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Alaska’s Food Trucks – The New York Times

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Last summer, on an overcast July day, the coastal town of Sitka, once the capital of Russian Alaska and long a popular stop on Inside Passage cruises in Southeast Alaska, was thronged with passengers disembarking from three cruise ships. To accommodate the crowds, the city had closed the main street to cars. In their place, food trucks, carts and stands had popped up, creating a festival atmosphere where ambulatory diners spooned seafood chowder and gobbled tacos.

“In summer, street food seems like the way to go in a place like this,” said Gretchen Stelzenmuller, who cooked professionally in San Francisco before moving back home to Sitka during the pandemic and opening her mobile food business, Enoki Eatery, which serves Japanese-inspired comfort food. “It’s healthy and uniquely celebrates Alaska ingredients, but you can also roll in and grab a bite and still do your tour.”

In the wake of the pandemic, as cruising returns to full strength in Alaska, food trucks and other vendors have proliferated in ports from Ketchikan to Seward.

“With a food truck, you can get into the restaurant business without the full brick-and-mortar entrepreneurial costs,” said Jon Bittner, the state director of the Alaska Small Business Development Center. “That’s pretty attractive in smaller communities that service cruise ships.”

For passengers with only a few hours in port and lots to see — including ferry riders taking the Alaska Marine Highway — food trucks offer local flare at relatively reasonable prices and in less time than full-service restaurants.

“Food trucks are a natural extension of what draws people to Alaska, being outside,” said Aaron Saunders, the senior editor at Cruise Critic.

Expect to pay a little more than in the Lower 48, given the high cost of living. Last summer, I bought a chicken and rice dish for $16 from a stand in Seward, a few dollars more and a free can of Pepsi less than the equivalent truck fare in New York City.

For the 2023 cruise season, which generally runs April to October, Alaska cruise authorities expect 1.65 million cruise passengers, up from the record of 1.3 million in 2019. Most will sail the Inside Passage, a roughly 500-mile route in Southeast Alaska that weaves through islands protecting it from the churn of the Pacific Ocean.

While ship-bound visitors may make their way through Anchorage — which has its own thriving food truck scene — the following popular cruise stops form a locally grown coastal culinary trail.

Often the first call in Alaska for northbound Inside Passage cruises, Ketchikan — a traditional Tlingit fishing camp that today thrives on tourism, commercial fishing and forestry — booms with the arrival of cruise ships. Passengers disembarking for day trips in the Tongass National Forest or to see the totem poles at Saxman Native Village will find a few food stalls among the vendor booths on the cruise dock — including D’s Fish and Chip Shack — while more robust food-truck offerings can be found within walking distance.

“If you want to see someone make out with a chicken sandwich, come by our truck sometime,” wrote Thane Peterson, the owner of the food truck Chicke Chicke Bang Bang, which specializes in chicken sandwiches ($12), in an email. He described diners with “eyes closed, groaning, mumbling ‘Oh my god.’”

The truck, which launched last year, can often be found parked near the cruise docks, and passengers, Mr. Peterson said, account for two-thirds of annual sales.

A few blocks from the cruise berths, Amber Adams aims to open the town’s first food truck lot, Dock Street Yard, in August with room for three vendors.

After moving to Ketchikan from New Orleans four years ago, Ms. Adams found herself cooking Creole dishes with Alaskan ingredients as both a reminder of home and a necessity in a small town with few dining options. Currently the only tenant on the lot, her business, the Food Truck, will serve shrimp and grits ($15) and rib-eye banh mi po’ boys ($18).

“Starting a restaurant is scary,” Ms. Adams said on a break from prepping her truck. “But it’s a different beast here because of the huge influx of people for six months that basically doubles the population in town.”

In the high season, disembarking passengers can match Sitka’s population of about 8,500. Again this year, the city is restricting the main thoroughfare, Lincoln Street, to foot traffic on days when cruise ship capacity in port exceeds 5,000, inviting mobile businesses to set up.

“I think it’s a really great way to showcase all the talent in this town,” said Ms. Stelzenmuller, who launched Enoki Eatery last year as a Lincoln Street pop-up serving variations of Hawaiian-style musubi, a wedge of rice topped with Spam or fish and bound by a seaweed wrap. “Street food should be a reason to come here.”

This year, she purchased a food truck and parked it downtown. The vehicle has allowed her to expand the menu, which may include steamed buns stuffed with pork or salmon and cream cheese ($9) and smoked salmon musubi ($8.50).

Just off Lincoln Street, behind Ernie’s Old Time Saloon, Barbara Palacios serves poke, chowder and ceviche from her cart, the Fresh Fish.

“We’re having a food-truck boom here in Sitka,” said Ms. Palacios, who plans to upgrade her vehicle later this year to a full-size food truck and continue offering poke (tuna or salmon, $18), halibut ceviche ($14) and seafood chowder ($9 a cup, $14 a bowl).

“It’s a labor of passion and love,” said Ms. Palacios, who often works 12 hours a day in season.

A few blocks east, past the Russian Orthodox St. Michael’s Cathedral, Ashley McNamee runs Ashmo’s, serving locally caught fish in smoked salmon macaroni and cheese ($9), black cod on coconut rice ($10) and lingcod sandwiches ($12).

Like many food truck operators here, Ms. McNamee, whose résumé includes 14 years cooking at an Alaskan fishing lodge, chose the food truck over “the restaurant grind.” Still, she added, “With the influx of people off cruise ships, it’s almost all I can do to keep up.”

From the center of town, it’s a little over a mile to Harbor Mountain Brewing Co., where Cambria Goodwin and Luke Bruckert base their brick-and-mortar Campfire Kitchen, a wood-oven pizza specialist. This year, they’ve added a mobile kitchen at the site to prepare fried chicken sandwiches ($15) and fried cheese curds ($9) to keep up with the crush of business.

