a half-mile (790 meters) across. Its closely circling moon is a mere one-tenth-of-a-mile (220 meters) in size.

NASA sent Lucy past Dinkinesh as a rehearsal for the bigger, more mysterious asteroids out near Jupiter. Launched in 2021, the spacecraft will reach the first of these so-called Trojan asteroids in 2027 and explore them for at least six years. The original target list of seven asteroids now stands at 11.

Dinkinesh means “you are marvelous” in the Amharic language of Ethiopia. It’s also the Amharic name for Lucy, the 3.2 million year old remains of a human ancestor found in Ethiopia in the 1970s, for which the spacecraft is named.

“Dinkinesh really did live up to its name; this is marvelous,” Southwest Research Institute’s Hal Levison, the lead scientist, said in a statement.
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Fewer high school students are vaping this year, the government reported Thursday.

In a survey, 10% of high school students said they had used electronic cigarettes in the previous month, down from 14% last year.

Use of any tobacco product — including cigarettes and cigars — also fell among high schoolers, according to the Centers for Disease Control and Prevention report.

“A lot of good news, I’d say,” said Kenneth Michael Cummings, a University of South Carolina researcher who was not involved in the CDC study.

Among middle school student, about 5% said they used e-cigarettes. That did not significantly change from last year’s survey.

This year’s survey involved more than 22,000 students who filled out an online questionnaire last spring. The agency considers the annual survey to be its best measure of youth smoking trends.

Why the drop among high schoolers? Health officials believe a number of factors could be helping, including efforts to raise prices and limit sales to kids by raising the legal age to 21.

“It’s encouraging to see this substantial decrease in e-cigarette use among high schoolers within the past year, which is a win for public health,” said Brian King, the Food and Drug Administrations tobacco center director.

The FDA has authorized a few tobacco-flavored e-cigarettes intended to help adult smokers cut back but has struggled to stop sales of illegal products.

Other key findings in the report:

Among students who currently use e-cigarettes, about a quarter said they use them every day.
About 1 in 10 middle and high school students said they recently had used a tobacco product. That translates to 2.8 million U.S. kids.
E-cigarettes were the most commonly used kind of tobacco product, and disposable ones were the most popular with teens.
Nearly 90% of the students who vape used flavored products, with fruit and candy flavors topping the list. 

 

In 2020, FDA regulators banned those teen-preferred flavors from reusable e-cigarettes like Juul and Vuse, which are now only sold in menthol and tobacco. But the flavor restriction didn’t apply to disposable products, and companies like Elf Bar and Esco Bar quickly stepped in to fill the gap.

The growing variety in flavors like gummy bear and watermelon has been almost entirely driven by cheap, disposable devices imported from China, which the FDA considers illegal. Those products now account for more than half of U.S. vaping sales, according to government figures.

In the latest survey, about 56% of teens who vape said they used Elf Bar, trailed by Esco Bar and Vuse, which is a reusable e-cigarette made by R.J. Reynolds. Juul, the brand widely blamed for sparking the recent spike in teen vaping, was the fourth most popular brand, used by 16% of teens.

The FDA tried to block imports of both Elf Bar and Esco Bar in May, but the products remain widely available. Elf Bar has thwarted customs officials by changing its brand name, among other steps designed to avoid detection.

On Thursday, the FDA announced another round of fines against 20 stores selling Elf Bar products. The agency has sent more than 500 warning letters to retailers and manufacturers of unauthorized e-cigarettes over the past year, but those citations are not legally binding and are sometimes ignored.

In the latest report, the CDC highlighted one worrisome but puzzling finding. There was a slight increase in middle schools students who said they had used at least one tobacco product in the past month, while that rate fell among high school students. Usually those move in tandem, said Kurt Ribisl, a University of North Carolina researcher. He and Cummings cautioned against making too much of the finding, saying it might be a one-year blip.
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