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Archive for the ‘Preventative Medicine’ Category

Medical Wellness Market Strategies and Insight Driven Transformation 2019-2025 – News Parents

Thursday, February 20th, 2020

Dataintelo.com, has added the latest research on Medical Wellness Market, which offers a concise outline of the market valuation, industry size, SWOT analysis, revenue approximation, and the regional outlook of this business vertical. The report precisely features the key opportunities and challenges faced by contenders of this industry and presents the existing competitive setting and corporate strategies enforced by the Medical Wellness Market players.

As per the Medical Wellness Market report, this industry is predicted to grow substantial returns by the end of the forecast duration, recording a profitable yearly growth in the upcoming years. Shedding light on brief of this industry, the report offers considerable details concerning complete valuation of the market as well as detailed analysis of the Medical Wellness Market along with existing growth opportunities in the business vertical.

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Concepts and ideas in the report:Analysis of the region- based segment in the Medical Wellness Market: As per the report, in terms of provincial scope, the Medical Wellness Market is divided into USA, Europe, Japan, China, India and South East Asia. It also includes particulars related to the products usage throughout the geographical landscape. Data related to the evaluations held by all the zones mentioned as well as the market share registered by each region is included in the report. Sum of all the product consumption growth rate across the applicable regions as well as consumption market share is described in the report. The report speaks about consumption rate of all regions, based on product types and applications.

Brief of the market segmentation: As per the product type, the Medical Wellness Market is categorized intoComplementary and Alternative MedicineBeauty Care and Anti-AgingPreventative & Personalized Medicine and Public HealthHealthy Eating, Nutrition & Weight LossRejuvenationOther

Furthermore, the market share of each product along with the project valuation is mentioned in the report. The report consists of facts related to every single products sale price, revenue, growth rate over the estimation time period.

The Medical Wellness Market, according to the application spectrum, is categorized intoFranchiseCompany Owned Outlets

Data pertaining the market share of each product application as well as estimated revenue that each application registers for is slated in the report.

Propelling factors & challenges: The report provides data concerning the forces influencing the commercialization scale of the Medical Wellness Market and their effect on the revenue graph of this business vertical. Data pertaining to latest trends driving the Medical Wellness Market along with the challenges this industry is about to experience in the upcoming years is mentioned in the report.

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Implementing marketing tactics: Ideas about numerous marketing strategies implemented by the renowned shareholders with respect to product marketing is present in the report. Information related to the sales channels that companies select is also included in the report. Along with the dealers of these products, it also presents the summary of the top customers for the same.

Analysis of the major competitors in the market:An outline of the manufacturers active in the Medical Wellness Market, consisting ofMassage EnvySteiner Leisure LimitedWorld GymFitness WorldUniversal CompaniesBeauty FarmVLCC Wellness CenterNanjing ZhaohuiEdge Systems LLCHEALING HOTELS OF THE WORLDGolds Gym InternationalBon VitalKaya Skin ClinicThe Body HolidayKayco VividArashiyu Japanese Foot SpaEnrich Hair & SkinWTS InternationalBiologique RechercheGuardian LifecareHealthkartalong with the distribution limits and sales area is reported. Particulars of each competitor including company profile, overview, as well as their range of products is inculcated in the report. The report also gives importance to product sales, price models, gross margins, and revenue generations. The Medical Wellness Market report consists of details such as estimation of the geographical landscape, study related to the market concentration rate as well as concentration ratio over the estimated time period.

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Some of the Major Highlights of TOC covers:Medical Wellness Regional Market Analysis Medical Wellness Production by Regions Global Medical Wellness Production by Regions Global Medical Wellness Revenue by Regions Medical Wellness Consumption by Regions

Medical Wellness Segment Market Analysis (by Type) Global Medical Wellness Production by Type Global Medical Wellness Revenue by Type Medical Wellness Price by Type

Medical Wellness Segment Market Analysis (by Application) Global Medical Wellness Consumption by Application Global Medical Wellness Consumption Market Share by Application (2014-2019)

Medical Wellness Major Manufacturers Analysis Medical Wellness Production Sites and Area Served Product Introduction, Application and Specification Medical Wellness Production, Revenue, Ex-factory Price and Gross Margin (2014-2019) Main Business and Markets Served

For More Information on this report, Request Inquiry At https://dataintelo.com/enquiry-before-buying/?reportId=114037

About DataIntelo: DATAINTELO has set its benchmark in the market research industry by providing syndicated and customized research report to the clients. The database of the company is updated on a daily basis to prompt the clients with the latest trends and in-depth analysis of the industry. Our pool of database contains various industry verticals that include: IT & Telecom, Food Beverage, Automotive, Healthcare, Chemicals and Energy, Consumer foods, Food and beverages, and many more. Each and every report goes through the proper research methodology, validated from the professionals and analysts to ensure the eminent quality reports.

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On the move at Aker Ink, Sagewood, Plexus, Jaburg Wilk – AZ Big Media

Thursday, February 20th, 2020

Aker Ink bolsters team

Having embraced marketing and digital strategies over the last decade while cementing a reputation for excellence in serving B2B clients, boutique agency Aker PR & Marketing has expanded by hiring Valliere Jones as director of public relations and Tim Gallen as account executive.

Aker Ink serves clients in highly technical or specialized industriesfinding professionals who can turn difficult concepts into easily understood, relatable materials is a challenge, said Aker Ink President Andrea Aker. These seasoned practitioners are adept at telling our clients stories in a compelling way to position themand Aker Inkfor growth.

Jones, a public relations agency veteran with more than 25 years of experience at global, regional and local firms, will plan and execute public relations campaigns that integrate with companys marketing capabilities while supervising and mentoring the agencys account executives and coordinator.

We knew Vallieres proven track record in executive communications and thought leadership, as well as her strategic planning and media relations abilities, would be a tremendous assetso we created a position to leverage her strengths, Aker said. With a wealth of expertise in a wide variety of writing styleseverything from short social media posts to case studies and bylined articlesValliere is perfectly suited to coach our junior staff and help them hone their writing skills.

Gallen, who previously served as digital editor for the Phoenix Business Journal, is an award-winning journalist who crafted news articles and other content on a wide range of topics spanning restaurants, retail, small business, technology, real estate and the economy, diving into business operations, innovations and the latest industry trends.

As a former journalist with deep digital expertise, Tim is a natural fit for Aker Ink, said Aker. He knows what makes a great story, how to tell a great story and how to get that story noticed. He also thinks creatively and is willing to experimenttwo fundamental traits of any successful PR pro.

