Wildlife, land-use change and health infra: Scientists identify ways of preventing next pandemic – The Tribune

New Delhi, January 4

How to prevent the next pandemic? As 2021 begins with COVID-19 continuing its global spread, scientists have spotlighted three approaches to at least reduce the risk of pandemic potential diseases screening animals, reducing land-use change and improving health infrastructure.

There can be no one answer to the question at the centre of an anxious debate across a world coping with COVID-19 and wondering what will happen if another one comes but the global scientific community has been working on multiple tracks to ensure that humankind is better prepared.

Following several multidisciplinary studies in 2020, scientists now firmly believe aperfectstorm for an outbreak with pandemic potential is created by the combined forces of land-use change, high population density and the presence of interfaces between wildlife and domestic animals.

Weare only as strong as our weakestlinkgiven our globally connected society, Krutika Kuppalli, an expert in emerging infectious diseases affiliated with theStanford University School of Medicine in the US,told PTI.

Manuel Ruiz, wildlife veterinarian at Montana State University in the US, added that one of the best ways to prevent the next pandemic was tosampleanimals across the world to characterise potential pathogens.

Instead of spending money to curb outbreaks once they occurred,wecould invest in reforestation and in trying to change the way we interact with wildlife, and alter our level of land-use change, Ruiz said.

Earlier in the pandemic, it became clear that efforts applying scientific approaches to prevent the next big outbreak could cost countries way less than the expenditures they have meted out to control COVID-19.

A study published in July in the journal Science estimated that COVID-19 may likely cost the global economy between $8.1 and 15.8 trillion. It added that preventing major outbreaks could be 500 times cheaper than the expenditures meted out to curb the ongoing pandemic.

According to Ruiz, detecting or classifying every single pathogen in the worlds wildlife would be close to impossible but new methods using machine learning algorithms can be used to generate a catalogue of pathogens from which the animal host and place where the next outbreak may happen could be predicted.

One such international collaborative project that came into the spotlight in 2020 was USAIDs PREDICT, which aimed tostrengthen global capacity for the detection of new viruses with pandemic potential.

Working with over 30 countries and screening more than 1,64,000 animals and people, the project has detected nearly 100 novel viruses globally, including the Bombali ebolavirus and thedeadlyMarburg virus.

The PREDICT project by the US has created this big dataset of viruses circulating in bats and other wildlife. And even now we know only a small proportion of the potential pathogens circulating out there, Ruiz, who studies the transmission of diseases from bats to humans, told PTI.

As several studies in the past have highlighted, bats have unique super immune systems, enabling them to carry viruses such as the Nipah virus and the SARS-CoV-2 without being infected. These pathogens can however jump or spill over to humans and cause new diseases in them when they make close contact with the flying mammals.

Disease ecologist Abi T Vanak from theAshoka Trust for Research In Ecology And The Environment(ATREE) in Bengaluru added that projects such as PREDICT, which scan the horizon for new pathogens, can help identify groups that have pandemic potential in the future.

From surveillance, we can find out the longevity of the viruses outside the host. Some wont even last for a few minutes. Some can last for days, Vanak told PTI.

This influences how often a virus can jump from an animal and cause an outbreak in humans.

As these pathogens spill over under very specific conditions, scientists have also unravelled the role played by land-use change in contributing to new outbreaks from animals to humans known as zoonotic diseases.

A major research in this domain, published in the journal Nature in August, analysed mammal and bird species across the world, and found that songbirds, bats, and rodents have the highest potential for spreading new diseases to humans.

Land-use change is acting as a kind of ecological filterand these species that do get through the filter are those that carry more pathogens, Rory Gibb, a co-author of this study from University College London, told PTI.

In several studies published in 2020, parts of India were classified as potential hotspots from where the next pandemic may emerge, partly due to increased rates of land-use change in the country.

Commenting on this observation, Virat Jolli, director of the New Delhi-based organisation Biodiversity and Environmental Sustainability(BEST), said the risk of new pandemic-potential diseases jumping from rodents, bats, and birds, were particularly high in India, especially in the Western Ghats.

The forest areas of Western Ghats, in his view, are under pressure because of plantation, overgrazing and human settlements.

Forest fragmentation for mining, road, and railways projects may lead to the emergence of new diseases, Jolli warned.

The buffer area of 10 kilometres around the protected area should in no way be reduced or altered, he added.

Since unravelling the when and the where of the next pandemic is a complex question, scientists have also made strides in applying a multidisciplinary approach to predict the emergence of new outbreaks.

In a study, published in April in the journal PLOS, Vanak and his team for the first time applied a co-production model to predict how the tick-borneKyasanur forest disease(KFD)a viral haemorrhagic fever endemic to south Indiawas triggered by factors including land-use change.

The co-production approach brings together different forms of knowledge and expertise fromscientists and a wide range of stakeholders to try to understand and address a key problem.

It became much clearer from similar studies in 2020 that collaborative research involving experts from across disciplines is the way forward.

Diseases dont exist in individual animalstheyre part of an ecosystem. Sampling an animal for viruses and analysing them is just one part of the puzzle. We need virologists talking to public health experts, social scientists, ecologists and epidemiologists, Vanak added.

Another major study, which took a multidisciplinary approach to predict global hotspots where the next pandemic could emerge, was published in November in the journal One Health.

It analysed where wildlife-human interfaces intersected with areas of poor health infrastructure and globalised cities, and also pointed to parts of India as potential hotspots.

Michael Walsh, study co-author from the Prasanna School of Public Health, Manipal University, agreed the Western Ghats, as well as northeastern parts of the country, havebroadareas of risk.

Instead of focusing on specific species, more resources could be invested in improving human health infrastructure in these regions, Walsh told PTI.

While parts of Kerala and Tamil Nadu fall under these hotspots, he said these statesarenot in the highest tier of risk because they have quite good health infrastructure relative to other states.

Ruiz believes some parts of India are potential hotspotsnotbecause lots of viruses are circulating there but because these have high rates of land-use change and these are also places with high-density of human populations.

If the novel coronavirus had emerged in a rural village which wasnt a transport hub like Wuhan, probably the virus may have died off there, Ruiz added. PTI

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Wildlife, land-use change and health infra: Scientists identify ways of preventing next pandemic - The Tribune

Longevity and Anti-senescence Therapy Market Size and Growth Factors Research and Projection 2026 – Farming Sector

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Longevity and Anti-senescence Therapy Market Size and Growth Factors Research and Projection 2026 - Farming Sector

Investment in AI and nanotech surges in wake of COVID-19 – IT Brief Australia

The fallout from COVID-19 is driving huge investment within AI and nanotechnology, with healthcare investment expected to grow at a rate of nearly 50% more a year towards a market set to be worth $1.333 trillion by 2027, according to Vector Innovation Fund.

The acceleration highlights wide recognition that the world cannot afford the human and economic cost of another pandemic, it says.

At present, 70% of global healthcare provision is spent on providing care for the last few months of our lives.

It is further accepted that the pandemic has shown the inefficiency of the worlds centralised healthcare model and its poor outcomes, with far reaching economic effects and negative impacts on treating cancers, mental health, cardio-vascular conditions, and the emerging challenge from Long COVID.

But observers say this will now trigger the greatest transformation of investment in advanced healthcare technologies since World War II.

These include sophisticated nanotechnology-based diagnostics, biomarkers, vaccines, novel therapies, highly targeted nanomedicines and AI, allowing us to move to a more sustainable, digitised, decentralised and democratised point-of-care environment.

"With dynamic investment these will free our economies and future-proof us from infectious diseases as well as develop solutions to antibiotic resistance, another global healthcare challenge that only technology can solve," VIF says.

"Investors are already switching to this accelerated model, away from traditional healthcare infrastructure and onto point of care and precision medicine.

"This delivers sustainable healthcare economics as well as improving life and longevity. Such investment is expected to bring transformational impact and returns over the next decade and beyond."

This trend was apparent before COVID-19 but investment in healthcare technology in the second half of 2020 has already reached record levels and is set to climb significantly over the next decade.

One particular investment group has developed a unique gateway fund to innovative and disruptive technologies, targeting current and future pandemics, as well as transforming global healthcare.

This international investment platform operated by Vector Innovation Fund G-P Srl, is registered and regulated as an Alternative International Investment Fund, domiciled in Luxembourg due to the country's world class reputation for tax efficiency and regulatory standards. This highly innovative fund is attractive and available only to sophisticated international, UHNW, family office, sovereign wealth, and other institutional investors.

Vector Innovation Fund (VIF) has now launched a $300 million sub-fund for pandemic protection and future healthcare, aiding and supporting precision medicine, highly advanced point of care and AI technologies to support the global economy, sustainable healthcare, and life longevity.

Paul Stannard, chairman and general partner of VIF, says, "Politicians are always forced to defend our old, centralised healthcare model but the pandemic has proved beyond doubt its not fit for purpose.

"A new approach to emerging technologies is vital," he says.

"We have brought together some of the worlds leading figures in biomedicine, advanced diagnostics, nano biomarkers, telemedicine, AI and machine learning to accelerate these transformational technologies into the markets, backed by sophisticated and institutional investors creating one of the most dynamic international investment structures," Stannard explains.

"Globally, we have had to deal with Ebola, Zika Virus, Bird Flu, and now COVID-19 in one decade, but the economy must adapt to a new future, where prevention and early intervention as well as using AI to drive more sustainable models for healthcare and investment."

One example of this is the profound change in telemedicine in just a few months. These technology solutions for GPs and patients, have allowed us to monitor and support many more patients during this pandemic the start of an unstoppable transformation.

Stannard says previous investment criteria were holding back innovation and only reinforcing the broken property-focused and centralised models for healthcare. Innovators have proved that they can develop and commercialise novel technologies and have some approved within months, not years, and this trend will advance beyond the current crisis, which is creating this groundswell of pent-up investment in advanced technologies.

"Our team have an excellent track record in industry, healthcare, technology and investment, with 21 exits and a total value creation of $2.4 billion, including two successful IPOs," he says.

A recent report by KPMG and HFS Research highlighted how companies and governments need to make smart investments in emerging technologies if they are to prevail against future pandemics: 65% of 900 global executives polled said: We don't have a choice or we risk threatening our very existence.

Paul Sheedy, founder of The World Nano Foundation, an international not-for-profit organisation for the commercialisation of nanoscale technologies, adds, "Nanomedicine and the decoding of the genome have been enhancing healthcare for a number of years, but the pandemic has catapulted healthcare investment creating a hockey stick effect for investors.

"This includes vastly improved home testing and advanced diagnostics where we know outcomes are significantly improved through early intervention," he says.

"Added to this, highly targeted precision medicines or therapies are going to transform all forms of healthcare, allowing us to work in parallel with and then ultimately move away from the current archaic centralised healthcare system delivery."

Nanotechnology is forecast to more than double from $54.2 billion this year to $126.8 billion by 2027 and will create a positive force for change when combined with AI and machine learning, forecast on its own to soar 22.5% a year through to 2027 from a $284.38 billion market in 2019.

"We are going to see these twin forces of innovation transform how we live, work, and manage our health in real time as well as develop sustainable models for everything from food production and energy to transport and pollution, all of which improve health and well-being.

"The world of philanthropy and impact investing is also undergoing significant change as we realise that we must advance everything from healthcare for all with more affordable point of care to climate change, improved biodiversity, and reversing pollution."