In a separate endeavor, Ms. Goodwin recently opened Sitka Salmon Wagon, serving salmon bisque ($10 a cup, $16 a bowl) from a trailer parked downtown “to feed the masses,” she said.

The weather can be a challenge to outdoor dining in Southeast Alaska’s temperate rainforest. After one year running Blumen Dogs hot dog cart, Shawn Blumenshine is adding a food truck and will operate in several locations, serving Nathan’s Famous franks ($7) and creative versions ($11), including the Banh Mi Dog with carrots, cabbage, jalapeños, vinaigrette and sweet chili sauce. To date, patrons are largely local. “I’ve got hardcore banh mi fans,” said Mr. Blumenshine.

The state capital, Juneau, is no stranger to food carts and trucks. Trailblazers in town include Bernadette’s, a Filipino barbecue cart started in 1996 that draws lines of visiting cruise ship crew members, many of whom are Filipino, and Pucker Wilson’s, opened nine years ago, and dishing two-fisted burgers like the Huskey Dawson topped with bacon, onion rings and cheese ($16).

Visitors looking for Alaskan seafood on the go will find it a few blocks from the cruise pier at Deckhand Dave’s, a fish taco purveyor that anchors a food-truck yard. The truck and yard are run by Dave McCasland, a self-taught chef who worked for two years as a cook on a commercial fishing boat to pay off his college loans before launching his truck in 2016 with items like blackened rockfish tacos ($13.50 for three).

In 2019, he developed the food truck lot with room for the original business, a spinoff oyster and champagne bar and other mobile tenants, today including the Alaskan Crepe Escape and a cotton candy maker.

“People travel for a taste of place, and when they come to Alaska they really want to eat seafood and eat local,” said Midgi Moore, who runs Juneau Food Tours, guiding visitors to places like Deckhand Dave’s.

Five miles from downtown, in the direction of the Mendenhall Glacier, the Alaskan Brewing Company tasting room hosts food trucks, including Forno Rosso, serving wood-fired Neapolitan-style pizzas ($13 to $17 for 10-inch pies). Before moving to Juneau, the truck’s owners, Alexander and Kym Kotlarov, lived in Rome where they developed a passion for pizza that led to the mobile business named for their red-tiled oven.

If visitors find out-of-the-way Forno Rosso, they tend to be independent travelers or craft beer fans, according to Ms. Kotlarov, who uses specialty flour, San Marzano tomatoes from California and locally grown Genovese basil.

“I feel like we’re swimming upstream with our agenda of caring about quality and staying true to the Italian thing,” Ms. Kotlarov said, noting that she continues to offer Italian potato pizza as a special periodically.

A port on the Kenai Peninsula, roughly 130 miles south of Anchorage, Seward tends to get cruise ships at the start or end of their itineraries. On the road system, it also draws travelers by land.

“They disembark and embark in Seward,” said Kameron Weathers, the owner of Wild Spoon food truck and catering company. “We’re not a stop.”

Still, ship crew and road-trippers patronize her stand for souped-up reindeer or buffalo dogs topped with beet kimchi and ginger aioli ($10), and venison specials.

In summer 2020, despite the collapse of tourism during the pandemic, Faith Alderman and Fiona Crosby launched their breakfast-and-lunch business, the Porthole, to capture the early morning traffic at Seward Harbor with breakfast burritos ($12) and English muffin sandwiches ($8). Open at 4:30 a.m., the business draws captains, deckhands and visitors taking boat trips to the nearby Kenai Fjords National Park.

Seward travelers bound for Alaska SeaLife Center, an aquarium and marine research center on Resurrection Bay, can’t miss Los Chanchitos, a busy Mexican food truck that anchors a nearby lot shared by Early Bird coffee truck and an ax-throwing business. It specializes in birria or beef brisket tacos ($17), among other fare.

Peter Cavaretta, who spent more than a decade in the southern Baja Peninsula, opened the truck last April after visiting his sister in Seward and seeing “lines out the door for semi-average food at high prices,” he said. “I wanted to do super-good food at moderate prices.”

Smoke From Canada’s Wildfires Returning to U.S. Cities This Week

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Smoke from wildfires in Western Canada drifted across the Midwest and the Northeast of the United States on Monday, blotting out blue sky and sun and blanketing dozens of cities with unhealthy air that triggered warnings to limit the time spent outdoors.

It was the second time in less than a month that the borderless impact of climate change could be felt with a breath. In June, heavy smoke from Quebec wafted into the East Coast, and blew from New York City, past Washington, as far west as Minnesota.

This week, as nearly 900 wildfires burned across Canada, the smoke came from fires in the western part of the country, billowing into its southern neighbor across a wide trail.

By 1 p.m. Eastern time, about 71.6 million people in 29 states were affected by the shifting, migrating smoke, according to estimates based on information from the National Oceanic and Atmospheric Administration and LandScan, a population database.

“Unfortunately, the wildfire smoke will begin to make a return to the region to start the new week,” according to the National Weather Service in the Philadelphia area.

Air quality alerts, ranging from moderate to very unhealthy, were issued by government agencies from Montana to the Dakotas and parts of other states, including Nebraska, Alabama, Tennessee, Ohio, North Carolina and along the Northeast.

Residents were advised to take precautions, from limiting outdoor activities to covering up with masks. In Chicago, where the air quality deteriorated through the weekend, Mayor Brandon Johnson warned children, older residents and those with heart or lung disease to limit outdoor activity.

“We are acutely aware that the recent weather events prominently impacting our City this summer are the direct result of the climate crisis,” he said.

Gov. Kathy Hochul of New York on Sunday issued air quality health advisories for Monday. The air quality in parts of upstate New York was expected to reach unhealthy levels for all residents, while conditions in the Lower Hudson Valley, New York City and Long Island were expected to be unhealthy only for sensitive groups.