Jones is a former National President of the Public Relations Student Society of America and graduate of Brigham Young Universitys renowned public relations program. Gallen has a degree in communications with an emphasis in journalism from Pacific Lutheran University.

Sagewood, a Life Plan Community featuring resort-like amenities focused on independence and well-being, has named Jennifer LaForest director of business development at Sagewoods Acacia Health Center.

She brings more than 20 years of experience in the skilled nursing and retirement community industry to Acacia Health Center. LaForest previously served as the campus director of admissions and marketing at Springsdale Village in Mesa, Ariz. and prior was the director of admissions and marketing at Avalon Shadow Mountain in Scottsdale, Ariz.

LaForests background in skilled nursing and senior care is impressive, said Natalie Miko, administrator of Acacia Health Center. She truly understands what goes into working with admissions and helping residents get what they need and will be a great asset at Acacia Health Center.

For more information on Sagewood, visit SagewoodLCS.com and Like the communitys Facebook page at Facebook.com/SagewoodLCS.

Plexus Worldwide, a leading direct-selling health and wellness company focused on health and happiness, is pleased to welcome Dr. Jim Logan to its Medical Advisory Board. Dr. Logan has decades of experience caring for Americas astronauts and is dedicated to helping all people achieve and maintain optimal health.

As a Medical Advisory Board member, Dr. Logan will help guide product development using his experience as a medical doctor and his passion for sharing preventative practices.

Plexus is thrilled to welcome Jim to our team because he is committed to helping people achieve a healthy lifestyle through the art of combining science-backed products with motivational strategies, said Tarl Robinson, CEO and Founder of Plexus. His insight and passion in helping people live happier, healthier lives is already inspiring our team.

Dr. Logan is Board Certified by the American Board of Preventive Medicine and spent 22-years at NASA Space Center serving as Chief of Flight Medicine and Chief of Medical Operations. Among his top priorities was to care for American astronauts and their families for 25-Space Shuttle missions by optimizing their health and preventing medical issues.

I am excited to work with the team at Plexus to help people around the world work towards whole body wellness using a team approach that leverages the power of science to reach maximum health potential, said Dr. Logan. My personal philosophy of medical care is that prevention is vastly superior medically, financially and emotionally to aggressive, long-term, and invasive treatments that result from significant medical issues.

Alden A. Thomas has been named to the Board of Directors of Audreys Angels.

Thomas, an employment law and insurance coverage attorney at Jaburg Wilk, said Audreys Angels is a great organization. The difference that music can make in the life qualify of elderly people is amazing. Im proud of the number of homes that Audreys Angels is currently assisting and look forward to helping them to deliver even more programming.

Audreys Angels provides music and art by bringing live music and craft programs to enrich the lives of elderly who are living in small residential care homes in Maricopa County. Founded in 2001, they have grown to support more than 100 homes and adult day care centers with assistance from 75 music and craft angels.

Thomas received her J.D. from the Sandra Day OConnor College of Law at Arizona State University and her undergraduate degree from the University of Texas at Austin. Prior to starting private practice, Alden clerked for Judge Patricia Orozco of the Arizona Court of Appeals.

AZ Business Leadersis an annual business-to-business publication that combines the whos who of Arizona business community with their valuable leadership advice and knowledge. The magazine is published byAZ Big Media. To learn more about Az Business Leaders, contactSheri Brown, director of sales.

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Researchers move forward with a shot to prevent Lyme disease – WXOW.com

Thursday, February 20th, 2020

(WKOW) -Lyme disease cripples hundreds of people in Wisconsin each year and now researchers are working on a shot to prevent the problem.

The Badger State is a hot spot for the tick-borne disease. According to the Centers for Disease Control and Prevention, the average number of cases has more than doubled over the last decade. In 2018, Wisconsin saw 1,121 cases.

It's a problem that Alicia Cashman knows all too well.

"It destroys your life," she said. " It makes life unbearable."

She said it started with her dog and then moved to her husband.

"All of a sudden he was limping and had to crawl up the stairs."

Finally, Alicia was diagnosed with Lyme disease.

"I would walk into a room and forget why I was there," she said.

Now researchers are looking for a way to prevent the spread of Lyme disease with medicine.

"You give the shot right at the beginning of the season," said Dr. Mark Klempner, a researcher at MassBiologics, University of Massachusetts Medical School. "Take the shot sometime in March or April and then we are anticipating that it would work for eight months."

He said it's the same general idea used in protecting babies from certain viral infections.

"We use an immune molecule called an anti-body that would provide immediate immunity with very little or no side-effects."

After four years of development, Dr. Klempner said things are moving forward. They are about to begin first in human testing to show it's safe and learn how long it will last in the bloodstream.

He said he is well aware of a possible challenge in informing people of the difference between this shot and one called Lymrix, taken off the market years ago due to fears of vaccine side-effects and declining sales.

"Lymrix was a vaccine, this is quite different," said the doctor. "Instead of a bacterial protein, this is a human protein that is in the protective molecule."

The shot is still a few years away from being released to the public, but Dr. JoAnne Kriege at SSM Health in Madison says there are some things you can do to protect your family now.

-Stay to the center of trails. Don't go into the brush.-Wear long-sleeved shirts and pants when outside.-Use a repellant with DEET.-Check for ticks right after outdoor activities.

As for Cashman, while the preventative shot comes a little too late, she said she and her husband are doing well now and has found her passion as she continues to recover. Lyme disease education.

She runs amonthly support groupin Wisconsin for people with questions. Each meeting, the group talks about the struggles and successes they've had with the diagnosis.

During the month of February, several businesses across the country are coming together to raise money for Lyme disease research for a cure.

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Researchers move forward with a shot to prevent Lyme disease - WXOW.com

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Heartworm: It’s time to fit prevention into your routine – Rutland Herald

Thursday, February 20th, 2020

Somehow I let Valentines Day pass without talking about heartworms! This was a big lapse on my part that I will try to make up for now. Those of you who are less veterinary-inclined probably dont automatically associate the two as I do, but you still have to come on this journey with me! Heartworm disease isnt as common in Vermont, but that being said, I am currently treating a few. As the climate of Vermont changes and we bring up more Southern dogs, heartworm becomes more and more prevalent.

What are heartworms?