Naz Bashir, trustee of global technology charity World Science Aid, says, "The world has suddenly woken up to the fact that the global challenges of healthcare, pollution and climate change must now be tackled head on.

"The pandemic has proved that money has no value without sustainable life and a stable economy. The world has reinforced the mistakes of supporting tired funding models for too long, and one positive outcome from the current global crisis is recognition that we now need to invest for the future, and these new technologies can right some of the wrongs of the past.

"For instance, two billion of the worlds seven billion people still do not have access to clean water or simple point of care technology," says Bashir.

"The next generation deserve and demand a better future that these enabling technologies can offer our governments and investors towards building a better post-pandemic future."

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Investment in AI and nanotech surges in wake of COVID-19 - IT Brief Australia

How to Help Your Family Go Plant-Based and Be Healthy, By Doctors – The Beet

This holiday, chances are you'll be sharing a table with a smaller group than ever, but since 1 in 4 Americans is eating more plant-based, you will likely be told by one member of the group: "I am eating plant-based or vegan these days." It could even be you, telling your family about your resolve to be healthier, for yourself and the planet and for the sake of animals. Luckily two doctors have written a new book on how to go plant-based and get your family on board, and do it in a way that is healthy and sound. These doctors, one pediatrician and another a plant-based health expert, both know the ins and outs of getting enough vitamins and minerals, protein and micro-nutrients, and how to make sure that everyone at your table who chooses to eat plant-based does so healthfully and safely, without compromising any aspect of their diet.

Dr. Reshma Shahis a Pediatrician in the Bay Area, a clinical affiliate at Stanford University Medical School, and a practitioner of integrated medicine at Stanford. Dr. Brenda Davis is a dedicated plant-based doctor who has written a total of 12books on the topic, having raised her now-grown kids at a plant-based table.

Together they have written a new book, a comprehensive guide to getting started on plant-based nutrition for families, calledNourish:.

"If there is a parent who is plant-based or who is interested in being more so, wewanted to give them the tools they need to feed their families this way, and to not have to worry about nutrient deficiency, so we provide practical tips and strategies," Dr. Shah said. The book has over 50 recipes to help them get started."Dr. Brenda Davis is one of the pioneering dieticians on plant-based eating for all ages. She has written books on how to eat healthy on a vegan or vegetarian diet, a raw vegan diet, and how to eat to avoid or reversetype 2 diabetes. Dr. Davis has been pioneering this topic for 30 years, has spoken in 30 countries, and conducted research on this topic, even in the Canary Islands. She helpsfamilies eat plant-based from every age and life stage, taking them through pregnancy and lactation and of course parenting.

"People know I am vegan and plant-based and parents will come to me and say my daughter wants to be vegetarian and can you please convince her not to be? Instead, I want to help parents learn that she can be, and it's healthy. And that they can do it too. We wanted to give them the tools to do it safely and effectively. And of course, now there are manyparents who think it's better for the planet and their family's health, but it would not know where to begin."

"The one thing we want people to know is that it's completely possible to raise healthy, vibrant kids on a plant-based diet. It's not that difficult," says Dr. Shah. "People think that if you are plant-based or vegan, you have to focus on the nutrients, but I would point out that this is true of omnivorous kids too. All diets have to be appropriately planned. You can do it safely and adequately on a plant-based diet."

"And people assume if I need a supplement on a plant-based diet, it's not as good to eat that say," Dr. Davis adds. "But the grains that we all buy at the store now are fortified with vitamins and so is our milk and our formulas. We have supplements in our diets already."

"People think they have to do it all at once, but you don't. Go at a pace that is a fit for your family. So you don't have to go all at once," Dr. Shah points out. "The first thing to do is to stake stock of what your family enjoys and look at that. Do they love pasta with marinara sauce? Great. Or if they are used to meat sauce, you can add plant-based meat if you want to. Try a tofu scramble instead of eggs one morning. Figure out how to make whatever they already enjoy into a plant-based version, and trying doing more of that."

Substitute the easy things: Almost or oat milk for the real thing. Non-dairy butter, cheese spreads, and nut cheese work well. You can easily substitute a flax egg or chia egg, the doctors recommend. Make swaps where your family is not going to even notice.

"We definitely emphasize cooking at home with whole grain and whole food ingredients but swap in plant-based meals as often as you like at first, then do more of that over time," Dr. Shah says. Don't sweat it if you backtrack. No vegan police are going to come around and say you can't use a veggie burger. Some of these foods are really helpful as kids are trying to transition.

Some parents worry about birthday parties and soccer, she points out. "Try to be plant-based at home and don't worry too much about what happens outside the home," she suggests. "Or bring your own snack. People who have allergies like celiac or nut allergies so less judgment around that."

Dr. Shah adds: It's so easy to transition breakfast. so many plant milk and scrambles. It gets a little trickier at dinner because it's built around animal products in our culture. But look at the spaghetti and meatballs or tacos and look at how m=you might transition that to a plant-based version. Try veggie balls andall diff things and see how your family likes them. Keep experimenting, adding one recipe at a time or one meal at a time can be really helpful.

And of course, if it's the teenager that has decided to become vegan and it's the parents who are resistant. it the teenager who has to be responsible for going to the store and bringing home vegan options.

Sometimes the kids are the ones leading the charge. "How your family handles it will depend on whether it is the parent's idea or the kid's idea," says Dr. Shah. "The kids are going to be a lot keener if it's their idea. Children will be sensitive about this transition," she adds, especially since if they come home from a rescue farm or petting zoo and announce they're not eating meat, they want to be respected in that decision.

If the kids are the ones transitioning then the parents may be reluctant, Dr. Davis has found. Some people will watch Forks over Knives or What the Health, or whatever the movie is and they are vegan the next day. How the transition goes will depend a lot on how who is driving and how fast you want to transition.

"There are so many advantages with a plant-based diet in terms of disease,butthere is also the potential for deficiencies," says Dr. Shah. The two you worry the most about are vitamins B12 and D. But the truth is that most of the population is lacking in vitamin D. The other things that could be a deficiency in calcium, especially foryoung kids growing fast, like 4 to 8-year-olds. Even an adult can have a hard time getting 1,000 milligrams a day of iodine, but if you cook with iodized salt that can help. For vegans, you do have to be somewhat aware of iodine sources.

"Supplements can help put parents at ease," she adds. "We are not opposed to parents using a multivitamin that has some of the nutrients like D and B and iodine, especially for kids, but we recommend a liquid supplement like a vegan chewable... to prevent choking."

The bottom line is you can be plant-based and healthy at every age and stage.

Dr. Davis pointsout that for longevity, plant-based eating has been a boon to her health. "I am close to 62 and I don't feel much different from when I was 35. "I can still do handstands and headstands and rollerblade and run and ski and have races with my grandkids.

"Eating plant-based has preserved the integrity of my body. I look at my relatives and in comparison, I am still the same weight, a few =pounds thinner than when I got married. Really grateful for that. That is one of the perks of living a healthy lifestyle. there are a lot of perks."

And, she adds, if you need one more reason: "I think it's easier to feel good about yourself."

Original post:
How to Help Your Family Go Plant-Based and Be Healthy, By Doctors - The Beet

Some Scientists Struggle With Why There Are Grandmothers – Walter Bradley Center for Natural and Artificial Intelligence

Pop science specialist Alison Gopnik, author of several books, including The Philosophical Baby (2010) and Scientist in the Crib (1999) explains grandmothers:

On an evolutionary timescale, Homo sapiens emerged only quite recently. Yet in that short time, we have evolved a particularly weird life history, with a much longer childhood and old age than other animals. In particular, were very different from our closest primate relatives. By at least age seven, chimpanzees provide as much food as they consume, and they rarely live past 50 theres no chimp equivalent of human menopause. Even in forager cultures, where growing up is accelerated, children arent self-sufficient until theyre at least 15. Whats more, even in communities without access to modern medicine, if you make it past childhood you might well live into your 70s. We live some 20 years longer than chimpanzees and, except for a few whale species, particularly orcas, we are the only mammals who systematically outlive our fertility

Chimpanzee mothers do almost all the childrearing. But humans evolved exceptionally extended and varied sources of caregiving to deal with their costly babies, including fathers who take care of the kids, post-menopausal grandmothers, and alloparents other people who help to raise children. Prairie-vole dads, orca-whale grandmothers and rhesus-monkey alloparents also help to raise babies, but these kinds of care are rare among mammals. No other species except humans appears to have all three kinds of care.

If it were not rigorously pounded out of you by a pop science education, youd almost think that human intelligence has something to with longevity

Human grandmothers are treasured, not eaten.

Here are some instances of pop science, over the years, trying to understand grandmotherhood:

2010 Despite its anecdotal support and intuitive appeal, the grandmother hypothesis lacked much quantitative proof showing that it was possible for longevity to evolve from grandmothering, says Kachel, whose team ran a mathematical simulation to test the theorys plausibility.

2011: The hazard of death for Dogon children was twofold higher if the resident paternal grandmother was alive rather than dead. This finding may reflect the frailty of elderly grandmothers who become net consumers rather than net producers in this resource-poor society. Mothers were of overwhelming importance for child survival and could not be substituted by any category of kin or nonkin. The idea of cooperative breeding taken from animal studies is a poor fit to the complexity and diversity of kin interactions in humans.

2016: Menopause is an evolutionary puzzle, as an early end to reproduction seems contrary to the laws of natural selection, where passing on genes to the next generation is the main purpose of life. Yet female humans, and some other mammals, spend up to a third of their lives unable to reproduce.

2017: Study fails to discover why old women exist: Evolution has no further use for us once we lose the capacity to reproduce. Theory tells us, in fact, that we should expect to shuffle off quite promptly once were out of the parenting game. So, how then do we understand the fact that women live for many decades beyond menopause?

2019: Women living past menopause helps grandkids survive, but that benefit doesnt always withstand the test of age and distance, two studies suggest.

Wow. Theyre getting closer all the time, arent they?

Alternatively, wisdom matters. And wisdom is not a material thing. Its a human thing.

Anyway, hug or otherwise contact your grandma while you can.

Link:
Some Scientists Struggle With Why There Are Grandmothers - Walter Bradley Center for Natural and Artificial Intelligence

Late-Breaking Study Results of the Supreme HT Healing-Targeted DES Demonstrated Equivalent Outcomes with Exceptional Safety – PRNewswire

The PIONEER III study enrolled 1,629 patients (randomized 2:1 experimental to control) from North America, Europe and Japan and had a primary composite endpoint of target lesion failure (TLF) at one-year. The TLF outcomes showed that the Supreme HT met the non-inferiority endpoint at 5.4% compared to 5.1% from the DP DES (p=0.002). A grouped analysis of secondary endpoints showed a numerically better result for Supreme HT in cardiac death or target-vessel myocardial infarction (TV MI) with 3.5% in the Supreme HT arm compared to 4.6% in the control arm (p=0.27). Lower late stent thrombosis data (Supreme HT 0.1% compared to DP DES 0.4%, p=0.22) also suggested exceptional safety for the HT DES. A powered, landmark TLF analysis evaluating the healing superiority of Supreme HT between 1 and 5 years is ongoing.

"I am very pleased that Japanese patients will benefit from the most advanced DES in the US, Europe and Japan," said Shigeru Saito, MD, Shonan Kamakura General, Japan and primary investigator of the Japanese cohort of the PIONEER III study . "The results combined with the safety measurement of cardiac death, target vessel MI and late stent thrombosis favor the Supreme HT, supporting the early endothelial healing concept."