“New Yorkers should once again prepare for smoke from the wildfires in Western Canada to impact our state’s air quality this week,” Ms. Hochul said in a statement, adding that officials were activating emergency notifications on roads and public transit systems and making sure that masks were available for distribution in counties across the state.

The air quality index in Rochester was already at 141 early Monday, while Buffalo’s was at 116. New York City officials said that conditions, which are considered unhealthy for sensitive groups, could persist for the initial part of the week.

The index runs from 0 to 500; the higher the number, the greater the level of air pollution. An A.Q.I. of 201 or more is considered very unhealthy.

So far, the air quality warnings were not as bad as they were in early June, when there were readings above 400 on the East Coast, signaling a hazardous level.

But by 10 a.m. Eastern time on Monday, cities across the Midwest were reporting some of the worst air quality in the country, according to the Environmental Protection Agency Billings, Mont., and Fort Wayne, Ind., had an A.Q.I. of 161, while the Cleveland area was at 157.

The forecast is expected to cause “unhealthy for all” conditions in the areas closest to the Canadian border, according to AirNow, a website run by the E.P.A., which oversees air quality across the United States.

The Ohio Environmental Protection Agency said its advisory was in effect through Monday. In the southwestern region of the state, residents were told to limit use of their vehicles, to refrain from mowing lawns and to avoid burning firewood and yard waste.

Local officials also advised residents to limit outdoor activity or using their cars, and to wear masks. The message was repeated from Buffalo — where Mayor Byron W. Brown told residents to take precautions — to Chicago, where an air quality alert was in effect through Sunday night.

In Pennsylvania, where the Department of Environmental Protection issued a statewide “code orange” alert, officials suggested residents and businesses help by limiting burning of leaves, trash, and other materials, and avoiding the use of gas-powered lawn and garden equipment.

Wildfire smoke from Canada is forecast to linger through Tuesday, propelled by northwesterly winds, the Weather Service said.

Early last month, the level of particulate matter in the air from smoke became so unhealthy that many U.S. cities set records. At points, it was hazardous to breathe everywhere from Minnesota and Indiana to sections of the Mid-Atlantic and the South.

Visibility decreased to startling degrees in cities, including New York, Toronto and Cincinnati. In some places, smoke from the fires blanketed the sky in an orange haze. That smoke could be traced to wildfires burning in Quebec.

Damage to Crimean Bridge Captured in Satellite Images

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Satellite images taken on Monday, July 17, captured damage on a bridge linking Crimea to Russia’s Krasnodar Krai over the Kerch Strait after Russian authorities accused Ukrainian forces of carrying out an attack.

Russia’s National Anti-Terrorism Committee said Ukrainian forces struck the bridge with two unmanned sea drones shortly after 3 am, killing two adults and injuring one child.

Sergey Aksyonov, the Russian-installed head of Crimea’s occupying government, advised people to avoid the bridge and take alternative routes through occupied areas of Ukraine’s Kherson, Zaporizhzhia, and Donetsk oblasts.

President Vladimir Putin called an emergency meeting of the Government Commission on the Crimean Bridge that was attended by Aksyonov, Deputy Prime Minister for Construction and Regional Development Marat Khusnullin, Minister of Transport Vitaly Savelyev, Governor of Krasnodar Krai Veniamin Kondratyev, and the Russian-installed head of occupied Kherson, Vladimir Saldo, according to a Kremlin press release.

Khusnullin said road sections of the bridge were damaged and traffic was suspended, but said the railway parts of the bridge were still operational. Authorities were hoping to reintroduce two-way traffic by September 15, Khusnullin said.

Putin instructed Khusnullin to begin repairs “as quickly as possible” and called for “concrete proposals to improve the security” of the bridge, the Kremlin said.

Ukraine had not officially commented on the incident but, after the explosions, the Security Service of Ukraine (SBU) reposted its comment from October last year, when an explosion caused part of the bridge to collapse. “Again, the bridge went ‘to sleep’ again,” the SBU’s post read, according to a machine translation. Credit: Maxar via Storyful

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RSV Shot Is Approved for Infants

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The Food and Drug Administration on Monday approved a shot to protect infants and vulnerable toddlers against respiratory syncytial virus, or RSV offering one of the first protections for an illness that fills children’s hospitals year after year.

The monoclonal antibody shot is expected to be available at the start of the fall R.S.V. season. The F.D.A. is also considering approval of an R.S.V. vaccine by Pfizer for pregnant women that is meant to protect infants from the virus.

The treatment approved on Monday, called Beyfortus by its developers Sanofi and AstraZeneca, addresses an illness that can be severe in older adults and young infants. About 80,000 children ages 5 and younger are hospitalized with the virus each year, according to the Centers for Disease Control and Prevention.

“R.S.V. can cause serious disease in infants and some children and results in a large number of emergency department and physician office visits each year,” Dr. John Farley, an official in the F.D.A. Center for Drug Evaluation and Research, said. “Today’s approval addresses the great need for products to help reduce the impact of R.S.V. disease on children, families and the health care system.”

The potential to blunt the effects of R.S.V. will extend to older adults: In recent months, the F.D.A. has approved two vaccines against the virus for adults 60 and older. The virus is linked to 60,000 hospitalizations and up to 10,000 deaths each year in people 65 and older, according to the C.D.C. The agency estimated that more than 21,000 people in that age group would need to take the GSK vaccine to prevent one R.S.V. death in one year; the number was nearly 25,000 for the Pfizer shot.

Agency advisers considering the antibody shot for infants cast a unanimous vote in June in favor of approving the treatment for infants. More than 3,200 infants were given the shot in studies that Sanofi and AstraZeneca submitted to the F.D.A. One six-month study found that efficacy against very severe R.S.V. that required medical attention was 79 percent.

F.D.A. advisers were more cautious about an R.S.V. shot by Pfizer intended for pregnant women. In May, a panel voted 10 to 4 that the vaccine was safe, a reflection of concerns about slightly elevated rates of preterm births among mothers who received the vaccine, compared with those who received a placebo.