The easy answer is that they are worms living in a pets heart. Moving, wiggling, worms living in the chambers of the heart. Literally. The microfilariae (which are baby worms) migrate through the bloodstream, then mature in the heart. Heartworms live for about two years. The pets do not clear the infection after two years, however, since the worms continue to reproduce and more and more develop. Without treatment some pets die because there are so many worms that they actually prevent blood from flowing at all. These pets go into heart failure secondary to their worms. Heartworms can also be found in other places in the body if they migrate out of the heart.

How do I prevent heartworm?

Heartworm infection is prevented by a monthly pill or topical treatment. There are several types of drugs depending on the brand, but they all work in the same manner. These drugs kill the microfilariae at a larval stage within the bloodstream so that they dont have a chance to migrate to the heart and mature. It is recommended by the American Heartworm Society to use these medications year-round, but it is essential during the warmer months when mosquitoes are present. Because these medications cannot kill adult worms, it is important not to skip months when mosquitos are present. If your dog is infected and several months go by, the medication will no longer be able to kill the microfilaria and these will be progressing into adults.

How is heartworm spread?

Heartworm is spread by mosquitos. They cannot be spread any other way. Mosquitoes carry the juvenile stage of worms from one infected animal to another. Dogs, foxes, coyotes and wolves are all able to harbor and spread heartworms through mosquito vectors. The microfilariae become infective after spending time in the mosquito, and are then deposited on the skin of pets when the mosquitos bite. The microfilariae then migrate into the animal and into the bloodstream, where they eventually mature in the heart. Heartworm can be spread between wild animals and dogs, so even if your pet doesnt live around other dogs they are at risk if you see mosquitos.

What if my pet has heartworms?

Heartworm is detected on an annual screening test. Heartworm treatment consists of killing the adult worms, the microfilariae, and treating the side effects of the worm death. Your veterinarian will run a confirmation test and stage the heartworm disease based on looking at bloodwork and chest x-rays. Your pet will receive an injection of a medication that kills the adult worms, then two more injections a month later. This injection must be given in the muscles along the back, and because it must be given in a sterile manner your pet will have the hair shaved in those injection areas.

They will also receive heartworm prevention pills beforehand and monthly for a year after treatment (at least.) This will ensure that any baby worms are killed before they have a chance to develop into adults. Dogs will receive antibiotic treatment that will help prevent a bacteria called Wolbachia that lives with the heartworms from developing. They will also get steroids after their injections.

There is another method that consists of treating the juvenile form monthly and waiting for the adults to die. This is less expensive, but not recommended. Worms can live at least two years, during which time they alter how the heart muscles work. These alterations will be permanent and often lead to irreversible heart damage.

How soon after we find heartworm are they treated?

Your pet should be treated as soon as possible after they are diagnosed with heartworm. Since the treatment is staged, starting sooner means the adults live in the heart for less time. The danger of not treating heartworm is that the structure of the heart changes to accommodate the worms. As the blood-flow changes, because it has to go around the worm, the heart and lung structure is affected. The longer the worms are living in the heart the more damage is done which we cannot reverse.

What happens after treatment?

The number-one most important thing that I cannot emphasize enough is that dogs MUST be confined for 4-6 weeks after treatment. Unfortunately, this means they must be quiet from after the first treatment until at least a month after the second and third. They can only go outside to go to the bathroom, and can never never be off-leash. Indoors they need to be crated or confined to a small space unless you are next to them. They cannot run, jump, play or have any sudden bursts of energy.

When we give the injection to kill the worms, they disintegrate into small pieces as they die. If dogs have a burst of energy or their heart is required to pump faster, there is a high chance that the pieces of the worm will become lodged throughout the body. These act just like clots (by stopping blood flow) and can cause serious damage to the heart, lungs, organs, or even lodge in the brain and cause sudden death. After six weeks the pieces will have dissolved to the point that they are no longer dangerous.

It can be very difficult for owners to keep a dog fully confined for that long, especially those that are used to daily exercise. Since they appear normal, the urge to let them loose can be very strong. This is the hardest part of treatment, and some dogs need mild sedation in order to relax. This period of time is a small price to pay, however.

Can cats get heartworm?

Cats CAN get heartworm. It is much more prevalent in the southern climates than Vermont, but is still a possibility. Cats are an aberrant host, which means that they cannot spread heartworms to mosquitoes. However, they can get the disease and suffer problems as well. There is also heartworm prevention for cats, so make sure to speak to your veterinarian about it.

The bottom line is that preventing heartworm is much easier than treating it. Treatment is painful since we are injecting a reactive medicine into their muscle. Before treatment, we give pets pain medication and a light sedative because it is uncomfortable. Treatment usually costs between one and two thousand dollars for the bloodwork, x-rays, hospitalization, and medication, depending on the size of the dog and stage of the disease. Confinement after treatment can be difficult as well. Not treating heartworm dramatically shortens the lifespan of pets and leads to serious heart and lung disease. Dogs can be affected by heartworm more than once, so even after treatment they must receive preventative pills. Most dogs look forward to their monthly treat, and there isnt much better than preventing a deadly disease while making your dog happy.

The American Heartworm Society has a very informative website to answer other questions. http://www.heartwormsociety.org.

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Heartworm: It's time to fit prevention into your routine - Rutland Herald

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Here’s Why The Flu Poses A Bigger Risk Than The Coronavirus – Peoria Public Radio

Thursday, February 20th, 2020

China is facing one of its largest public health crises: the outbreak of the novel coronavirus.

But U.S. healthcare officials are far more concerned about the spread of other viruses, like the flu.

WCBU talked to Lori Grooms, director of infection prevention for OSF HealthCare, about why the flu poses a bigger threat.

Dana Vollmer: Explain why people are more at risk of contracting the flu than coronavirus.

Lori Grooms, director of infection prevention for OSF HealthCare, talks to reporter Dana Vollmer.

Lori Grooms: The flu is something that we see every year and it is commonly circulating. The coronavirus that they're hearing on the news, while there are cases in the United States, the chances of coming in contact with the virus itself are very, very low. The flu virus, it's more common. You could come across somebody at the grocery store, because we all feel like we can wait it out. We have a cough, so I can go to the store and I can get the medicine to take care of it. I can go to work when I'm sick, because I'm just that important that I need to be at work. Unfortunately, because we have the idea that the flu is no big deal and we can go to work with it, we tend to spread it on to others.

DV: Why do people tend to worry about things like coronavirus, but not always think of the flu as potentially deadly?