Contemporary DES have emphasized delay healing through prolonged drug delivery to suppress the body's response to injury, hypersensitivity, or progression of disease. The Supreme HT development was based on the "wound-healing window" concept originally proposed in 2013 and represents a novel class of DES that highlight the importance of early, timely healing. Through patented designs and proprietary processes, the Supreme HT was tailored to help patients accelerate their wound-healing process and restore their natural endothelial function. This healing-targeted mechanism may help overcome the long-standing problem of tradition-DES implantation, allowing for safer long-term results.

"We are very grateful to the extraordinary group of medical professionals and all the patients who have endured through this difficult pandemic and completed this study milestone in such a timely and professional manor," saidJianhua Sun, PhD., Chairman & Chief Executive Officer of SINOMED."The results have been extremely encouraging and if we reach superiority in the landmark analysis, wecould revolutionize the understanding of healing and the future of implantable devices,"

More information on the PIONEER III study is available at http://www.clinicaltrials.gov, identifier: NCT03168776.

About SINOMED

Sino Medical Science Technology Inc. (SINOMED), a global medical device company engaged in research, development, production, and commercial distribution of interventional devices. We are focused on developing breakthrough technologies to target unmet clinical needs in the interventional treatment of coronary, neurovascular and structural heart disease. Our mission is to expose more patients to the benefits of our medical innovations, increasing patient longevity and quality of life.

For more information, visit: http://www.sinomed.com

SINOMED B.V Cindy Zheng T: +31 10 307 6295 E: [emailprotected]

Photo - https://mma.prnewswire.com/media/1333951/SINOMED_Stent.jpg Logo - https://mma.prnewswire.com/media/1333950/SINOMED_Logo.jpg

SOURCE SINOMED

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Late-Breaking Study Results of the Supreme HT Healing-Targeted DES Demonstrated Equivalent Outcomes with Exceptional Safety - PRNewswire

Late-Breaking Study Results of the Supreme HT Healing-Targeted DES Demonstrated Equivalent Outcomes with Exceptional Safety – BioSpace

TIANJIN, China, Nov. 17, 2020 /PRNewswire/ -- SINOMED today announced that Prof. Alexandra Lansky from the Yale School of Medicine, USA, presented data from its first inter-continental PIONEER III study comparing the safety and efficacy of the Supreme HT (Healing-Targeted) Drug-Eluting Stent, to the Xience or Promus Durable Polymer Drug-Eluting Stent (DP DES). One-year results, revealed at the 2020 American Heart Association Scientific Late-Breaking Trials Session, showed equivalent clinical performance of the Supreme HT to the market-leading DES and will be used to support U.S. Food and Drug Administration and Japanese regulatory approvals.

The PIONEER III study enrolled 1,629 patients (randomized 2:1 experimental to control) from North America, Europe and Japan and had a primary composite endpoint of target lesion failure (TLF) at one-year. The TLF outcomes showed that the Supreme HT met the non-inferiority endpoint at 5.4% compared to 5.1% from the DP DES (p=0.002). A grouped analysis of secondary endpoints showed a numerically better result for Supreme HT in cardiac death or target-vessel myocardial infarction (TV MI) with 3.5% in the Supreme HT arm compared to 4.6% in the control arm (p=0.27). Lower late stent thrombosis data (Supreme HT 0.1% compared to DP DES 0.4%, p=0.22) also suggested exceptional safety for the HT DES. A powered, landmark TLF analysis evaluating the healing superiority of Supreme HT between 1 and 5 years is ongoing.

"I am very pleased that Japanese patients will benefit from the most advanced DES in the US, Europe and Japan," said Shigeru Saito, MD, Shonan Kamakura General, Japan and primary investigator of the Japanese cohort of the PIONEER III study . "The results combined with the safety measurement of cardiac death, target vessel MI and late stent thrombosis favor the Supreme HT, supporting the early endothelial healing concept."

Contemporary DES have emphasized delay healing through prolonged drug delivery to suppress the body's response to injury, hypersensitivity, or progression of disease. The Supreme HT development was based on the "wound-healing window" concept originally proposed in 2013 and represents a novel class of DES that highlight the importance of early, timely healing. Through patented designs and proprietary processes, the Supreme HT was tailored to help patients accelerate their wound-healing process and restore their natural endothelial function. This healing-targeted mechanism may help overcome the long-standing problem of tradition-DES implantation, allowing for safer long-term results.

"We are very grateful to the extraordinary group of medical professionals and all the patients who have endured through this difficult pandemic and completed this study milestone in such a timely and professional manor," said Jianhua Sun, PhD., Chairman & Chief Executive Officer of SINOMED. "The results have been extremely encouraging and if we reach superiority in the landmark analysis, we could revolutionize the understanding of healing and the future of implantable devices,"

More information on the PIONEER III study is available at http://www.clinicaltrials.gov, identifier: NCT03168776.

About SINOMED

Sino Medical Science Technology Inc. (SINOMED), a global medical device company engaged in research, development, production, and commercial distribution of interventional devices. We are focused on developing breakthrough technologies to target unmet clinical needs in the interventional treatment of coronary, neurovascular and structural heart disease. Our mission is to expose more patients to the benefits of our medical innovations, increasing patient longevity and quality of life.

For more information, visit: http://www.sinomed.com

SINOMED B.VCindy ZhengT: +31 10 307 6295E: cindy.zheng@sinomed.com

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Late-Breaking Study Results of the Supreme HT Healing-Targeted DES Demonstrated Equivalent Outcomes with Exceptional Safety - BioSpace

Finding Your Place in The Medical Field – Michigan Medicine

Some people are born to be medical researchers like Ronald Koenig, M.D., Ph.D., an endocrinologist specializing in thyroid cancer at the University of Michigans Rogel Cancer Center. According to him, the excitement of diving into the unknown and potentially cracking the nut on a big, biological mystery is one of the medical fields greatest joys.

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To think about an unanswered medical question and then create a test to try and solve that, using my knowledge and experience, has been incredibly rewarding, he says.

Now, as he transitions into retirement after his 40-year career, Koenig reflects on his proudest medical discoveries, advice for new medical students and the future of thyroid cancer care.

I moved to Michigan in 1988, splitting my professional time between medical research and being a physician. Being in a lab, but also being able to develop relationships with patients has provided unique aspects of professional fulfillment that the other doesnt for me. It gave me balance in my career that Ive appreciated.

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Ive been drawn to the intellectual challenges of research since college. Often times, research can be frustrating, but the draw of solving a medical question yet to be solved is irresistible. The fact I can test a hypothesis because I find it interesting and important and take it wherever the data may lead that intellectual freedom is wonderful. Thats how science progresses.

On the other hand, I dont think Id be happy without patient care which is why Ill still do that part time at the Rogel Cancer Center. Its rewarding work. I get to see patients longitudinally, over years and years, and develop personal relationships with them.

The Medical Scientist Training Program is a combined M.D. and Ph.D. program consisting of 100 medical students. As director, I was in charge of defining the nature of program. I really enjoyed the relationship Id build with the students over the eight or nine years it takes to get both degrees and help prepare them for the field of academic medicine.

My own M.D. and Ph.D. training was critical in defining who Id become as a professional. The University of Michigan is an educational institution, and this program exists because the medical school recognizes its importance. Im grateful.

No career is perfect. Every career path has its pros and cons. Especially in medical research, there are times where you feel rejected or like you shouldve seen something and didnt. You have to learn how to adapt and move forward.

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Finding Your Place in The Medical Field - Michigan Medicine

3 Discoveries That Could Impact Diagnosis, Treatment of PTSD and Gulf War Illness – BU Today

Effective diagnosis still remains a barrier for many veterans who are coping with medical disorders as a result of active duty. But early diagnosis and intervention is critical to prevent an overall impact on health and longevity.

Boston University researchers on the Medical Campus are working with collaborators at the VA Boston Healthcare System and other universities to speed up diagnostic processesfor post-traumatic stress disorder (PTSD) and other lesser-known disorders like Gulf War Illnessand understand the underlying risks that could compound the effects of PTSD or other psychological disorders to accelerate the bodys biological aging process.

The Brink rounded up three recent studies that present promising findings for better identifying and understanding the health issues facing veterans.

Post-traumatic stress disorder (PTSD) affects eight million adults in the United States, including hundreds of thousands of veterans of the conflicts in Iraq and Afghanistan. But diagnosing PTSD is a time-consuming process, taking upwards of 30 minutesa barrier for the screening to be included in most routine clinical visits.

Now, researchers from the BU School of Public Health and the VA Boston Healthcare System say machine learning could help streamline and speed up PTSD diagnosis in veterans. Published in the journal Assessment, their recent study utilized machine learning to find that out of the 20 gold standard PTSD screening questions from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (SCID-5), 6 questions could be cut out because only 14 of them were required to accurately identify PTSD in veterans with 90 percent accuracy.

The researchers made the discovery using data from SCID-5 assessments of 1,265 veterans of the Afghanistan and Iraq conflicts, and a kind of machine learning system called random forests (made up of forests of decision trees). The random forests system learned how strongly different items in the diagnostic questionnaire predicted a PTSD diagnosis. This allowed the researchers to identify which questions had weak enough associations that they could be cut from the screening while still maintaining at least 90 percent accuracy.

The most important item for a diagnosis was detachment or estrangement from others. This was true both for the whole sample and for male and female veterans separately. However, they also found that certain questions tended to be more or less revealing of PTSD status depending on whether a veteran is male or female.

This study demonstrates very clearly that the most efficient manner of diagnosing PTSD may differ for men and women, says study senior author Brian Marx, staff psychologist at the National Center for PTSD at the VA Boston Healthcare System and a BU School of Medicine professor of psychiatry. This finding is especially critical in a setting like VA, which serves a small but growing number of women veterans.

And with the COVID-19 pandemic leading to more PTSD, depression, anxiety, substance use, and other disorders in the general population, the application of machine learning methods to streamline mental health assessments may help reduce the burden and help people receive care more efficiently, says study lead author Tammy Jiang, a BU SPH doctoral candidate in epidemiology, and help people receive care more efficiently.

Researchers led by BU psychiatrist Erika Wolf are on a mission to find out the consequences that PTSD has on veterans physical health. A lot of individuals will develop early onset age-related conditions, like metabolic diseases, Alzheimers cardiac disease, a whole host of changes can occur. We wondered if acceleration of aging is at play, says Wolf, a clinical research psychologist for the National Center for PTSD at VA Boston Healthcare System and a MED associate professor of psychiatry.

Using data from individuals who donated their brains to the VAs National PTSD Brain Bank, the researchers examined how genetic variation and PTSD status interacted with each other. They found that older adults with PTSD showed evidence of accelerated aging in their brain tissue if they had a certain at-risk variant of a gene known as klotho, which is associated with longevity. Their results were published online in the journal Neuropsychopharmacology. The findings may also help explain why chronic stress negatively impacts the biological age of individuals with other psychological disorders.

We know that PTSD doesnt exist in a vacuum, that it has similar types of effects as other stress disorders, Wolf says, which could include people who have generalized anxiety disorder, depression, substance abuse, antisocial personality disorder, and more. Its about the idea that this gene variant is impacting the relationship between PTSDor other forms of psychological stressand aging.