Studies of a similar vaccine by GSK were halted after researchers detected an increase in preterm births. The agency has yet to make a decision on that maternal Pfizer vaccine, called Abrysvo, though a company spokeswoman said that approval was anticipated in the coming weeks.

Aliyah Boston of the Indiana Fever Has Officially Arrived

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Aliyah Boston said she usually keeps it cool when she faces the star basketball players she grew up watching on television. But her poker face slipped last month.

Boston, a rookie power forward and center for the Indiana Fever, was in a close contest against the Las Vegas Aces and she was shoulder to shoulder with her childhood idol, Candace Parker.

“It was unreal,” Boston said. “We’re standing on the free-throw line, cracking jokes. And I’m like: ‘Aliyah, don’t laugh. This is serious business.’”

Fifteen years ago, when Boston was just 6 years old, Parker won the W.N.B.A.’s Rookie of the Year Award. Now Boston is on track to do the same.

She was the first rookie to be named a starter for the W.N.B.A. All-Star Game in nine years and only the eighth rookie ever. The achievement added to what has been an impressive season for Boston, who is drawing comparisons to greats like Brittney Griner, A’ja Wilson and Elena Delle Donne just weeks into her professional career.

“She’s going to be a great one,” said Aces Coach Becky Hammon, who also coached Boston in the All-Star Game in Las Vegas on Saturday. “Indiana has a centerpiece, literally a center piece to build around.”

Boston is averaging 15.4 points per game, the most of any first-year player, and she is shooting a league-leading 61 percent from the field. The No. 1 pick in this year’s draft, Boston has swept rookie of the month award honors so far this season.

“I never thought I’d be an All-Star my rookie season,” Boston said on Saturday. “It’s just a blessing to be in this position right now.”

Boston exudes confidence. As the All-Star lineups were announced, she danced out onto the stage to the delight of her veteran teammates. And she is poised on the court. With her Indiana Fever down 3 to the Liberty last week, Boston knocked down a 3-pointer at the buzzer to send the game into overtime. The Fever eventually won, 95-87.

“She is going through uncharted territory a little bit,” Liberty forward Breanna Stewart said, “but still making sure that she’s able to have an impact on the court and play her game.”

Boston is known for having an impact. While playing for Coach Dawn Staley at South Carolina, Boston was a four-time all-American and set several team records, including in rebounds, double-doubles and triple-doubles. In 2021, she led the Gamecocks to their second N.C.A.A. Division I title in program history. Now she’s trying to make her mark on a Fever team that has struggled for years. Wins are still hard to come by, but Boston has already proved her value.

“It’s a smooth transition for her,” Staley said. “She makes it look easy. And I know it’s not.”

That transition from college to the W.N.B.A. includes myriad challenges, from the pace of play to the constant travel to the increased physicality, said Liberty guard Sabrina Ionescu, the No. 1 draft pick in 2020.

“It’s hard, and hats off to her and the entire Indiana organization for helping her do what she does,” Ionescu said. “That’s why they drafted her at 1, because they know what she’s capable of doing.”

Boston said her basketball I.Q. is the main skill that has translated from college to the pros. Staley agreed.

“She makes the right basketball decisions,” Staley said. “And when you’ve played that way your entire life, nothing changes. It’s only the people that change.”

One of the new people Boston has faced is Delle Donne, who was named the rookie of the year in 2013. Delle Donne said that one of the trickier aspects of joining the league is how quickly players need to get used to a new program, new coach and new teammates, but said that none of that seems to have slowed down Boston. Last month, against Delle Donne’s Washington Mystics, Boston scored 23 points and grabbed 14 rebounds in the Fever’s 87-66 win.

“She’s so dominant,” Delle Donne said. “I mean, she crushed us the other game. She’s a rookie that requires veteran defensive schemes.”

Delle Donne added that it can be hard to manage the pressure of coming in as the No. 1 overall pick. Last season, the Fever finished at the bottom of the 12-team league with a 5-31 record.

“To know the expectation that you’re supposed to come and completely change a team is hard, but you can do it,” Delle Donne said. “Coming into the league, there’s always so much excitement about a new player who’s going to continue to raise our game and make it even better. So night in and night out, people are watching what you’re doing.”

For now, Boston seems unfazed by the attention.

“Something that I always take with me is, never get too high with the highs and too low with the lows,” Boston said. “Stay levelheaded.”

New Study Finds Alzheimer’s Drug Donanemab Can Modestly Slow Memory Decline

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Treating Alzheimer’s patients as early as possible — when symptoms and brain pathology are mildest — provides a better chance of slowing cognitive decline, a large study of an experimental Alzheimer’s drug presented Monday suggests.

The study of 1,736 patients reported that the drug, donanemab, made by Eli Lilly, can modestly slow the progression of memory and thinking problems in early stages of Alzheimer’s, and that the slowing was greatest for early-stage patients when they had less of a protein that creates tangles in the brain.

For people at that earlier stage, donanemab appeared to slow decline in memory and thinking by about four and a half to seven and a half months over an 18-month period compared with those taking a placebo, according to the study, published in the journal JAMA. Among people with less of the protein, called tau, slowing was most pronounced in those younger than 75 and those who did not yet have Alzheimer’s but had a pre-Alzheimer’s condition called mild cognitive impairment, according to data presented Monday at the Alzheimer’s Association International Conference in Amsterdam.

“The earlier you can get in there, the more you can impact it before they’ve already declined and they’re on this fast slope,” Dr. Daniel Skovronsky, Eli Lilly’s chief medical and scientific officer, said in an interview.

“No matter how you cut the data — earlier, younger, milder, less pathology — every time, it just looks like early diagnosis and early intervention are the key to managing this disease,” he added.