LG:Because it's new. We're always more scared by the things that we don't know about. Because the flu circulates every year, it's something that we're used to seeing. The coronavirus, we don't know a lot about it and we're being told that we don't know a lot about it. That in itself makes people afraid. Even when you hear things from the Centers for Disease Control and Prevention (CDC) or from the World Health Organization, they're still investigating. They can't tell us exactly everything about this virus because it is so new and there's they're still learning about it. That's what makes people afraid.

DV: What role does social media play in spreading misinformation about virus outbreaks?

LG: Social media, while it's a wonderful thing, it can also be a detriment. Not everything you see on the internet is true. With that, misinformation can spread very easily. What I always try to do is defer back to the experts. If you really want information, CDC has a very good website that anyone in the public can get on to and read the World Health Organization the same way. Those are the organizations that are actually investigating and looking at this virus. They have the most up-to-date and the most current information. The Illinois Department of Public Health also has the most current information. You're not always going to find that with every other website.

DV: The coronavirus is not the first major respiratory virus to pop up in recent years.

LG: It happens every two to three years. I've been in my role in infection prevention for over 15 years. Every two or three years, we're having discussions about a virus that has changed and the transmission is a little bit different. We've seen it with SARS, we've seen it with [MERS] in the more recent years. It's not something that is new to the healthcare profession. We've been planning for things like this. And once something like this comes up, infection prevention at your hospitals, your emergency preparedness we're ready to handle it. We keep current on the information and we just make tweaks to what we're doing on an everyday basis.

DV: Is it inevitable that more viruses like this will surface?

LG: Yes. Viruses are genetic makeup, so anytime you have genes you have the ability for them to change as they reproduce. So you will always see changes in viruses. The thing about the coronavirus that you're hearing on the news the one coming out of Wuhan, China is that this was spread from animals to humans at the start. That always causes concern. Once it is caught by humans, we don't know what's going to happen. You're seeing a lot of cases in China because of that because it's a new strain circulating in humans, but it had been in animals for years.

DV: What do you say to people who are still concerned about contracting coronavirus -- should they postpone their travel plans?

LG: My professional answer is to investigate. Would I travel to China right now? Not unless it was essential. CDC has a travel website that anyone can go to and actually put in the country that they are looking to travel to, and they can see whether or not they recommend traveling to that country. At this point in time, Chinais not recommended to travel for leisure and it is only for, like I said, essential travel. Other countries, if you're traveling there, I would go to the website and I would look it up.

DV: Any other advice for people to protect themselves?

LG: All I would say is that with any infection, with any virus it's the basic preventative measures: if there's a vaccine available, get the vaccine; frequent handwashing; avoid touching your eyes, your nose and your mouth without clean without clean hands; coughing into your elbow, coughing into a tissue and throwing it away; cleaning your hands after you've coughed; staying home if you're sick and avoiding purse other persons who are ill.

People like you value experienced, knowledgeable and award-winning journalism that covers meaningful stories in the Peoria area. To support more stories and interviews like this one,please consider making a contribution.

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Here's Why The Flu Poses A Bigger Risk Than The Coronavirus - Peoria Public Radio

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Researchers move forward with shot to prevent Lyme disease – WKOW

Thursday, February 20th, 2020

(WKOW) -- Lyme disease cripples hundreds of people in Wisconsin each year and now researchers are working on a shot to prevent the problem.

The Badger State is a hot spot for the tick-borne disease. According to the Centers for Disease Control and Prevention, the average number of cases has more than doubled over the last decade. In 2018, Wisconsin saw 1,121 cases.

It's a problem that Alicia Cashman knows all too well.

"It destroys your life," she said. " It makes life unbearable."

She said it started with her dog and then moved to her husband.

"All of a sudden he was limping and had to crawl up the stairs."

Finally, Alicia was diagnosed with Lyme disease.

"I would walk into a room and forget why I was there," she said.

Now researchers are looking for a way to prevent the spread of Lyme disease with medicine.

"You give the shot right at the beginning of the season," said Dr. Mark S. Klempner, Executive Vice Chancellor, MassBiologics of UMMS. "Take the shot sometime in March or April and then we are anticipating that it would work for eight months."

He said it's the same general idea used in protecting babies from certain viral infections.

"We use an immune molecule called an anti-body that would provide immediate immunity with very little or no side-effects."

After four years of development, Dr. Klempner said things are moving forward. They are about to begin first in human testing to show it's safe and learn how long it will last in the bloodstream.

He said he is well aware of a possible challenge in informing people of the difference between this shot and one called Lymrix, taken off the market years ago due to fears of vaccine side-effects and declining sales.

"Lymrix was a vaccine, this is quite different," said the doctor. "Instead of a bacterial protein, this is a human protein that is in the protective molecule."

The shot is still a few years away from being released to the public, but Dr. JoAnne Kriege at SSM Health in Madison says there are some things you can do to protect your family now.

-Stay to the center of trails. Don't go into the brush.-Wear long-sleeved shirts and pants when outside.-Use a repellant with DEET.-Check for ticks right after outdoor activities.

As for Cashman, while the preventative shot comes a little too late, she said she and her husband are doing well now and has found her passion as she continues to recover. Lyme disease education.

She runs a monthly support group in Wisconsin for people with questions. Each meeting, the group talks about the struggles and successes they've had with the diagnosis.

During the month of February, several businesses across the country are coming together to raise money for Lyme disease research for a cure.

On Feb. 20, Isthmus Tattoo in Madison is hosting a day of tattooing for Lyme awareness as part of the event. Learn more about the event HERE.

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Edited Transcript of SHL.AX earnings conference call or presentation 18-Feb-20 11:00pm GMT – Yahoo Finance

Thursday, February 20th, 2020

NORTH RYDE , NSW Feb 19, 2020 (Thomson StreetEvents) -- Edited Transcript of Sonic Healthcare Ltd earnings conference call or presentation Tuesday, February 18, 2020 at 11:00:00pm GMT

* Paul J. Alexander

* David A. Low

Citigroup Inc, Research Division - Director & Head of Healthcare in Australia and New Zealand

* Megan J. Kirby-Lewis

Welcome, again, to the Sonic Healthcare half year results presentation.

I will now hand you over to your presenter, Dr. Colin Goldschmidt. Go ahead, please.

Colin Stephen Goldschmidt, Sonic Healthcare Limited - CEO, MD & Executive Director [2]

Thank you very much, Darren, and good morning, ladies and gentlemen. Welcome to Sonic Healthcare's results presentation for the half year ended 31 December, 2019.