Having the at-risk variant of the klotho gene could be important clinical knowledge for healthcare providers to be aware of for any patients that are experiencing high stress, trouble sleeping, high anxiety levels, and intrusive memories. The gene variant can be detected by blood, although genotyping hasnt yet become mainstream in psychiatric care, Wolf says. But she looks to the progression of cancer treatment, where most patients undergo genetic sequencing to determine the best course of treatment, and is hopeful that the trend will soon catch on in other areas of medicine.

Wolf and her team are now exploring whether the expression of the at-risk klotho gene can be moderated through exercise, cholesterol medication, or other factors.

Researchers and Gulf War veterans have fought for decades for recognition of Gulf War illness (GWI), whose patients experience debilitating symptoms, including memory impairment, chronic pain, fatigue, gastrointestinal issues, and earlier onset of age-related chronic diseases.

Right now, Gulf War illness is diagnosed by self-report of health symptoms, says Kimberly Sullivan (MED99), a BU SPH research associate professor of environmental health, and Gulf War veterans have struggled to have their symptoms taken seriously as a unique disorder and not treated as chronic symptoms found after other wars or of those encountered as part of other similar chronic multi-symptom disorders.

But a new study led by Sullivan could potentially change that. She and collaborators found that central nervous system proteins in the blood could objectively diagnose GWI. Their findings were published in Brain Sciences.

The research team, led by Sullivan and Mohamed Abou Donia, professor of pharmacology and cancer biology and of neurobiology at Duke University School of Medicine, compared blood samples from 171 veterans with GWI, 60 healthy Gulf War veterans, and 85 civilians with similar chronic medical conditions (50 with myalgic encephalomyelitis/chronic fatigue syndrome and 35 with irritable bowel syndrome).

Compared to the other groups, the study participants with GWI had significantly higher levels of 9 out of the 10 kinds of central nervous system proteins measured in the study, distinguishing them from both healthy Gulf War veterans and from civilians with these similar medical conditions.

This brings us one large step closer to having a simple blood test to diagnose the disorder and to differentiate it from other chronic medical disorders, Sullivan says.

Past studies by Sullivan and other GWI researchers indicate that the GWI symptoms are caused by brain inflammation caused by exposure to the nerve agent sarin, pyridostigmine bromide pills that were meant to protect against sarin gas, and the pesticides meant to protect soldiers against insect-borne illnesses.

An objective biomarker for GWI, such as one that can be identified from a blood sample, will make it much easier for veterans with the disorderan estimated 250,000, or one-third of those who served in the Gulf Warto receive benefits and treatment at their local VA hospitals, Sullivan says.

The new study also supports previous research indicating that brain alterations caused by toxin exposure are the cause of GWIs physical symptoms. These proteins should not be in the blood if [soldiers] did not at least at some point have damage to the central nervous system and changes to the blood-brain barrier, Sullivan says.

This research was supported by the Department of Defense, the Department of Health & Human Services, the National Institute on Aging, the Department of Veterans Affairs, the U.S. Army Medical Research and Materiel Command, a Presidential Early Career Award for Scientists and Engineers, the National Center for PTSD, and the National Institute of Mental Health.

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Late-Breaking Study Results of the Supreme HT(TM) Healing-Targeted DES Demonstrated Equivalent Outco – PharmiWeb.com

TIANJIN, China, Nov. 17, 2020 /PRNewswire/ -- SINOMED today announced that Prof. Alexandra Lansky from the Yale School of Medicine, USA, presented data from its first inter-continental PIONEER III study comparing the safety and efficacy of the Supreme HT (Healing-Targeted) Drug-Eluting Stent, to the Xience or Promus Durable Polymer Drug-Eluting Stent (DP DES). One-year results, revealed at the 2020 American Heart Association Scientific Late-Breaking Trials Session, showed equivalent clinical performance of the Supreme HT to the market-leading DES and will be used to support U.S. Food and Drug Administration and Japanese regulatory approvals.

The PIONEER III study enrolled 1,629 patients (randomized 2:1 experimental to control) from North America, Europe and Japan and had a primary composite endpoint of target lesion failure (TLF) at one-year. The TLF outcomes showed that the Supreme HT met the non-inferiority endpoint at 5.4% compared to 5.1% from the DP DES (p=0.002). A grouped analysis of secondary endpoints showed a numerically better result for Supreme HT in cardiac death or target-vessel myocardial infarction (TV MI) with 3.5% in the Supreme HT arm compared to 4.6% in the control arm (p=0.27). Lower late stent thrombosis data (Supreme HT 0.1% compared to DP DES 0.4%, p=0.22) also suggested exceptional safety for the HT DES. A powered, landmark TLF analysis evaluating the healing superiority of Supreme HT between 1 and 5 years is ongoing.

"I am very pleased that Japanese patients will benefit from the most advanced DES in the US, Europe and Japan," said Shigeru Saito, MD, Shonan Kamakura General, Japan and primary investigator of the Japanese cohort of the PIONEER III study . "The results combined with the safety measurement of cardiac death, target vessel MI and late stent thrombosis favor the Supreme HT, supporting the early endothelial healing concept."

Contemporary DES have emphasized delay healing through prolonged drug delivery to suppress the body's response to injury, hypersensitivity, or progression of disease. The Supreme HT development was based on the "wound-healing window" concept originally proposed in 2013 and represents a novel class of DES that highlight the importance of early, timely healing. Through patented designs and proprietary processes, the Supreme HT was tailored to help patients accelerate their wound-healing process and restore their natural endothelial function. This healing-targeted mechanism may help overcome the long-standing problem of tradition-DES implantation, allowing for safer long-term results.

"We are very grateful to the extraordinary group of medical professionals and all the patients who have endured through this difficult pandemic and completed this study milestone in such a timely and professional manor," saidJianhua Sun, PhD., Chairman & Chief Executive Officer of SINOMED."The results have been extremely encouraging and if we reach superiority in the landmark analysis, wecould revolutionize the understanding of healing and the future of implantable devices,"

More information on the PIONEER III study is available at http://www.clinicaltrials.gov, identifier: NCT03168776.

About SINOMED

Sino Medical Science Technology Inc. (SINOMED), a global medical device company engaged in research, development, production, and commercial distribution of interventional devices. We are focused on developing breakthrough technologies to target unmet clinical needs in the interventional treatment of coronary, neurovascular and structural heart disease. Our mission is to expose more patients to the benefits of our medical innovations, increasing patient longevity and quality of life.

For more information, visit: http://www.sinomed.com

SINOMED B.V Cindy Zheng T: +31 10 307 6295 E: cindy.zheng@sinomed.com

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Late-Breaking Study Results of the Supreme HT(TM) Healing-Targeted DES Demonstrated Equivalent Outco - PharmiWeb.com

Are We Shortchanging Patients With Obesity? – Medscape

Every Wednesday evening after supper, I record in a marble notebook some anthropomorphic measurements: my weight taken first thing Monday morning and my waist circumference. I also add how I did with exercise since the previous week's entry and some comments about sleep, energy, and nutrition.

My personal log now comprises dozens of pages. To my surprise, the first entry was 5 years ago to the month. The earlier entries were far from weekly and contained a lot of narrative on how my food restriction scheme that month was being violated.

Looking just at the numbers, I did about as well as a control group participant in any medical study of diet modification. Until just a few months ago, there was no trend in either weight or waist circumference over those 5 years, including 2 years of retirement. But it wasn't for lack of trying. Keeping the journal for as long as I have and recently, as consistently as I have suggests serious intent but inadequate execution of the same principles I offered patients, who rarely did much better. But recent studies suggest that perhaps quite a few could.

A recent abstract from the European and International Congress on Obesity suggests that the impressions clinicians get from our office encounters may leave us underestimating the potential for our patients to lose enough weight to move them from one level of risk to another.

Using a national database of primary care visits, the investigators isolated about 550,000 records. Of these, about 60,000 (11%) had records showing weight reductions of 10%-25% (mean, 13%) over at least 4 years. Weight loss was by intent rather than from illness. The remaining individuals maintained their weight within 5% of the first measurement for the duration of the study.

Participants with stable body weight were compared with the successful weight reducers. This analysis showed that the risk for type 2 diabetes, osteoarthritis, sleep apnea, hypertension, and dyslipidemia all measurably declined in weight reducers. This held true whether the patient's baseline BMI showed modest or severe obesity. Patients with the highest BMI at enrollment actually reduced their risks for hypertension and dyslipidemia below population norms.

This study raises tantalizing, as yet unanswered questions: How did the successful 11% achieve their weight loss goals? Was it via a weight loss program, bariatric surgery, dietitian consult, or with no external assistance?

And of great significance to clinicians: What happened to the people who achieved 5%-10% weight reduction, as that is a more typical outcome of diabetes prevention trials or studies of weight loss medications? Were they excluded from the study because they did not lose enough weight to achieve the unequivocal health benefit?

Because the data came from an enormous database, the weight management strategies leading to success or failure what we really need to know to nudge our own patients into the favorable categories remain hidden.

Some answers emerged from a recently reported study in The New England Journal of Medicine comparing supervised diet and lifestyle adjustments (treatment group) with the less intense oversight typically offered by primary care clinicians (usual-care group).

The treatment group not only received the intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, but also participated in mandated training sessions on how to best use the resources provided by the study. Much of the care was delegated by physicians to "coaches" who focused on nutrition, exercise, and behavioral health, including supermarket strategy.

Nearly a quarter of the participants in the intensive intervention group achieved the 10% weight reduction needed to change health risk in a meaningful way. A similar proportion lost less than 10% of their body weight, and about half did not have a notable weight change. Peak weight loss at 6 months averaged 17 lb, and 9.6 lb at 2 years. While this may not seem very impressive considering the extensive resources utilized, there were those who experienced an extraordinary health upgrade not otherwise available, short of bariatric surgery.

Both studies indicate that even under the best-controlled, resource-replete circumstances, the rate of failure to achieve desired progress is very high. But there is a success rate.

The likelihood of success is difficult to interpret from the European data, as it compared only those with major weight loss and those with weight stability, excluding patients with less robust loss or weight gain. The controlled study, however, holds forth an alluring opportunity benefiting a quarter of the targeted participants and even about 5% of the controls who realized that they were being observed.

We also learn that supervision requires a lot more than having a well-meaning but not very well-trained physician ask a patient to log measurements and food intake. Health coaches seem to make the impact.

Failure rates of 50% have a way of dampening enthusiasm, but it may be best to approach the scourge of obesity by offering treatment to everyone with the expectation that not all will experience greatly enhanced quality of life and longevity. Not everyone will benefit, but these two studies confirm that we do have an underutilized capacity to help more people benefit than we currently do.

Richard M. Plotzker, MD, is a retired endocrinologist with 40 years of experience treating patients in both the private practice and hospital settings. He has been a Medscape contributor since 2012.

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Yvonne Orji: Black Women Should Put Their Health First – Longevity LIVE – Longevity LIVE

While some people may equate Yvonne Orji with the type-A character of Molly that she plays on Issa Raes Insecure, the real Yvonne Orji isnt as anal-retentive. In fact, the author of Bamboozled By Jesus is all about resting and prioritizing her health and wellness.

Ive been working on resetting my mind, body, and soul so that I can be more present in the now, she told Vogue.

The actress has made it her mission to ensure that black women prioritize their health, especially because theyre not only often guilty of putting everybody before themselves, but also because they face a heightened risk of certain cancers.

According to research, black women not only face a three-fold increased risk of developing triple-negative breast cancer, but theyre also 28% more likely to die than white women with the same diagnosis.