The findings and the recent approval of another drug that modestly slows decline in the early stages of Alzheimer’s, Leqembi, signal a potentially promising turn in the long, rocky path toward finding effective medications for Alzheimer’s, a brutal disease that plagues more than six million Americans. Donanemab is currently being considered for approval by the Food and Drug Administration.

Donanemab and Leqembi (also known by the scientific name lecanemab) have not been compared directly to each other in research studies. The individual trials of the two drugs differ in design and other aspects, making it hard to say which medication might be more effective.

Each drug poses significant safety risks, especially swelling and bleeding in the brain, which, while often mild, can be serious in some cases. The donanemab trial had higher rates of swelling and bleeding than the Leqembi trial, but comparisons are difficult because of differences in patients and other factors.

Neither drug reverses or repairs brain damage already caused by the disease. Many Alzheimer’s experts therefore consider them to be only a first step in a potentially fruitful direction.

“Whether the harms of these drugs are balanced by their modest clinical benefits will ultimately require more data,” three geriatricians wrote in an editorial published Monday in JAMA.

Three deaths were linked to donanemab in its clinical trial, the study reported. Three participants in trials of Leqembi also died, after experiencing brain swelling and bleeding. But Eisai, the Japanese company that makes Leqembi along with the company Biogen, based in Boston, has said it is unclear if the drug contributed to those deaths because those patients had complex medical issues.

The two drugs attack another protein, called amyloid, which clumps into plaques in the brains of Alzheimer’s patients. Over years of study, other anti-amyloid drugs failed to show that targeting amyloid could slow memory or thinking problems. And the F.D.A.’s decision in 2021 to give a type of conditional approval to the anti-amyloid drug Aduhelm while acknowledging uncertainty about whether it was beneficial generated controversy, congressional investigations and reluctance to prescribe it.

Donanemab and Leqembi, infusions that are administered intravenously, are the first amyloid-attacking drugs with clear evidence of slowing cognitive decline early in the disease. But some Alzheimer’s experts say the slowing is so modest it is unclear if it will be noticeable to patients and families.

Leqembi patients, who received infusions every two weeks for 18 months, declined 27 percent more slowly than patients receiving a placebo — a difference of less than half a point on an 18-point cognitive scale that assesses functions like memory and problem-solving. On the same scale in the donanemab trial, the overall group of patients receiving the drug, delivered in monthly infusions, declined 29 percent more slowly than the placebo group — or a difference of seven-tenths of a point.

Some Alzheimer’s experts say that for slowing of decline to be clinically meaningful or noticeable, the difference between a drug and a placebo must be at least one point.

Other aspects of the donanemab trial are likely to be especially intriguing to Alzheimer’s experts. Patients stopped receiving donanemab and were switched to a placebo if their amyloid was cleared below a certain threshold. About half reached the threshold within a year, and their decline kept slowing even after they stopped receiving donanemab.

Lilly scientists have estimated that it would take nearly four years for amyloid levels to bump up over the threshold again. It is uncertain whether slowing of decline would continue as amyloid begins accumulating again.

The donanemab trial divided participants into patients with high levels of tau and those with intermediate levels. Tau forms tangles after amyloid accumulates, and higher tau levels are more closely associated with memory and thinking problems.

The trial found that the intermediate group (which was larger) experienced 36 percent slowing of decline, compared with 29 percent for the combined intermediate and high tau groups and 21 percent in the high tau group alone. Another scale, which was the trial’s primary measurement tool, showed the same pattern. Lilly computed that decline for patients in the intermediate group would be slowed by 4.4 to 7.5 months over 18 months compared to people on placebo, while the combined population would see slowing of 2.5 to 5.4 months.

More people with intermediate tau remained at the same cognitive level in their first year in the trial — 47 percent compared with 29 percent of people in the placebo group, the study estimated. In the combined tau groups, 36 percent of people on donanemab remained at the same level compared with 23 percent of people on placebo.

In the intermediate tau group, donanemab patients with mild cognitive impairment slowed by 46 percent, while those who had already progressed to early Alzheimer’s slowed by 38 percent, the company reported. Intermediate tau patients who were younger than 75 slowed by 45 percent, while older patients slowed by only 29 percent.

One criticism of the study was that, as in many Alzheimer’s drug trials, a vast majority of patients were white, a concern highlighted by the authors of another editorial in JAMA, who noted that Black, Hispanic and other historically marginalized communities have higher risks of Alzheimer’s.

The difficulty of predicting if these drugs will be meaningful in daily life is reflected in the experience of a patient in another donanemab trial.

About four years ago, Jim Sirois, 67, of Berlin, Conn., began having trouble finding words during conversations and would forget which items to buy at the grocery store, his wife, Sue Sirois, said in an interview arranged by Eli Lilly.

In November 2021, Mr. Sirois, a former power company electrician, started receiving monthly donanemab infusions in a trial comparing whether the drug clears more amyloid than the drug Aduhelm does. Ms. Sirois, a former middle school math teacher, said that donanemab cleared the plaques and that treatment was stopped after about 13 months. But the couple said they don’t know if the medicine slowed Mr. Sirois’s cognitive decline.

While her husband’s symptoms haven’t worsened significantly, Ms. Sirois said, “there were some things he could do without problems last summer that he has difficulty doing this summer.”

Mr. Sirois is now unable to hook up their pool vacuum or insert string in their weed whacker. “He just has a lot of difficulty with planning and anything that has multi-steps,” she said.

Even bowling, an activity he excels at, has been affected. His aim can be less targeted now and, although he recently bowled a perfect game, “his average is probably a good 20 pins lower than it used to be,” she said.

“I don’t know if the drug has helped him or not,” Ms. Sirois said. “I can’t tell.”

But, she added, “Whatever we can do to slow the progression or at least have some hope of slowing the progression is what I would want to do.”