As Darren mentioned, my name is Colin Goldschmidt, CEO of Sonic Healthcare. And joining me here in Sydney today are 3 of my colleagues: Chris Wilks, Sonic's CFO; Paul Alexander, Sonic's Deputy CFO; and Dr. Stephen Fairy, Sonic's Chief Medical Officer. I plan to take you through the results presentation. And then, after the presentation, the 3 of us -- or the 3 will join me to discuss your questions.

Before commencing the formal presentation, I'd like to just make a few comments about the coronavirus outbreak or the 2019 novel coronavirus as it's more formally known. And I'd like to make these comments particularly because Sonic Healthcare is a key provider of essential medical services to large numbers of communities around the world.

All Sonic divisions, and that's on a global basis, have been working extensively with local and national health authorities to support and implement all the necessary pandemic control measures. Our teams of people, that's clinical teams, operational teams, have responded rapidly in order to ensure the continuity of our own clinical services.

And to that end, we've done a bunch of things like providing protection for our frontline employees and customers, providing patients and customers with access to testing for coronavirus. We've also provided reliable and up-to-date information and guidance to our staff, to our patients and customers. And we've also made sure that supply lines and logistics are uninterrupted during this period.

It's an interesting fact, just to know that our lab in Bremen, that's Laboratory Bremen in Germany, was the first lab in Germany to establish a validated PCR test for the coronavirus, which has now been shared by 2 other of our labs in Germany. And we believe that this was one of the very first labs in the whole of Europe to begin using a validated test for the virus. Now depending on circumstances, the coronavirus testing can be rapidly established in other Sonic labs, including in our Australian laboratories and we'll play that one as things pan out into the future.

And just a final comment to let everyone know that there's no indication that the coronavirus outbreak has impacted our business in any way, either negatively or positively.

So if I could commence the formal presentation. Going to Slide 3, which is a slide about our headlines. And first up on that headline list just a few points about our guidance. We are today reaffirming our guidance for the full financial year 2020, and that's after 7 months of trading. Our guidance, as you remember, which we issued in August of last year, is for 6% to 8% constant currency EBITDA growth. And so for the first half of the year, our EBITDA growth came in at 11% at constant currency level.

This is a particularly strong number, which was augmented by the Aurora Diagnostics acquisition, which was completed on the 30th of January 2019. So just as a reminder, this first half result includes a full 6 months benefit of Aurora, whereas the second half in train now will only have 1 month of the Aurora acquisition benefit because the deal actually cycled on 30th of January this year.

Another point is that the impacts of both Aurora and the PAMA Medicare fee cuts in the U.S. were both factored into our guidance. And so there is no change to our expectations after the 7 months that we've traded so far.

Another point, and that's the -- starting the second major bullet point just for noting is that this is our first reporting period, which incorporates the new lease accounting standard, AASB 16, which, as you know, requires the capitalization of operating leases to the balance sheet, with amortization over the term of the lease and with some associated P&L changes.

So essentially, what this means is that the rental expense line on the P&L largely disappears and is replaced or compensated by an increase in amortization expense, which is below the EBITDA line. AASB 16 has particular relevance and significance for a company like Sonic because we operate so many property leases. In our industries, that's the pathology industry or medical laboratory industry, in radiology and primary care, we use extensively patient centers. So in particular, we operate large numbers of leased collection centers for pathology specimen collection. We also operate large numbers of spaces for laboratories themselves, for imaging centers and for GP medical clinics.

And incredibly, all up, we have over 4,500 leases. So you'll get a sense of the magnitude of the task involved in order to transition to this new accounting standard. And so I guess, this would be a good time for me to acknowledge the incredible work completed by the Sonic finance team, assisted by Sonic's finance staff throughout the world and other staff in order to bring this essentially mammoth project to a successful completion.

So just looking at those headline numbers. Our revenue growth came in at 15% at actual currency level and 12% at constant currency level, and you'll see the Delta there is about 3%, which is due to foreign currency tailwind.

Our organic revenue growth came in at 5% on a constant currency basis. And the underlying EBITDA number, which I mentioned, was 11% at constant currency level and 14% at actual currency level. And net profit growth was at similar metrics. Now pleasingly, we did achieve margin accretion in both the laboratory and imaging segments.

And the next point, just 1 year post acquisition, the Aurora Diagnostics acquisition is tracking well and performing to expectation. And I'll discuss a bit further the interim dividend for FY 2020, which has been declared at $0.34 per share.

If we move on to Slide 4, the table on this slide presents a summary of Sonic's headline financials for the half year. Including in the far right column, that's with the red heading, our headline numbers expressed under AASB 16 for the first time. And you'll see there that the most striking features to change to Sonic's EBITDA number, which for the half increases by around $150 million.

So if we look at the full year expectation, we're anticipating that EBITDA will increase by around $300 million for the full year under this standard. Also, just a reminder that the numbers in this table are expressed in actual currency in Australian dollars.

Just a few further comments about the table. Our actual revenue growth for the half came in at 15%, as mentioned, and the organic growth rate was 5% for the half. And these are pleasing numbers for us, especially in the face of some of the headwinds that we're experiencing with fees in the U.S. and the choppiness in Germany associated with the EBM fee quotas, which we can talk a bit about later.

Also, very pleasingly, we achieved 10 basis points of margin accretion in the global laboratory division. And this is a very good result, given the headwind that we're experiencing in the U.S., in particular, in terms of top line.

The Imaging division continues to perform strongly and achieved 40% -- 40 basis points of margin accretion in the half. The net profit number, the growth of 15% was in line more or less with our growth in revenue. Earnings per share, however, was impacted by the shares issued as part of the equity raise associated with the Aurora acquisition, which does give us balance sheet flexibility for future growth.

And finally, another point, the lower than usual growth in cash generation from operations and the conversion of EBITDA to gross operating cash flow is due to timing of creditor payments in the period, and we do expect this to reverse favorably in the second half of the year. And I guess I should just mention a final point about the FX tailwind. As I mentioned, it comes in at about 3% at both revenue and earnings levels. And just to give you the absolute numbers, the FX tailwind for the half was worth $83 million of revenue and about $13 million of EBITDA.

If we could turn to Slide 5. And this is really for information more than commentary. The first bullet point is essentially a reminder of our first year guidance, which is unchanged from August of last year when it was issued. And then the second major bullet point, we're reaffirming our guidance of 6% to 8% EBITDA growth at constant currency level.

Going to Slide 6, which we show in the table, a $0.01 increase in the interim dividend for FY 2020, which is a 3% increase over the interim dividend last year. The dividend will be franked to 30% and the record and payment dates are 11 and 25 March 2020, respectively. The dividend reinvestment plan is to remain suspended, particularly in light of the major equity raise as part of the Aurora acquisition.