With these startling statistics, the Insecure actor partnered withpharmaceutical company Merck for theirUncovering TNBCinitiative, which is aimed at raising awareness around triple-negative breast cancer.

With a masters degree in public health, Orji is well aware of the increased risk that black women face, and she also knows first-hand how it feels to have a cancer experience,

I had a breast cancer scare my senior year of high school. There was a lump, and I was the one who found it. My mom was a nurse for 27 years so we always had an awareness of [how to check]. So I knew the general gist of how to do that. One particular day something moved and as Im touching it Im like, I dont know, that feels different.

Thankfully, the lump was benignand after having it surgically removed, Orji has made it her mission to continuouslyadvocate for regular screenings and checkups, and thats something she hopes the Uncovering TNBCinitiativewill help achieve,

Through open and honest conversations, the series aims to help educate black women about their higher risk for developing TNBC than women of other racial/ethnic backgrounds and help to equip them to advocate for themselves in a biased system.

In addition to educating them about their increased cancer risk, Orji also has a few ways in whichBlack women can put their health first.

Icommit to my own check-ups and screenings so that others will be influenced to be proactive about their health and so we can all receive consistent and high-quality care, regardless of health insurance or demographics.

yvonneorji/instagram

Regular check-ups and screenings are very important, especially if youre already at an increased risk for chronic disease. While you should monitor your body and be conscious of any changes, its critical that you also get into the habit of visiting the doctor and letting them do their own evaluation.

While Yvonne Orji has been an incredibly busy girl, what with the release of her new film and comedy special, that doesnt mean that the Nigerian-born actress doesnt rest.

One of the things Im saying goodbye to in 2021 is the hustle and grind. I want to grant myself time to rest and let abundance find its way to me.

So how does the 37-year-old relax and unwind? The same way we all do with a relaxing bath, Baths have been really important in helping me wind down she says, adding that she incorporates Epsom salt bathsinto her routine.

Unfortunately for black women, asking for help can almost feel like admitting defeat, but thats a notion that Orji is attempting to let go of.

Im learning to ask for help when I need it. she says. Orji admits that shes a recovering perfectionist, and she still needs to re

yvonneorji/instagram

mind herself that its okay to delegate and lean on people she trusts. In doing so, shell have more time for herself and her self-care.

Theres always room for growth, and thats something that Orji truly believes in.

Not only does her morning routine consist of her listening to music and watching her vision board, but she also believes in the power of therapy, sharing that, Therapy is also huge for me. I recognize the growth that I personally have felt this year, just being able to be like,Okay, we got to deal with some stuff.

Another celebrity that prioritizes putting her health first is Katy Perry, especially in the mornings. The I Kissed A Girlsingerrevealed thatshe always makes room for self-care in the morningsand there are definitely a few things we can learn from her.

MAIN IMAGE CREDIT: Yvonne Orji/Instagram

Cho, B., Han, Y., Lian, M., Colditz, G. A., Weber, J. D., Ma, C., & Liu, Y. (2021). Evaluation of Racial/Ethnic Differences in Treatment and Mortality Among Women With Triple-Negative Breast Cancer.JAMA oncology,7(7), 10161023. https://doi.org/10.1001/jamaoncol.2021.1254

McCarthy, A. M., Friebel-Klingner, T., Ehsan, S., He, W., et al. (2021). Relationship of established risk factors with breast cancer subtypes.Cancer medicine,10(18), 64566467. https://doi.org/10.1002/cam4.4158

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Yvonne Orji: Black Women Should Put Their Health First - Longevity LIVE - Longevity LIVE

Genetics and Alcohol Use Disorder: 5 Things You Should Know – Longevity LIVE

The Penn Medicine team identified 18 genetic variants that are related to either heavy alcohol consumption, alcohol use disorder, or both. Five of these variants overlapped, while eight were associated solely with heavy alcohol consumption. Another five were traced with alcohol use disorder only.

One finding from the study was that, although heavy drinking is a prerequisite for alcoholism, variants for particular genes may predispose someone towards alcoholism. Examples of gene variants cited by the Penn Medicine researchers are DRD2 and SIX3. This finding is important because identifying these gene variants in a person may help medical professionals better ascertain their risk for alcohol use disorder.

Ultimately, paying attention to the genetic aspect of a persons alcohol use disorder may contribute to their treatment. There are ongoing studies about patients receptiveness to certain medications for treatment, based on their genes.

For example, naltrexone is a drug thats commonly used to treat dependence on alcohol, as well as opiates. In research cited by the NIAAA, it was found that patients with a specific gene variation responded positively to naltrexone treatment. Those who didnt have the gene, however, did not. In the future, this kind of information may factor into the accuracy and responsiveness of medical treatment for alcohol addiction.

Conclusion: Unlocking Important New Knowledge about Genetics and Alcohol Addiction

Though the relationship between genes and alcoholism has been under scrutinous scientific study for some time, it isnt always common knowledge to laymen. But not being able to see the bigger picture of what contributes to alcoholism may allow certain myths about it to prevail. Many people may still believe that alcohol addiction is 100% a personal choice. But as the information above about genetics and alcohol use disorder portray, its never that simple.

In any case, whether genes influence someones predisposition to alcohol use disorder, no attempt at healing from it is a futile one. Be both compassionate and knowledgeable when approaching the issue of alcoholismbecause your support could save a life.

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The Real-Life Partners Of The Cast Of Chicago Med – Nicki Swift

Ethan Choi is the Head of Emergency Medicine on "Chicago Med" and just broke up with Nurse April Sexton, played by Yaya DaCosta, after finding out that she and Crockett Marcel (Dominic Rains) had become rather cozy. Luckily, Brian Tee's personal life is void of any heart-rending love triangles. The star is happily married to Mirelly Taylor and they have one daughter together.

Taylor is a Mexican actor who nearly chose another career path, according to Eerie Digest, until she fractured her skull at 19. She spent three days in a coma with doctors telling her mother (who's also a medical practitioner) that she probably would not make it. Just before brain surgery, her little brother touched her arm and said her name. In that split second when she woke up, she had "such clarity" about her path forward. She "enrolled into a two-year conservatory for acting." In the interview, she described Tee as "my soul mate" and revealed that they "take time for ourselves outside of our careers."

In 2015, the actor told People about the women in his life and raved that Madelyn Skyler was an "angel baby." He gushed, "As soon as she was born, there was just this incredible overwhelming power of love that completely filled my existence." Talk about a picture-perfect romance.

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The Real-Life Partners Of The Cast Of Chicago Med - Nicki Swift

Slash Your Cancer Risk in Seconds, Say Cancer Experts | Eat This Not That – Eat This, Not That

You're about to hear advice from the last people you'd ever want to meet. Oncologists specialize in the diagnosis and treatment of cancer. If you're talking to one, and you're not at a dinner party, you might be one of the 100 million folks around the world who have it. With those staggering stats, you might think getting cancer is an inevitably. It isn't. Read onand to ensure your health and the health of others, don't miss these 19 Ways You're Ruining Your Body, Say Health Experts.

"I am very careful about keeping up with proven cancer screening interventions," says Amy Tiersten, MD, clinical breast medical oncologist at Mount Sinai. She stays current on preventative tests like colonoscopy, skin cancer exams, and gynecologic follow-ups.

Late diagnoses are a leading cause of premature death due to cancer. Interventions, like those Dr. Tiersten recommends, allow for early detection and diagnosis where patients can start treatment earlier. This is especially impactful in breast, cervical, and colorectal cancers.

The American Cancer Society recommends:

Ten years after the HPV vaccine was introduced, there is "compelling evidence" that we're on track "to eradicate cervical cancer within decades." A June 2019 study reviewed 60 million individuals', mostly girls and women, eight-year post-vaccination status and found that the vaccine has exceeded expectations.

The CDC recommends both boys and girls get the HPV vaccine at ages 11-12, with the second dose within a year. It's recommended up to age 26 for women and age 21 for men.

Newer versions of the vaccine require two doses instead of three, ensuring adherence to the full vaccination schedule. As well, it's gender-neutral and targets more HPV strains.

Exercise every single day that's the walk Kathryn Schmitz, Ph.D., a leading exercise oncology researcher at Penn State University, walks and talks. "We oncologists run, walk, or roll our way to cancer prevention," she said, citing research that supports a relationship between physical activity and cancer prevention. She's the biggest proponent of strength training, something she introduced in the chemo lab at Penn State Cancer Institute and shares as "exercise snacks" each week on her Instagram. "I try to exercise 30 minutes a day to stay fit. We know that regular physical exercise does reduce cancer risk in many cases. Decreasing your body weight, even by 5%, can make a big difference in terms of cancer risk," says Xavier Llor, MD, Medical Director of the Cancer Screening and Prevention Program.

RELATED: The #1 Reason You Could Get Cancer, According to Science

"Embrace your social networks; recognize who loves you and let them in," is how Dr. Don Dizon, MD, FACP, FASCO, director of medical oncology at Rhode Island Hospital and Professor of Medicine at Brown University prevents cancer. He says it's well-established that whether your social network includes a spouse, kids, best friend, or church, these connections are key to good health and that social isolation is associated with an increased risk of death.

"In one study, social isolation scores were associated with risk of death from heart disease and in all-cause mortality. This was true for men and women, Blacks and whites."

As an oncology clinical pharmacist, there are several things Allison Baxley, PharmD, BCOP of Stephenson Cancer Center does to prevent cancer. She recognizes that many elements are out of our control, like genetics, so she does all she can to reduce the risk through things she can control.

"Working primarily in GI oncology, I'm very aware of the link between colon cancer and processed and red meat consumption. I eat these in moderation, and rarely if ever eat highly processed meat like hot dogs and bacon."

She avoids what Micahel Pollen has called "edible food-like substance," which is the majority of what's in the center aisles of the grocery store.

RELATED: Signs You're Getting One of the "Most Deadly" Cancers.

Our daily diet choices play a powerful role in cancer prevention, reminds Dr. Terry Wahls, author of The Wahls Protocol series. For optimal cancer prevention, she aims for 9 cups of plant-based foods each day: 3 cups of greens, 3 cups of sulfur-rich foods like cabbage, onions, or mushrooms, and 3 cups of color from berries.

"We can choose to eat more greens and non-starchy vegetables and berries to markedly reduce the risk of developing cancer (and surviving cancer if it is diagnosed)," she explains. "Or we can choose the standard American diet, full of sugar and flour, which drives up insulin and insulin-like growth hormone and have a much higher risk of pre-cancers and overt cancers."

LaShyra "Lash" Nolen, an MD candidate at Harvard Medical School, points out that Black women have a disproportionately higher rate of mortality from breast cancer than white women, according to 2016 research.

"Therefore, I think it is so important for me, as a young Black woman, to take agency over my body," shared Nolen. "One way I do this is by regularly performing a physical exam of my breasts to search for abnormalities or unusual lumps."

She adds that, sometimes, women allow others to know their bodies better than they do themselves, but that this has to change in order to detect cancers at earlier stages and improve outcomes.

As an American Cancer Society Research Professor and Associate Dean for Oncologic Sciences at Brown University, Dr. Wafik El-Deiry says it's important to remember that half of all cancer is preventable. One of his preventive efforts is to limit or moderate alcohol consumption, as alcohol has been linked to cancers of the mouth, throat, liver, colon, breast, and others.

"Be aware and keep in the back of your mind that this is a substance that can do harm," he advises. El-Deiry says there's a lot of evolving and emerging data on the association between alcohol and cancer, but that the relationship does exist.