Paris Without the Crowds – The New York Times

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Summer has arrived in Paris, and the world with it. By day, international hordes pile into the Musée d’Orsay to catch the final month of the blockbuster “Manet / Degas” exhibition as throngs surround the closed, fire-damaged Notre Dame Cathedral to snap any possible selfies. By night, the available picnic space quickly disappears on the lawns of the Champ de Mars and its direct view of the Eiffel Tower.

But even in a global travel darling like the French capital, strategies exist for dodging the droves — especially if you can sacrifice a few “musts” in favor of worthy but less-famous alternatives. Here’s a six-point plan to help create a little space and comfort in the height of high season.

Less touristed and less expensive, many Paris suburbs offer a respite from the masses while featuring distinctive culinary, cultural and historical draws of their own. And no need to worry about transportation: Most are linked to the city center by metro or commuter rail.

Montreuil, just beyond the city’s eastern edge, has become a haven for musicians, artists and self-styled bohemians who hang around craft-beer bars like Brasserie Croix de Chavaux and Beer and Records, and live-music clubs such as La Marberie and Le Chinois.

Northeast of Paris, Pantin is the base of the Hermès luxury brand and some cultural powerhouses as well, notably the Centre National de la Danse and an exhibition space from Thaddeus Ropac, one of Paris’s most well-known art gallerists. Staying in Pantin also offers quick access to top cultural venues in Paris’s 19th arrondissement. The Philharmonie de Paris complex includes a Jean Nouvel-designed concert hall and music museum, while the nearby Grande Halle de la Villette hosts exhibitions and performances.

Across the city, beyond Paris’s western limit, the upscale town of St.-Germain-en-Laye (birthplace of King Louis XIV) contains museums devoted to former residents like the composer Claude Debussy and the painter Maurice Denis as well as numerous fine-dining options. Le Wauthier by Cagna, a chic contemporary bistrot, and the gastronomic restaurant of the century-old Cazaudehore hotel (noted for its wine selection) are among the top tables.

In a global food capital where simply landing a table at a corner bistro can require booking hours or days ahead, scoring a dinner reservation in a lauded dining room or cult foodie haunt can require making your restaurant choices even before purchasing your plane tickets.

In such supersaturated conditions, the lunch hour could be your ticket. During this less-coveted period, top restaurants typically have more tables available and serve a more affordable menu that might cost half of what a dinner would run. You get the same kitchen, cooks, dining room and savoir-faire, but the whole package is easier to reserve — and to pay for.

This recent list from the Michelin Guide features several top restaurants offering good-value lunches. In a quiet street in the Bastille area, the Japanese chef Nobuyuki Akishige runs the kitchen at Automne, which features one of the most affordable Michelin-starred meals in town: a three-course lunch for just 45 euros. (Dinner menus start at 85 euros.) Such a deal makes the restaurant “the perfect place to discover haute cuisine for a small price,” in the words of the French newsweekly Le Point.

For a date with history, the one-star Auberge Nicolas Flamel occupies the oldest house in Paris, a 15th-century mansion in the Marais that underwent total renovation in 2021. These days the chef Grégory Garimbay and crew serve a three-course lunch for 64 euros, which saves you 50 percent from the cheapest dinner menu, a five-course meal for 128 euros.

Another bonus: you can spend the rest of the day walking off your feast among the celebrated boulevards and parks in the City of Light.

Now that your evenings are free, grab a quick bite and take advantage of the city’s many “nocturnes”— the nights that museums stay open late. According to museum representatives and Paris tour guides, these are the periods when crowds tend to be most manageable.

Museums with nocturnes include the Jeu de Paume photography and film museum (Tuesdays until 9 p.m.), Musée d’Orsay (Thursday until 9:45 p.m.), Louvre (Friday until 9:45 p.m.) and Musée Rodin (Thursday to Saturday in summer until 9:30 p.m.), which also allows nighttime visitors to picnic on the lawn of its sculpture garden.

Other top cultural institutions are open late nearly every night. The Pompidou Center is open until 9 p.m. most nights (and 11 p.m. on Thursday), while the Palais de Tokyo contemporary art museum is generally open until 10 p.m. and until midnight on Thursdays.

The iconic Sacre-Coeur basilica is also a night owl, welcoming visitors (for free) until 10:30 p.m. every evening.

It’s the age-old question: To soak up classic Parisian décor and literary history while eating baked goods and sipping some of the city’s best hot chocolate, should you go to the Café de Flore or the neighboring Café aux Deux Magots? Correct answer: Neither.

Rather than line up behind the velvet ropes of these famed Left Bank cafes, cross the Seine to some Right Bank gems. Carette, a century-old pastry shop and tearoom alongside the Place du Trocadero is known for its chocolat chaud and homemade macarons. Their newer, 21st-century location, under the stone arcades of the aristocratic Place des Vosges, ups the charm and tosses in some writerly vibes: just across the square is the former townhouse of novelist Victor Hugo, now a museum. Or head to fashionable rue Saint Honoré. Operating since 1880, Verlet roastery serves myriad house-label coffees and teas inside its elegant café-boutique.

Like the old expression implores, when everyone else zigs, you zag. Instead of crushing onto the decks of the mobbed sightseeing boats that ply the Seine, try a cruise up or down the Canal St. Martin, a slim waterway that winds north by northwest from the river and takes you through the trendy 10th and 19th Arrondissements.

Rather than hiking the steep, crowded, souvenir-filled streets of Montmartre to ogle Paris from the high perch of the Sacre-Coeur basilica, you can discover one of Paris’s most lovely parks — Buttes Chaumont — which sports a hilltop house of worship of its own: a replica Roman temple with views over northeast Paris, a bohemian and multicultural area far from the city’s well-trodden tourist zones.

As when others are jamming themselves into the trains that head westward to the overrun gilded halls of Versailles, opt instead to ride the rails south to Fontainebleau and stroll through some of the 1,500-plus rooms of the equally opulent Château de Fontainebleau. Built mainly over the course of the Middle Ages and Renaissance, the sumptuous, art-filled royal palace and residence was home to a long succession of French kings and rulers, from François I to Louis XVI to Napoleon.