Now if we go to Slide 7, where we show our usual pie chart. In statutory revenue, Australian dollars, split by country and major division, and just to note, this pie does not include small impacts from interest income and AASB 16. At the full year result in August last year, we did flag that Sonic's U.S. division would move clearly into the #1 position as our largest division in FY 2020, and you can see this now clearly on the chart already for the half year.

And just a few other observations about the chart, particularly when you compare it to a year ago. First of all, the pie itself has increased by 15%. That's our actual currency revenue growth. And then just of interest of our total revenue of $3.34 billion for the half, 63% of Sonic's revenue is now international, with 37% in Australia. 5 years ago, that split was around 50-50, Australia to International. So you can really see a trend that is set to continue well into the future.

If you look at just our laboratory division, that's the pathology segment by taking out Imaging and SCS, 73% of Sonic's revenue is international, with 27% Australia. So just for the laboratory division, the split is about 3/4 to 1/4, as we speak right now. And as mentioned, we certainly expect the International division to keep growing, and its growth will outstrip the Australian growth as we capitalize on the greater opportunities in M&A and contracts and joint ventures in the U.S.A., U.K. and Europe.

Now moving on to some commentary on our divisions. First of all, the U.S.A., where revenue came in at 45% in Australian dollars, in actual dollars, and 37% on a constant currency basis. Obviously, that number is big because it includes the Aurora acquisition. Our organic revenue growth came in at 2% on a constant currency basis, and it was impacted by the PAMA Medicare fee cuts to the tune of about 1.3% of revenue. So I guess, ex-PAMA, our organic growth rate would be 3.3% for the half.

About the Aurora acquisition, as I mentioned, the business is performing to expectation, and we are well underway with a major cost and revenue synergy program. The cost synergies include things like procurement, IT and administration. And as flagged previously, the revenue synergies include things like cross-sell between anatomical pathology and clinical pathology, but we also get revenue synergies in oncology and molecular pathology offerings. And also in ThyroSeq, which is a new test, which I'll discuss in a moment.

And just for interest, an example of cross-sell is that, at the moment, we -- one example is that we are referring dermatopathology specimens, that's skin pathology specimens, from our Los Angeles operations where we do not have a histopathology lab, to our Aurora anatomical pathology lab in Las Vegas. That's one example. And we believe there will be several more to come.

In terms of our U.S. operations, our growth strategies are gaining momentum. It's likely that despite the slight headwind from the PAMA Medicare fee cuts, we will be presented with additional opportunities because this is probably going to encourage further consolidation of the market. We certainly feel we are large enough and strong enough not only to weather the somewhat choppy conditions, but, in fact, also to benefit from them.

Under the strong leadership of Sonic's U.S. CEO, that's Dr. Jerry Hussong, we are pushing forward with a comprehensive program to enhance Sonic's position in the U.S. lab market, which is the largest medical lab market in the world. This is a program which includes a growth initiative. And that's particularly following the Aurora acquisition, but it also includes an efficiency drive and a push to greater service excellence, and these are all under the guidance of our medical leadership principles.

Finally, just a word about ThyroSeq. This is a relatively new and clinically valuable genetic test, which predicts the malignant potential of thyroid masses or thyroid nodules. Something like 20% to 30% of thyroid nodules are diagnosed as indeterminate after they undergo fine needle aspiration, which is the normal way of initial assessment of a thyroid mass.

The ThyroSeq test then allows classification of these indeterminate cases into those that need immediate surgery and those that can be watched. And the whole purpose of this is to avoid the unnecessary costs and complications of unnecessary surgery. We have licensed this test on an exclusive basis from UPMC, that's the University of Pittsburgh Medical Center, and we offer the test out of our CBLPath lab in New York, which is already an established thyroid cancer center of excellence. The test is fully reimbursed by Medicare and by most of the private payers that we deal with. And we're embarking on a national sales initiative to push this test as strongly as possible into the market, and it certainly does present a very exciting opportunity for Sonic in the U.S.A. We also have and are pursuing an active pipeline of further acquisitions in the U.S. market.

Moving on to Slide 9, which is Australian Pathology. And by way of a general comment about Australian Pathology or an introduction, I should say, we are the #1 player and the market leader in Australia. And our Australian Pathology division is an outstanding Sonic division, which is in a strong and very stable position. And also performing to the highest standards of laboratory medicine. We have outstanding leadership teams and staff throughout Australia who are essentially continually pushing to the edges of best practice, both at operational level and at financial level. And again, under Sonic's medical leadership model.

Revenue for the half came in strong at 7%. At an earnings level, the result was also strong, and we delivered margin accretion to boot. The margin accretion was largely due to the healthy top line growth, but also due to the stabilization of collection center costs and the ongoing scale and synergy benefits, we continue to work on in this division.

At operational level, we are currently building a dedicated Sonic Pathology Australia management team under the leadership of our Australian Pathology CEO, Dr. Ian Clark. And as flagged previously, we've almost completed the national rollout of our total automation system, which is actually the GLP Systems -- Total Lab System, which commenced some years ago, first in Sydney and then in Brisbane and now being rolled out nationally. This rollout brings us absolute cutting-edge operations in our labs. It'll add to our financial efficiencies, and it's also going to improve workflows and are already excellent turnaround times.

In our Australian division, we continue to record strong growth in our genetics sub-division, and we expect this positive trend to continue as demand increases for the existing tests. And as we bring onstream new genetic tests, which keep happening as we go.

Now moving on to Slide 10, which is Germany. And just as an introduction, Germany, as you can see on that pie chart, is one of our 3 largest divisions. Its annual revenues are well in excess of $1 billion. So it's a pretty big division and growing all the time. We are the market leader, the #1 player in the German clinical pathology market. And excitingly now, we've also entered the fragmented anatomical pathology market as well. And so when you put the 2 together, we are very optimistic about our future growth in Germany.

Sonic's medical leadership culture, and I think I've made this point at previous presentations, is deeply embedded in our German division. And it's a division which consistently delivers outstanding services and financial results. And I have to say, the ongoing performance of Sonic Healthcare Germany is a function of not only our staff, but an incredibly dedicated leadership team, headed by our CEO in Germany, Evangelos Kotsopoulos, whom some of you on the call will know.