How much is too much? The American Cancer Society advises no more than 2 drinks per day for men and 1 drink per day for women.

Jeffrey Meyerhardt, MD, MPH, medical oncologist for the Dana-Farber Cancer Institute, works hard to maintain a healthy body weight. He cites consistent evidence in observational studies that link obesity and higher BMI with a variety of cancers, including colorectal, ovarian, and pancreatic.

In particular, he cited a 2003 study that analyzed the relationship between body weight and mortality from cancer in nearly one million American adults. When the heaviest participants had a BMI of 40, death rates from all cancers were 62% higher in women and 52% higher in men when compared to those of "normal weight."

RELATED: The #1 Cause of Obesity, According to Science

"I eat a balanced diet of real food. The less processed, the better!" says Allison Betof Warner, MD, Ph.D. of Memorial Sloan Kettering Cancer Center. Of course, this melanoma medical oncologist splurges and doesn't always eat healthy (like the rest of us!), but when she does, moderation is key.

While no single food can prevent cancer, a well-rounded diet with a variety of vegetables, fruits, and grains can go a long way toward risk reduction.

"I try to live by the 80/20 rule," she caveats. That's 80% whole, healthy foods in balanced proportions and 20% treats and other "less" healthy stuff.

"I make sure to get plenty of Vitamin D," says Kevin Dawravoo, MD, hematologist and medical oncologist at Northwestern Medicine Cancer Center Warrenville. He cites numerous studies that support the anti-cancer effects of this nutrient. Anyone can check for a vitamin D deficiency with a simple blood test at their doctor's office. That deficiency was linked in a 2014 study to a greater risk for more aggressive prostate cancer.

The best source for vitamin D is the sun, but new research says sunblock does not compromise the absorption of the vitamin. Fish is the best food source for vitamin D, including salmon, rainbow trout, and swordfish, as well as fish oil/cod liver.

Most Americans are "woefully sleep deprived," says Dr. Stephen C Schimpff, MD, MACP. Board certified in medical oncology, Schimpff is sure to "get enough sleep" each night. It's a subject important enough that he addresses it in his book, Longevity Decoded The 7 Keys to Healthy Aging.

"Inadequate sleep predisposes to high blood pressure, stress, overeating [in general] and the wrong foods, obesity, and hence predisposes to cancer," he continued

Monisha Bhanote, MD, FASCP, FCAP meditates regularly, a practice she says can "help balance life's daily stressors." The most benefit is gained from daily practice, even if just five minutes, than if done sporadically.

The triple board certified physician at Baptist MD Anderson Cancer Center says, "Managing stress is important for preventing chronic disease and predisposing one to cancer. Stress weakens the immune system and lowers its defenses to fight diseases." Consistent meditation can move the body into a parasympathetic state (rest and energy conservation) as opposed to a continuous sympathetic state (aka fight or flight).

Bhanote cited a 2004 study that found chronic stress can impair the body's immune response and contribute to the development of cancer.

A variety of sources like cell phones, wifi, power lines, and battery-powered cars bombard us every day with EMFs, or electromagnetic fields. Dr. Jonathan Stegall, an integrative oncologist and medical director of The Center for Advanced Medicine in Atlanta, says he tries to limit his exposure to EMFs.

"I recommend that my patients not hold a cell phone up to the ear, and instead hold it away from the body using speaker phone. This significantly minimizes the amount of radiation absorbed by the body," advises the author of the bestselling book Cancer Secrets. He also recommends installing a timer on any WiFi modem/router at home so that it turns off while you are sleeping.

RELATED: The #1 Reason You Could Get Cancer, According to Science

It's family first for Dr. Timothy S. Pardee, chief medical officer, Rafael Pharmaceuticals and oncologist and director of Leukemia Translational Research at Wake Forest Baptist Health. He believes this time is super important, and notes that familial relationships can reduce stress and increase overall well being.

A global study found that larger families, those with many children, have a reduced risk of cancer. And that's not just the nuclear family. Larger household sizes with multiple generations living together enjoy that same protective benefit. The study authors cite the "special emotional environment" as having a positive effect that contributes to disease resistance, as well as the benefit of family members supporting each other in a healthy lifestyle.

Did you know you can get paid to prevent cancer? Roshni Rao, MD, Chief of the Division of Breast Surgery at New-York Presbyterian Hospital and Columbia University Medical Center and says even she participates in clinical trials. "I was part of an MRI trial where I was in [the] machine for over an hour, and I got paid $25!," she said.

She's also participating in the T-MIST trial, a national study working to identify how often women should get mammograms and what type of mammogram to get. Rao says this trial is currently open at Columbia and seeking up to 165,000 women to participate.

"I drink a few cups of green tea or coffee every day," says William W. Li, MD, author of Eat to Beat Disease: The New Science of How Your Body Can Heal Itself. After 20 years of cancer prevention research, he says he's well aware of the scientific evidence that points to tea and coffee doing the body good.

They each "contain different types of polyphenols (micronutrients from plant-based food), but they all activate our body's key health defense systems (starving cancer, feeding our healthy gut bacteria, repairing damaged DNA, improving immunity) that help us resist cancer. From lab studies to clinical trials to large-scale public health studies showing that tea or coffee lowers risk across different forms of cancers, I consider it a no-brainer to drink these beverages." And it's a cherry on top that he loves the taste!

The lead authors of a large-scale study from the University of Glasgow in 2018 now know it's best to keep screentime to a minimum. They analyzed nearly 400,000 people and found a strong correlation between higher screentime and a higher risk of all-cause mortality, cardiovascular disease, and cancer. This was independent of known cancer-causing factors like smoking, BMI, and diet.

The more discretionary, or leisure, time spent on tablets, smartphones, and other media devices directly contributes to a sedentary lifestyle, the result of which is lower physical fitness, grip strength, and overall poor health.

RELATED: I'm A Doctor And Warn You Never Take This Supplement

Nearly half the deaths from an astounding 12 different cancers can be attributed to smoking cigarettes: liver, colorectal, lung, oral and throat, esophageal, larynx, stomach, pancreas, bladder, kidney, cervix, and acute myeloid leukemia. That's why it's a smoke-free life for Dr. Wafik El-Deiry, Associate Dean for Oncologic Sciences at Brown University. While fewer people smoke in 2019, plenty are still addicted to one of the single-most unhealthy habits.

He does note that quitting smoking can have a positive impact, but that the risk never fully goes away compared to the general population. It can take 8-10 years to truly minimize the risks associated with cigarette smoking.

Likewise, Dr. El-Deiry isn't vaping, either.

"The message needs to get out that [vaping] is potentially cancer causing and we have to be aware," he warns. "The more we talk about itto save anyoneis worth it."

He says the more we learn about vaping the more we realize how unsafe it is in different ways. The vapor exposes users to chemicals known to cause cancer, for instance. And while e-cigs have their place for smokers trying to quit, the vape pens aren't benign. El-Deiry reminds that no substantial research has yet been completed on the relationship between vaping and cancer.

The National Institutes of Health warns that teens are vaping in record numbers; higher than opioid or marijuana use.

Dr. Katherine Crew, director of the Clinical Breast Cancer Prevention Program at New York-Presbyterian and Columbia University Medical Center, walks at least a mile every day. "For a busy oncologist, it's not always easy to find time to lead a healthy, active lifestyle, but I try to incorporate it into my daily routine."

Each of those steps is worth the time. Walking a single mile each day at a moderate 20-minute pace can reduce mortality in breast cancer patients by as much as 40% and almost 30% in prostate cancer patients. Risk for endometrial cancer is also reduced by a moderate intensity walking regimen.

Dr. Crew also takes the stairs "whenever it's humanly possible" to gain an extra burst of physical activity in her day.

RELATED: 9 Everyday Habits That Might Lead to Dementia, Say Experts

As an exercise oncologist, Kathryn Schmitz, PhD gets as much movement as she recommends. Before heading outdoors though, "I slap on the sunscreen, since exercise increases the risk of melanoma by 28%." While this 2016 study found that exercise reduces the risk for 10 different cancers, it increased risk for malignant melanoma significantly.

Schmitz echoed the researchers' assumption that increased time exercising or enjoying leisure physical activity increased exposure to the sun, which in turn increased the incidence of skin cancer. If you're spending time outside, be sure to wear a broad spectrum sunblock with SPF 30 or higher and remember that "water resistant" is not the same as "waterproof."

Making "greener" choices can ultimately support everyone's goal to reduce their risk of cancer. Climate change is having a negative impact on more than just the earth's health and sustainability. Human life is taking a negative toll, too.

Stratospheric ozone depletion is implicated in an increase in skin cancer incidence, like melanoma, and scientists expect to see a continuation over the next couple of decades.Exposure to air pollution increases the risk of breast cancer in premenopausal women. And the very air we breathe has been deemed carcinogenic by WHO, citing a direct correlation to nearly a quarter-million lung cancer deaths in 2010 alone.

How much "good" fat do you have in your diet? It's something Dr. Stephen C Schimpff, MD, MACP, author of Longevity Decoded The 7 Keys to Healthy Aging, prioritizes in his own diet. He recommends avocado, nuts and seeds, olive oil, and fish like tuna and salmon.

What makes a fat good for you? These unsaturated fats remaining liquid, not solid, at room temperature and are generally derived from plants.

Tree nuts like almonds, walnuts, and pecans can decrease your risk of colon cancer, which is why Kevin Dawravoo, MD, hematologist and medical oncologist at Northwestern Medicine Cancer Center Warrenville, makes them a regular part of his diet.

For men and women, a 2018 study found a "statistically significant" link between eating nuts three times per week and a reduction in colorectal cancer risk.

Another 2018 study found that stage 3 colon cancer patients who had two 1-ounce servings of tree nuts (which included walnuts, cashews, almonds, pistachios, hazelnuts, pecans macadamia nuts, and Brazil nuts) each week were 42% more likely to experience disease-free survival and 57% greater chance of overall survival.

Turn up the flavor experience of roasted vegetables, rice, soup, smoothies, and tea by adding turmeric. This Indian spice, most common in curries, has an earthy sweet-pungent flavor and bright orange hue that can truly transform any food. That, and the cancer-preventative benefits, are why Roshni Rao, MD, Chief of the Division of Breast Surgery at New-York Presbyterian Hospital and Columbia University Medical Center, loves to eat turmeric-laden foods.

"Most of the studies do show a benefit from this anti-inflammatory, and there is no study that shows that it is detrimental," she says.

A 2015 study reviewed the multifaceted role of curcumin (the source of turmeric) in cancer prevention, and found that it can "suppress initiation, progression, and metastasis of a variety of tumors."

The plastics we brush our teeth with, eat and drink from, build toys with, type on, and so much more inundate every aspect of our lives, but the chemicals within are taking away our health and mortality. Especially when plastics are heated or scratched, they can leach the chemicals used to develop the products. Once inside our bodies, these chemicals, like BPA, disrupt the natural role of hormones and create an imbalance that can ultimately lead to cancer.

"BPA has been shown to play a role in the [development of]hormone-dependent tumors such as breast and prostate cancer," states a 2015 study that reviewed the health risks associated with exposure to bisphenol A.

Avoid plastics whenever possible by looking for BPA-free products and carrying reusable glass or steel drinking vessels. Do not cook or reheat food nor store hot food in plastic containers.