The city empties out in late summer as Parisians depart on their annual holiday and tourist numbers dip, leaving Paris blissfully quiet and calm. (Many locals and expats who hang around say that this is their favorite time of the year.) Museums, monuments and parks generally stay open, as do many hotels, allowing you to enjoy iconic Paris with more breathing room. And though many restaurants and shops are shuttered for a few weeks, those that operate can be reserved or enjoyed with less hassle. Lists of restaurants that typically stay open in August are published by Sortir à Paris and Paris by Mouth.

Follow New York Times Travel on Instagram and sign up for our weekly Travel Dispatch newsletter to get expert tips on traveling smarter and inspiration for your next vacation. Dreaming up a future getaway or just armchair traveling? Check out our 52 Places to Go in 2023.

As Climate Shocks Multiply, Designers Seek Holy Grail: Disaster-Proof Homes

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Jon duSaint, a retired software engineer, recently bought property near Bishop, Calif., in a rugged valley east of the Sierra Nevada. The area is at risk for wildfires, severe daytime heat and high winds — and also heavy winter snowfall.

But Mr. duSaint isn’t worried. He’s planning to live in a dome.

The 29-foot structure will be coated with aluminum shingles that reflect heat, and are also fire-resistant. Because the dome has less surface area than a rectangular house, it’s easier to insulate against heat or cold. And it can withstand high winds and heavy snowpack.

“The dome shell itself is basically impervious,” Mr. duSaint said.

As weather grows more extreme, geodesic domes and other resilient home designs are gaining new attention from more climate-conscious home buyers, and the architects and builders who cater to them.

The trend could begin to dislodge the inertia that underlies America’s struggle to adapt to climate change: Technologies exist to protect homes against severe weather — but those innovations have been slow to seep into mainstream homebuilding, leaving most Americans increasingly exposed to climate shocks, experts say.

In the atrium of the Smithsonian’s National Museum of American History, students from the Catholic University of America recently finished reassembling “Weatherbreak,” a geodesic dome built more than 70 years ago and briefly used as a home in the Hollywood Hills. It was avant-garde at the time: roughly a thousand aluminum struts bolted together into a hemisphere, 25 feet high and 50 feet wide, evoking an oversize metal igloo.

The structure, designed by Jeffrey Lindsay and inspired by the work of Buckminster Fuller, has gained new relevance as the Earth warms.

“We started thinking about how our museum can respond to climate change,” Abeer Saha, the curator who oversaw the dome’s reconstruction, said. “Geodesic domes popped out as a way that the past can offer a solution for our housing crisis, in a way that hasn’t really been given enough attention.”

Domes are just one example of the innovation underway. Houses made from steel and concrete can be more resilient to heat, wildfire and storms. Even traditional wood-framed homes can be constructed in ways that greatly reduce the odds of severe damage from hurricanes or flooding.

But the costs of added resiliency can be about 10 percent higher than conventional construction. That premium, which often pays for itself through reduced repair costs after a disaster, nonetheless poses a problem: Most home buyers don’t know enough about construction to demand tougher standards. Builders, in turn, are reluctant to add resilience, for fear that consumers won’t be willing to pay extra for features they don’t understand.

One way to bridge that gap would be to tighten building codes, which are set at the state and local level. But most places don’t use the latest code, if they have any mandatory building standards at all.

Some architects and designers are responding on their own to growing concerns about disasters.

On a piece of land that juts out in the Wareham River, near Cape Cod, Mass., Dana Levy is watching his new fortress of a house go up. The structure will be built with insulated concrete forms, or ICF, creating walls that can withstand high winds and flying debris, and also maintain stable temperatures if the power goes out — which is unlikely to happen, thanks to the solar panels, backup batteries and emergency generator. The roof, windows, and doors will be hurricane-resistant.

The whole point, according to Mr. Levy, a 60-year-old retiree who worked in renewable energy, is to ensure he and his wife won’t have to leave the next time a big storm hits.

“There’s going to be a lot of people spilling out into the street seeking sparse government resources,” Mr. Levy said. His goal is to ride out the storm, “and in fact invite my neighbors over.”

Mr. Levy’s new home was designed by Illya Azaroff, a New York architect who specializes in resilient designs, with projects in Hawaii, Florida and the Bahamas. Mr. Azaroff said using that type of concrete frame adds 10 to 12 percent to the cost of a home. To offset that extra cost, some of his clients, including Mr. Levy, opt to make their new home smaller than planned — sacrificing an extra bedroom, say, for a greater chance of surviving a disaster.

Where wildfire risk is great, some architects are turning to steel. In Boulder, Colo., Renée del Gaudio designed a house that uses a steel structure and siding for what she calls an ignition-resistant shell. The decks are made from ironwood, a fire-resistant lumber. Beneath the decks and surrounding the house is a weed barrier topped by crushed rock, to prevent the growth of plants that could fuel a fire. A 2,500-gallon cistern could supply water for hoses in case a fire gets too close.

Those features increased the construction costs as much as 10 percent, according to Ms. del Gaudio. That premium could be cut in half by using cheaper materials, like stucco, which would provide a similar degree of protection, she said.

Ms. del Gaudio had reason to use the best materials. She designed the house for her father.

But perhaps no type of resilient home design inspires devotion quite like geodesic domes. In 2005, Hurricane Rita devastated Pecan Island, a small community in southwest Louisiana, destroying most of the area’s few hundred houses.

Joel Veazey’s 2,300-square-foot dome was not one of them. He only lost a few shingles.

“People came to my house and apologized to me and said: ‘We made fun of you because of the way your house looks. We should never have done that. This place is still here, when our homes are gone,’” Mr. Veazey, a retired oil worker, said.

Dr. Max Bégué lost his house near New Orleans to Hurricane Katrina. In 2008, he built and moved into a dome on the same property, which has survived every storm since, including Hurricane Ida.