So looking at the numbers for the half, we achieved 5% revenue growth or 3% organic at constant currency level. That organic growth has been impacted by statutory insurance fee quota changes. But on a positive note, I can say that we are, more recently, sensing that the fluctuations around the EBM fee quotas as they are known, are slowly subsiding. And just a reminder to all that EBM fees represent about 40% of our total Sonic Germany revenues.

What we're observing this financial year is that our organic volume growth is slowly strengthening as we proceed through the year, and we certainly expect that to continue in the remaining 5 months of the year.

In terms of our operations, there continue to be a wide range of activities underway, all aimed at extracting synergies. These include a few laboratory mergers. A comment about our Trier acquisition, which was some 18 months ago. This is an anatomic -- our first anatomical pathology acquisition. This business is performing strongly and we expect that performance to continue. We're working and succeeding at synergy capture between anatomical pathology and clinical pathology. And these can be divided into revenue and cost synergies, as I've mentioned in the U.S. market.

We're achieving revenue synergies via new hospital contracts also via new molecular pathology testing. And also, interestingly, by international referrals of histopathology specimens into our anatomical pathology labs. We do service countries like the Middle East in the clinical pathology space. And so we've now been able to add significant volumes of anatomical pathology specimens, which we can now refer to our own labs.

And in terms of cost synergies, we're finding these in areas of molecular testing and logistics and administration, similar to the situation in the U.S.A. We also have an active pipeline of potential further acquisitions that we're looking at, and these are both in the clinical pathology and anatomical pathology spaces.

And in terms of the regulatory environment in Germany, we continue to work through these ongoing fluctuations in the EBM quota levels, but they are manageable. And I guess we can say that the environment is essentially stable.

Moving on to the next slide, which is the U.K. and Ireland, our revenue growth for the half was 16% or 13% at organic and constant currency level. We continue to enjoy strong growth in both private and the National Health Service market segments.

We're certainly very proud to have won the contract to provide cervical cytology screening, which includes HPV testing for the Greater London region. And I should say that exceptional work was done by our U.K. team, assisted by senior Australian cytology specialists with prior experience in this space here in Australia to launch this program successfully and to deliver it on time. So that cervical cytology contract commenced in the December just past. It's a GBP 15 million per annum contract and a 7-year term on it.

We were also successful in the half in renewing for 10 years the London North West NHS Trust contract, that's an existing contract, but we were pleased to renew that one for a 10-year period. We were not successful in our bid for the large, but I have to say, highly complicated, South East London NHS contract. In this particular situation, our bid was very competitively priced. And I should say that if we were under bid on this deal, as we do suspect, then this would be a deal that we would probably not be comfortable to proceed with at that sort of pricing. We are bidding on further NHS contract opportunities, and these have significant revenue potential as well.

There's also a bit of late-breaking good news in that Sonic's TDL business has been selected to provide laboratory services to the Cleveland Clinic London, which is a flagship new private hospital in Central London, slated to open sometime next year. This is a GBP 1 billion investment by the Cleveland Clinic from the U.S.A. and it seems sure to become a masthead for the brand outside of the U.S.

We are going to open an in-house lab at the same time that the hospital opens next year. But we are going to begin providing outpatient services to this hospital sometime later this year. So the hospital plans to commence outpatient clinical work much sooner than the inpatient beds will open sometime next year.

Now obviously, this is a great honor for Sonic, not only to have been selected, but for us to become now closely associated with the Cleveland Clinic brand, which is certainly one of the most respected medical brands in the world. Our NHS -- our non-NHS business, such as our private business, also remains very strong in the U.K. So this is made up of private hospital pathology, private referrals from the Harley Street market, direct-to-consumer testing, and other non NHS work as well.

We've also, in the period, established a couple of new laboratories to facilitate centralization of our service and this includes the creation of the U.K.'s largest anatomical pathology laboratory. This new anatomical pathology laboratory is located at 60 Whitfield Street, which is the address of our previous central laboratory in London before we relocated to the Halo lab on Houston Road. So we're now processing all the histopathology from UCLH and from the Royal Free Hospitals, which, as you know, are large tertiary teaching hospitals. And we're also processing privately referred specimens coming from private hospitals and the Harley Street market as well.

So you can tell from this particular slide how busy we are and how active we are in the U.K. pathology market. It's certainly a dynamic, if not, sometimes complicated market, but a market that's offering us great opportunities for the future. We're certainly very lucky to have an outstanding leadership team in London. So ably led by Sonic's U.K. CEO, David Byrne.

Moving on to Slide 12, which is Switzerland. We are the market leader in Switzerland as well. We operate in Switzerland under 2 brands: the Medica brand, which is the dominant player in Zurich; and Medisupport, which is headquartered in Geneva on the other side of Switzerland, which has extensive operations throughout the French and German-speaking regions of Switzerland. Both of our Sonic practices continue to operate at exemplary levels. Again, both at operational and financial levels together.

The revenue was strong at 13%, actual currency, 6% constant currency organic. At operational level, we've added a few hospital contracts following the major Zug Cantonal Hospital contract that we won, which we announced previously. We're -- we've completed an upgrade of our Zurich laboratory and efficiency programs have resulted from that upgrade. And the regulatory environment in Switzerland remains stable.

Belgium, and just an introductory few words, this is a strong and stable business, which continues to perform with distinction. Our main laboratory, as you know, is located in Antwerp, but we also run several other laboratories scattered throughout the northern part of Belgium or the Flanders part of Belgium.

All these labs are working together cooperatively to achieve synergies. The revenue growth for the half was 4%, 2% organic growth at constant currency level. And at operational level in keeping with our aim to drive synergies, we've completed the standardization of a Sonic National IT system or LIS system, laboratory information system. We're also expanding our menu of complex testing, and this include genetic tests and we're also working to enhance efficiencies at operational levels wherever we can. And in this half, this included 2 small mergers. The regulatory environment in Belgium also remains stable.

Moving on to Slide 14, which is a slide on Sonic Imaging. The Imaging division produced another strong result, with 8% revenue growth and 10% earnings growth, including a 40 basis point increment in margin, which is a great outcome. On the operations side, I'm pleased to announce that our Queensland X-Ray practice commenced providing imaging services at the Mater Public Hospital Brisbane, and this commenced in November 2019 under a long-term agreement.

Like some of the other deals that we've won or contracts that we've won, this is a great honor for Sonic Imaging, and it really is a tribute to the outstanding stature of our Queensland X-Ray practice. I should say that the strong result in our Imaging division does sheet to our excellent team of Sonic radiologists and imaging staff as well as to our very, very capable leadership teams in all 4 of our practices. It's also in part due to continuing investments that we're making in greenfield sites and in new equipment, and it's good to see the benefits flowing through from those capital investments.