"Especially important in the summertime is decreasing charred food consumption," says Kevin Dawravoo, MD of Northwestern Medicine Cancer Center Warrenville. Reminding that the blackened char marks on grilled meat is a known carcinogen. It's something he rarely eats.

The concern is that when meat is cooked over open flame, and burned or blackened, chemicals known as HCAs and PAHs develop. When consumed these can alter a person's DNA which increases the risk of cancer.

In rodent studies, HCAs developed tumors breast, colon, liver, skin, lung, prostate, and other tumors. Similar rodent studies found that PAHs caused leukemia, and identified gastrointestinal and lung tumors. In epidemiologic studies, higher consumption of well-done and "barbecued" meat was linked to increased risk of colorectal, pancreatic, and prostate cancers.

RELATED: Everyday Habits That Make You Look Older, According to Science

You might be bored answering all of your doctor's questions about your parents' and grandparents' health, but it truly matters. Dr. Wafik El-Deiry, Associate Dean for Oncologic Sciences at Brown University, knows his family history and strongly recommends that you do the same.

"Illnesses that are found in the family can be a major clue to what risks there are," he says, adding that a history of cancer is usually well known and not difficult to learn about.

Sharing your family history with your doctor means they can do additional screening sooner, and work to catch symptoms and tumors earlier, which is key in treating and curing cancer.

"This knowledge may also direct patients to genetic testing that can further help to figure out different options to manage the risks," he added.

"Read your mammography results letter. In many states, including Connecticut, we, as radiologists are required to inform the patient whether or not her breast tissue is dense. If your breast tissue is dense, talk to your doctor about whether you need additional tests: a screening ultrasound or possibly even a screening MRI, the latter being a useful complementary screening tool in some women at higher than average risk of developing breast cancer. Please note that screening ultrasounds and screening MRIs do not replace mammography; rather, they are a complement to it," says Liva Andrejeva-Wright, MD, a Yale Medicine radiologist who specializes in breast imaging.

"It is important to know that screening mammograms do not prevent breast cancer. They do help by detecting cancer early in many cases, before it becomes palpable, however, and therefore prevent disease and treatment related morbidity that would have occurred if the cancer was detected later by the patient or her doctor," she added. And to get through this pandemic without catching coronavirus, don't miss this essential list: Most COVID Patients Did This Before Getting Sick.

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Slash Your Cancer Risk in Seconds, Say Cancer Experts | Eat This Not That - Eat This, Not That

The limits of life – The Indian Express

A curious side-effect of sentience is the awareness of death. Medicine, wellness, meditation, philosophy, neural transfers, even literature and the arts a great deal of human endeavour is tasked with either trying to prolong life, or deal with the reality of its end. It turns out that even the best efforts at least those that aim at corporeal immortality and longevity are bound to be futile.

According to a study published in the journal Nature Communications, the human body cannot survive beyond the age of 150 years, eating right and exercising notwithstanding. Researchers used a combination of data from blood tests from over five lakh people as well as mathematical modelling to conclude what we all know already: Everyone is going to die. The body will deteriorate to such an extent that it will not be able to fight disease or recover from even minor injuries. Despite the obviousness of the finding, its implications are serious. Prolonged old age already, human beings are, on average, living longer than ever before means that the burden on the working population is bound to increase, and that retirement will have to wait for many. After all, if youre going to live to 150, its hardly possible to stop earning at 60. And, to make matters worse, there is no guarantee that the quality of life at 150 will really be something worth living for.

The fear of death, and the futility of life, is of particular resonance now the pandemic has made people confront their own mortality on a scale not seen since World War II. In the aftermath of that war, the absurdity of social norms and ambition was articulated by the existentialists. This time, perhaps, the lessons that are drawn will be a little more hopeful: At the end of it all, people may simply give up the race against death and see that theres more in the moment than planning for a future that can be robbed by a microbe.

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The limits of life - The Indian Express

Chinese New Year 2021: Oxen, luck and why you should avoid medicine, laundry and crying children – The Telegraph

Lucky Signs for the Ox

Lucky numbers for people born in the Year of the Ox are one andfour,and their lucky colours arewhite, green and yellow.Their lucky flowers aretulips and peach blossoms and their lucky directionsare north andsouth.

People born in the Year of the Ox are characterised as diligent andhard-working. They are honest, strong and dependable, with theirability to keep calm making them great leaders.

While Oxen are kind, they find it difficult to understand persuasion andnever look to be the centre of attention,which results intheir talent being hidden. Their hard-work and patience, however,helps them earn praise and successfully meet their goals.

Strengths:Patient, persistent and cautious

Weaknesses: Stubborn, less-talkative and obstructive

Oxen arevalued animals in Chinese culturebecause of their roles in agriculture and positive characteristics, such as being honest and reliable.In terms of the Yin and Yang theory, they are the yang and also representthe hours one to three in the morning and the Earthly Branch Chou.

A person born in the Year of the Rat is thought to be trustworthy, kind and gentle. In particular, men born in this year are mature, logical and put their heart into everything they do, while women are calm, loyal and never surrender to fate.

With 2021 being the Year of the Metal Ox,Chinese astrology specialists sayit is a good year for giving birth as metal symbolisesstability and longevity. Those born in the Year of the Metal Ox shall have plenty of great things in their lives.

In Chinese astrology, the 12 animal zodiac signs each have unique characteristics.

If you want to get into the swing of the festivities but dont have the foggiest how to decipher Mandarin characters, here is our handy guide to the most essential phrases.

1. / (xn nin kui l) Happy New Year!

In Mandarin:/sshin-nyen kweye-luh/

In Cantonese: /san nin fai lok/

2. / (Xn nin ho) New Year goodness!

In Mandarin: /sshin-nyen haoww/

In Cantonese: /sen-nin haow/

3. / (Gngx fci) Happiness and prosperity!

In Mandarin: /gong-sshee faa-tseye/

In Cantonese: Kunghei fatchoy /gong-hey faa-chwhy/

4. / (Bb goshng) A steady rise to high places! /on the up and up

In Mandarin: /boo-boo gaoww-shnng /

In Cantonese: /boh-boh goh-sshin /

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Chinese New Year 2021: Oxen, luck and why you should avoid medicine, laundry and crying children - The Telegraph

Pandemic Lessons in Improving the Medical System – The New York Times

One of the most dramatic examples was the abrupt substitution of telemedicine for in-person visits to the doctors office. Although telemedicine technology is decades old, the pandemic demonstrated how convenient and effective it can be for many routine medical problems, Dr. Navathe said.

Feb. 10, 2021, 7:15 a.m. ET

Telemedicine is more efficient and often just as effective as an office visit. It saves time and effort for patients, especially those with limited mobility or who live in remote places. It lowers administrative costs for doctors and leaves more room in office schedules for patients whose care requires in-person visits.

Even more important, the pandemic could force a reckoning with the environmental and behavioral issues that result increasingly in prominent health risks in this country. We need to stop blaming genetics for every ailment and focus more on preventable causes of poor health like a bad diet and inactivity.

Consider, for example, the health status of those who have been most vulnerable to sickness and death from Covid-19. Aside from advanced age, about which we can do nothing, its been people with conditions that are often largely preventable: obesity, Type 2 diabetes, high blood pressure, coronary artery disease and smoking. Yet most physicians are unable to influence the behaviors that foster these health-robbing conditions.

Many people need help to make better choices for themselves, Dr. Navathe said. But the professionals who could be most helpful, like dietitians, physical trainers and behavioral counselors, are rarely covered by health insurance. The time is long overdue for Medicare and Medicaid, along with private insurers, to broaden their coverage, which can save both health and money in the long run.

Policy wonks should also pay more attention to widespread environmental risks to health. Too many Americans live in areas where healthful food is limited and prohibitively expensive and where the built environment offers little or no opportunity to exercise safely.

Individuals, too, have a role to play. The pandemic has fostered an opportunity for patients to take on a more active role in their care, Dr. Shrank said in an interview.

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Pandemic Lessons in Improving the Medical System - The New York Times

City of Hope Scientists Have Developed a Precision Medicine Tool That Predicts If Chemotherapy Will Produce Debilitating Side Effects in Older Adults…

DUARTE, Calif.--(BUSINESS WIRE)--Researchers at City of Hope, a world-renowned independent research and treatment center for cancer, diabetes and other life-threatening diseases, have developed a tool that could predict if older adults with early-stage breast cancer will develop a severe or deadly reaction to chemotherapy.

This first-of-its-kind risk assessment tool called the Cancer and Aging Research Group-Breast Cancer (CARG-BC) Score helps oncologists make personalized treatment recommendations. Oncologists can discuss the score and its significance with early-stage breast cancer patients age 65 or older. Together, an informed decision about chemotherapy can be made as treatment benefit is weighed against quality of life concerns, said Mina Sedrak, M.D., M.S., co-first author of the new study and deputy director of clinical trials for the Center for Cancer and Aging Research at City of Hope.

Despite remarkable advances in cancer treatment, tools to characterize the toxicity of cancer therapies have remained virtually unchanged for the past 20 years, Sedrak said. This is a new precision medicine tool. Rather than basing treatment decisions and care on demographic data for a disease, we now can offer each elderly, early-stage breast cancer patient individualized toxicity information that could help align treatment with their goals for lifestyle, quality of life, longevity and other priorities.

More than 72% of older patients with cancer reported that they would not choose cancer treatment that results in functional impairment even if it improves survival, Sedrak said.

If the risk of chemotherapy toxicity is known in advance, oncologists and patients could work together to decide whether chemotherapy is the right choice. Treatment modifications such as dose reductions and longer periods between chemotherapy delivery could be recommended. Older patients could also preemptively be referred for supportive care interventions such as consults with physical therapists, occupational therapists, social workers and pharmacists, who could evaluate potential drug interactions with existing medications for chronic ailments. Additionally, patients could have someone evaluate their home for safety or necessary modifications.

The study, published on Jan. 14 in the Journal of Clinical Oncology, spanned 16 institutions across the nation, with City of Hope being the lead institution. It included 473 patients age 65 or older with Stage 1-3 breast cancer (283 in development cohort; 190 in validation cohort). They were all treated with chemotherapy either before or after surgery and were evaluated for geriatric and clinical symptoms predictive of severe (grade 3), debilitating (grade 4) or deadly (grade 5) side effects due to chemotherapy.

Though chemotherapy is an effective way to treat early-stage breast cancer, it also carries a risk of side effects. There is a delicate balance between the benefits of chemotherapy and the harm of possible side effects, said Canlan Sun, M.D., Ph.D., senior author of the study and associate research professor in the Department of Supportive Care Medicine at City of Hope.

The development of severe chemotherapy toxicity not only can harm the patient, but it can also compromise an older adults ability to complete the full course of chemotherapy, possibly reducing the potential benefit of the cancer treatment, she added.

Sedrak noted that most women with early stage breast cancer have a potentially curable disease and some would benefit from chemotherapy after surgery. Unfortunately, older adults aged 65 and over, who comprise about half of all breast cancer diagnoses, are significantly less likely to be offered chemotherapy compared to younger patients sometimes because their doctors fear they wont be able to tolerate it, he said. Older adults are also underrepresented in cancer trials, and we know little about how best to treat this heterogenous group.

The CARG-BC score is derived by combining eight disease and patient-reported predictors: use of an anthracycline chemotherapy, Stage 2 or 3 breast cancer, longer planned treatment duration, abnormal liver function, low hemoglobin, falls, limited walking ability and lack of social support.