Two features give domes their ability to withstand wind. First, the domes are composed of many small triangles, which can carry more load than other shapes. Second, the shape of the dome channels wind around it, depriving that wind of a flat surface to exert force on.

“It doesn’t blink in the wind,” Dr. Bégué, a racehorse veterinarian, said. “It sways a little bit — more than I want it to. But I think that’s part of its strength.”

Mr. Veazey and Dr. Bégué got their homes from Natural Spaces Domes, a Minnesota company that has seen demand jump the past two years, according to Dennis Odin Johnson, who owns the company with his wife Tessa Hill. He said he expected to sell 30 or 40 domes this year, up from 20 last year, and has had to double his staff.

The typical dome is about 10 to 20 percent less than expensive to build than a standard wood-frame house, Mr. Johnson said, with total construction costs in the range of $350,000 to $450,000 in rural areas, and about 50 percent higher in and around cities.

Most customers aren’t particularly wealthy, Mr. Johnson said, but have two things in common: an awareness of climate threats, and an adventurous streak.

“They want something that’s going to last,” he said. “But they are looking for something different.”

One of Mr. Johnson’s newer clients is Katelyn Horowitz, a 34-year-old accounting consultant who is building a dome in Como, Colo. She said she was drawn by the ability to heat and cool the dome’s interior more efficiently than other structures, and the fact that they require less material than traditional homes.

“I like quirky,” Ms. Horowitz said, “but I love sustainable.”

Alcaraz Wins Wimbledon in a Thrilling Comeback Against Djokovic

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After years of false starts, men’s tennis finally has a proper war between the generations.

In a startling comeback that rocked the All England Club’s venerable Centre Court, Carlos Alcaraz, the 20-year-old Spanish star who has blitzed the sport in his brief career, pulled off the nearly impossible, beating Novak Djokovic in a Wimbledon final on the grass that the man widely recognized as the greatest ever to play the sport has long treated as his back lawn.

Down a set and struggling simply to avoid embarrassment, Alcaraz rediscovered his unique combination of speed, power and touch and figured out the subtleties of grass-court tennis in the nick of time.

He clawed his way back into the match in an epic 90-minute second set in which he was a point away from what figured to be an insurmountable two-set deficit.

He seized control of the match midway through the third set, gaining a crucial second break of Djokovic’s often unbreakable serve during a game that included 13 deuces.

He teetered in the fourth set as Djokovic, Wimbledon’s four-time defending champion and seven-time winner of the most important of tennis championships and as dangerous a player as there has ever been when facing defeat, steadied himself and rediscovered the magical footwork that has long served as the foundation of his success.

But then Alcaraz rose once more to claim victory, 1-6, 7-6 (6), 6-1, 3-6, 6-4, not only overcoming Djokovic’s seemingly endless skills and talents but breaking his spirit, too.

When the momentum swung one last time, as Alcaraz cranked a backhand down the line to break Djokovic’s serve early in the fifth set, the Serb with the steeliest of minds smashed his racket on the net post. A few points before, he had frittered away his chance to seize control, swinging at a floating forehand in the middle of the court and sending it into the net. Now, just a few minutes later, the thing that has so rarely happened to him in recent years — a loss to a relative newcomer on a grand stage, especially this grand stage and with tennis history within his grasp — was happening.

For Djokovic, the 23-time Grand Slam men’s singles champion who last month finally vanquished his longtime rivals, Rafael Nadal and Roger Federer, the loss cost him a shot at one of the few prizes he has not achieved — becoming the first man since 1969 to achieve the Grand Slam, winning all four Grand Slam tournaments in a single year. He was within one match of pulling off the feat two years ago. This time, at 36 years old, an age when most champions have retired to the broadcast booth, he was eight matches away, which seemed so much closer than it would for anyone else.

This is a developing story. Check back for updates.

Chelsea Clinton Revealed How She Feels About People Ignoring ‘So Much Evidence’ About Maternal Mortality Rates

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Chelsea Clinton’s is angry about how people seem to be ignoring the overwhelming evidence that maternal mortality rates have been increasing heavily in the US, and how she wants this to change.

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In a panel with NBC’s Kristen Welker at the Aspen Ideas Festival, per Today, Clinton said, “I am quite angry that we continue to ignore so much evidence about what works to save women’s lives.”

In a new report from the Maternal Medical Association, it shows maternal mortality rates have not only doubled in the US in the past two decades, but have decreased globally, and in 2021 alone, over 1,200 women died from maternal mortality rates (a 40 percent increase from the year prior).

Click here to read the full article.

When asked what she believes the key contributing factors are to such high maternal mortality rates in the US, like “lack of access, education, or systemic racism?” The It’s Your World: Get Informed, Get Inspired & Get Going author quickly said, “I choose D, all of the above. I think there’s a real comfort in the complacency of ‘ugh, it’s also complicated!’ [But] inertia is never an excuse to not save someone’s life.”

Along with Clinton, a doula named Chanel Porchia-Albert talked about how Black, Brown, and Indigenous women aren’t the primary focus in healthcare, and how that needs to change. (And if you need proof, Black, Brown, and Native American women are up to three times more likely to die compared to white women.)

Welker and Clinton chatted more outside the panel, talking about why the US has one of the worst rates in developed countries. “We’re not using our resources to the best of our abilities and to what we know works best in the US,” Clinton said. “Maternal health doesn’t have to be a partisan issue. I think oftentimes it is finding those places are real common ground Where maybe people didn’t even know there was a common ground.”

The CDC revealed over 80 percent of maternal mortality deaths are preventable, and after Roe v Wade was overturned, it’s only worsened.

Welker then ended the video discussing the possible solutions Clinton mentioned like better education about complications and the increased risks for women of color, using more doulas, and ensuring every pregnant person has an advocate with them throughout it all.

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