This risk prediction model is an extension of prior work from the national Cancer and Aging Research Group led by scientists at City of Hope and elsewhere. As a National Cancer Institute-designated comprehensive cancer center, City of Hope offers integrated, multidisciplinary care that includes supportive care services addressing physical and emotional issues that can arise during and after treatment.

The newly developed CARG-BC score outperformed existing measures of patient performance status that are widely used in oncology such as the Karnofsky performance status or Eastern Cooperative Oncology Group performance status, both of which were developed and validated in younger patients.

Those clinician-based eyeball tests are imprecise and subjective, Sedrak said. They do not detect important factors such as functional reserve or the ability to respond to stress, which vary greatly between older patients of the same chronological age and are valued by patients and caregivers.

As a next step, the researchers will look to improve the chemotherapy toxicity risk assessment tool with more biological markers. They will attempt to identify biomarkers that could predict severe or deadly side effects to chemotherapy. They are working to identify interventions to support elderly breast cancer patients so that they derive the most benefit and the least toxicity from chemotherapy.

The researchers will also continue their efforts to improve access to cancer clinical trials for all patients, leveraging new innovations in technology and widely used social media networks.

The title of the study is Development and validation of a risk tool for predicting severe toxicity in older adults receiving chemotherapy for early-stage breast cancer (https://doi.org/10.1200/JCO.20.02063). It was supported by the National Institute on Aging (NIA R01 AG037037, K76 AG064394, K23AG038361, K24 AG055693, K24 AG056589), National Cancer Institute (K12CA001727, K12CA167540), National Institutes of Health (R21 AG059206), Breast Cancer Research Foundation, Susan G. Komen for the Cure (CCR14298143), American Cancer Society (125912-MRSG-14-240-01-CPPB) and Center for Cancer and Aging Research at City of Hope.

This research would not have been possible without the foundational scientific contributions made by the late Arti Hurria, M.D., former director of City of Hopes Center for Cancer and Aging Research.

About City of Hope

City of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threatening diseases. Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR T cell therapy. City of Hopes translational research and personalized treatment protocols advance care throughout the world. Human synthetic insulin, monoclonal antibodies, and numerous breakthrough cancer drugs are based on technology developed at the institution. AccessHope, a wholly owned subsidiary, was launched in 2019 and is dedicated to serving employers and their health care partners by providing access to City of Hopes exceptional cancer expertise. A National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network, City of Hope is ranked among the nations Best Hospitals in cancer by U.S. News & World Report. Its main campus is located near Los Angeles, with additional locations throughout Southern California and in Arizona. For more information about City of Hope, follow us on Facebook, Twitter, YouTube or Instagram.

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City of Hope Scientists Have Developed a Precision Medicine Tool That Predicts If Chemotherapy Will Produce Debilitating Side Effects in Older Adults...

Weed and Seven Benadryl: The Wild Lengths COVID Docs Are Taking to Get Sleep – The Daily Beast

One emergency medicine doctor at a New York City hospital has lost count of the number of sleep medicines shes tried since the coronavirus took over her life in February.

First it was temazepam and then trazodone, though even tripling her initial 50 mg dose didnt help. Shes been prescribed two different antidepressants, and tried medical marijuana.

One night, she said, she took seven Benadryl.

And my doctor was like, What happened? And I was like, I didnt sleep, said the emergency medicine doctor, who spoke to The Daily Beast on the condition of anonymity because she didnt want her employer to find out she sees a psychiatrist or takes medication.

Her newest cocktail: a combination of Ativan, melatonin, and high blood pressure medicines. But there are still days, she said, when she drags herself into work on no sleep at all. It absolutely affects how I do my job, said the doctor.

For a while, I was terrified of sleeping.

Emergency medicine doctor in New York

Of course, getting to sleep isnt even half the battle. Even when her medicines work and she can drift off, she finds herself woken up by a surge of adrenaline a few hours later.

And then there are the night terrors.

For a while, I was terrified of sleeping, she told The Daily Beast. I didnt even want to take my medicine to go to sleep, because youd just have really bad dreams of your patients dying and you couldnt save them.

Since the coronavirus went from curiosity to pandemic, frontline health-care workers tasked with caring for the hundreds of thousands of patients passing through their clinics, emergency departments, and hospitals have been mired in sleep disorders and insomnia. One study of New York City health-care workers treating COVID patients this spring showed that 75 percent of respondents had at least some insomnia and that, on average, they were sleeping less than six hours each night.

And then theres just so much death.

Dr. Jessi Gold

Now, as the second wave of the virus pummels the United States, experts say that percentage is likely much higherand that the arrival of a vaccine, while encouraging, offers little in the way of a respite.

Its a crisis, said Dr. Jessi Gold, a psychiatrist at Washington University in St. Louis who specializes in the mental health of health-care workers.

Pretty much no one is sleeping, she added. And that makes sense, because if you think of sleep as a symptom of acute stress, well, this job is in many ways an accumulation of traumas. Theres the anxiety of, Am I going to get sick? Am I going to get my partner or my children or someone else sick? Gold said.

And then theres just so much death.

In the short term, these sleep issues have severe consequences for the profession, according to Gold, who likens working on little sleep to drunk driving. But other doctors say the long-term consequences are perhaps even more dire.

Were never going to be the same again, said Dr. Tsion Firew, an assistant professor of emergency medicine at Columbia University Medical Center in New York City.

In May, Firew, who is also struggling with insomnia but does not take prescription sleep aids, co-authored a study that found more than half of frontline health-care workers during COVID were experiencing anxiety and depression.

The best medicine for someone who is going through a mental trauma, you advise the person or patient or find a way to avoid the trauma so they can begin the healing, she said. But for us, were still in it. Weve lost our friends, our colleagues, and some of us have lost our family members. So its going to be a thing thats going to haunt us forever.

For some health-care workers, seeing colleagues finally receiving the vaccine was one of the first bright spots since the pandemic began.

Its just nonstop terror, unfortunately.

Dr. Tsion Firew

This week, there happens to be some optimism, said Dr. Vignesh Doraiswamy, a hospitalist at Ohio State University Medical Center. Doraiswamy said he sleeps between five and six hours a night, but hasnt yet resorted to prescription medications.

But he and other health-care workers said that the vaccines slow rollout and the rising number of new cases and deathsand the crushing impact on hospital capacityvastly overshadowed the hope for relief.

The next couple of weeks are going to be even tougher, Firew told The Daily Beast, adding, Its very difficult to fathom what might happen with the holidays and people traveling and just peoples complacency. And once you see the number of cases rising, the next thing that happens is the wave of the dead. So its just nonstop terror, unfortunately.

One Bay Area geriatrician, who spoke to The Daily Beast on the condition of anonymity because she, too, didnt want her employer to know about her usage of sleep medicines, said trazodone didnt work.

Neither did CBD or CBD with THC, the antidepressant duloxetine, melatonin, Sleepytime tea, or obsessive knitting and watching Star Wars.

The two anti-anxiety meds shes on now, she said, help sometimes. But on Friday night, she still found herself awake at 4 a.m., replaying a PCR test shed given to a symptomatic patient that afternoon. The patient, she said, was confused and kept taking off their mask. And with the second wave limiting PPE yet again, shed been using the same N95 mask for a week. She felt like shed been exposed, and she wondered if shed brought the virus home to her partner and his son.

I worry about the effects it has on my overall wellbeing and my longevity in the profession, she said. I thought I had things treated better once I made this medication switch, but as things have come up again, its reared its ugly head. And all the medication in the world isnt going to change the external circumstances.

Sleep disorders were never rare among doctors and nurses in emergency medicine and other specialities with shifts that vary from morning to night, Gold noted. Whats different now, she said, is the sheer volume of health-care workers experiencing them and just how resistant these disorders have become to treatment.

Sleep is hard to treat. Period. Exclamation point, Gold said. Sleep in general is hard to manage. And then if you throw in a significant stressor like COVIDI tell a lot of people that its hard to drug the situation out of them. That doesnt mean that medication cant help, but it does mean if the stressor is still there, its still there. I dont have the ability to do an Eternal Sunshine of the Spotless Mind.

Sometimes, I wish I did.

What haunts Doraiswamy most when hes lying awake in his bed at night are the conversations. Hes asked people in their twenties if they have a living will or if theyve thought about what it means to be put on a breathing tube. Hes told countless children that their parents wont make it through the night.

Elderly couples always break my heart, he said. The number of times Ive had to tell someone in their eighties that your loved ones not doing well and were doing the best we can, but probably its not enough... And never did I think Id be having those conversations over the phone.

The emergency medicine doctor in New York who resorted to trying seven Benadryl said she often finds herself replaying the deaths of two men, both non-English-speakers, who died early in the pandemic.

Youre telling them its going to be fine, its going to be fine. But you know its not going to be fine, she recalled. I knew that I was lying to them. And they both passed away in the ER, not in a room. There was no dignity in that.

Without an effective sleep regime, she said, she and her colleagues at the hospital have more or less given up on sleeping well, and instead turned to coffee to stay awake. But even that had an unexpected side effect: now many of her colleagues, she said, have gastric ulcers. On Sunday, one doctor she works with went for a second endoscopy. She also has symptoms of an ulcer, she said, but it hasnt been diagnosed.

No time to get an endoscopy, she wrote in a text message to The Daily Beast. Im your typical bad patient doctor.

And this points to a grim irony, Gold said. Although doctors and nurses know more about medication and treatment, theyre often reluctant to seek treatment themselves, especially when it comes to issues of behavioral health like anxiety, depression and, of course, the insomnia currently gripping the profession.

There is a ton of stigma in general about mental health in medicine and this culture of stoicism and a fear that if you look weak it will affect your job, Gold said.

This is a huge problem as the pandemic continues to pummel the people charged with blunting its impact. The same study showing high rates of insomnia among New York health-care workers this spring indicated that nearly 60 percent were experiencing acute stress, often a precursor to post-traumatic stress disorder. In April, an emergency medicine doctor and an emergency medical technician, both of whom had worked on the frontlines of the pandemic in New York, died by suicide.

Unfortunately, just in the medical field, it sometimes takes courage to seek care. Its not like its easy to talk about, the way you talk about your high blood pressure or diabetes, said Firew, who had been a colleague of the emergency medicine doctor who died.

Thats why, the other New York emergency doctor said, even when she hasnt slept at all, she drags through the day at work, rather than call in sick. And when she decided to see a psychiatrist for her sleep issues, she said, she went to extreme lengths to make sure there wouldnt be a record, choosing a therapist who kept paper and not electronic files.

Despite the fact that shes drowning in more than $300,000 of medical school debt, she also pays for her visits with cash rather than go through her insurer.

Theres all this HIPAA stuff, but lets be real, they read your charts, and God forbid you come in with an elbow dislocation and they see that your last visit was with a psychiatrist, she said. You dont want that to be read.

Gold said that while fears like this are widespread, theyre only partly based in reality. The stigma is real, she said, but the idea that theyll ding your license or you'll lose your job, most of that is lore.

Still Gold said that seeking professional help, even under the table, is a best-case scenario. Because of these fears, many doctors wont seek medical interventions at all, or will end up self-prescribing.

Medication might not be ideal, but you have to sleep, she said. And Id rather they ask me for help than turn to prescribing themselves benzos or opioids, because that would be a problem.

Read more:
Weed and Seven Benadryl: The Wild Lengths COVID Docs Are Taking to Get Sleep - The Daily Beast