At a regulatory level, the environment is stable. We are going to gain, though, a small benefit from the implementation, a partial fee indexation, which is due to commence July of this year. And also from the introduction of a new MRI and PET CT fee for breast cancer, which has already commenced last November.

And finally, just while on the imaging slide, I'm also pleased to announce that Dr. Julian Adler is to take on the role of CEO Sonic Imaging, and that'll be from the end of this month. But for those of you who don't know Julian, he's a radiologist who joined Sonic 12 years ago. And he has been the CEO of Sonic's Castlereagh Imaging and Illawarra Radiology Group for most of his time with Sonic. And I want to take this opportunity to welcome Julian to Sonic's corporate leadership team.

Slide 15 on Sonic Clinical Services. Again, just to revise, SCS includes all our medical centers under a sub-division, IPN, and a large occupational health division under the brand Sonic HealthPlus. We are the largest primary care provider in Australia and the largest occupational health provider as well. We're operating 229 medical centers at the moment. And we have 2,450 GPs working in our centers, both IPN and Sonic HealthPlus.

Revenue growth for the half came in at 3%. And our sense is that the slightly difficult market conditions in terms of volumes or consultation levels is beginning to improve. Our operations are strong and active. And certainly benefit from an outstanding and very experienced corporate leadership team, headed by our SCS CEO, Dr. Ged Foley, who is an experienced ex-GP himself.

Our doctor recruitment and retention remains strong, and we're actively also engaged in the streamlining of our operations and rationalization of our low-performing centers, and we do this to enhance our efficiencies. And I guess, this will be one of those continuous improvement programs, of which we have many around Sonic Healthcare. The regulatory environment is stable in the private care market.

Moving on to Slide 16. The table on this slide shows only little change in our debt metrics over the prior period. But in summary, our balance sheet is very strong. It's at investment-grade level. And we have around $1 billion of headroom to fund our future growth, which is a nice position for us to be in.

And just a final slide, looking ahead, just a few points. And I guess on that first bullet point, I wanted to say that Sonic is in a strong and stable position. We've -- and it's very much enriched by our deeply embedded culture of medical leadership. As I've said before, it's this culture which continues to drive our brands, which are highly respected and our very high-quality services as well.

So I guess, overall, I feel I can say that Sonic Healthcare is in very good health at this point in time. But having said that, I want to reassure people that we are never complacent. There's no evidence of complacency anywhere around Sonic. And in fact, when I look around the company, I am constantly impressed by the energy, the flexibility or agility of our leaders and staff. And how can I put it? There's a sheer will to win attitude right across our global operations. And it's a good thing to know that Sonic is a company in which culture does run deep. And personally, as just one of our 37,000 employees in Sonic, I can say that it feels pretty good to be part of the spirit that is so strong within the company.

Moving on, and as we look ahead, we are also fortunate in Healthcare to enjoy favorable industry dynamics, which doesn't apply to all industries around the traps. Our industry provides fairly stable, ongoing, noncyclical organic growth. And this is driven by population, aging, new tests, preventative medicine, et cetera.

Looking into the future, our organic growth will obviously be assisted by these favorable industry dynamics, but of course, we also expect major enhancements to that growth to come from new acquisitions, joint ventures and contracts. In other words, the nonorganic growth -- growth of the nonorganic kind.

Our geographical diversification is another thing that we value enormously because it continues to provide benefits going forward. And that's both in terms of new growth opportunities in various markets, but also very much in terms of risk mitigation. We talk about the risk mitigation. If we were experiencing a bit of headwind in the U.S. at the moment with PAMA fee cuts, other divisions are performing strongly, and that leads to a smoothing out of our portfolio. And this has occurred going back many, many years. So there is a huge benefit in being in the 8 good markets that we currently operate in.

Our balance sheet remains pretty strong, as I mentioned, with investment-grade credit metrics, providing us flexibility for growth. And I guess, I do want to acknowledge this as -- and the whole Sonic finance team, which is obviously headed up by Chris and Paul sitting with me today, but also to make special mention of our treasury management team who've done an outstanding job over many years in managing Sonic's balance sheet as well as they have.

The last 2 bullet points on this slide are there to emphasize the ultimate importance of culture, which, as you know, I talk a lot about. Maybe too much about, although I say never too much about, but it's there to emphasize the importance of our -- not only culture, but leadership and our people as well in Sonic's future. And I guess, I have covered off on those sufficiently in this presentation.

So at this point, thank you very much for listening to the presentation. I'm now going to hand you back to our operator, Darren. And ask Chris, Paul and Stephen to join me to take your questions.

Thank you, and thank you, Darren.

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Questions and Answers

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Operator [1]

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The first question is from Lyanne Harrison from Bank of America, Sydney.

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Lyanne Harrison, BofA Merrill Lynch, Research Division - VP [2]

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First of all, can we touch on a little bit on the Australian market. Obviously, some very good organic growth there.

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Colin Stephen Goldschmidt, Sonic Healthcare Limited - CEO, MD & Executive Director [3]

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Sure. What's the question?

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Lyanne Harrison, BofA Merrill Lynch, Research Division - VP [4]

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Read the original:
Edited Transcript of SHL.AX earnings conference call or presentation 18-Feb-20 11:00pm GMT - Yahoo Finance

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Facing Doctor Shortage, Will California Give Nurse Practitioners More Authority to Treat Patients? – Lost Coast Outpost

Thursday, February 20th, 2020

Nurse Practitioner Surani Hayre-Kwan, left, and nurse practitioner student Kristina Crichton during an office visit with patient John Donaldson, a Guerneville resident who relies on Hayre-Kawn as his primary care physician. Photo by Anne Wernikoff for CalMatters.

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Nurse practitioner Surani Hayre-Kwan sees long-time patients and first-timers. She manages chronic illnesses, diagnoses kids with colds and refers people to specialists.

She goes it alone or works with another nurse practitioner at the Russian River Health Clinic in Sonoma County. Sometimes a supervising physician is on-site, but often is a telephone call away.

We dont have enough physicians working in community clinics, said Hayre-Kwan, who is also a nurse administrator for Sutter Health. If there were no nurse practitioners, the clinic would have to close for the day because no one would be there to deliver care.

As California faces a growing shortage of primary care physicians, the Legislature is considering what backers believe could be a partial solution: allowing nurse practitioners who get additional training and certification to work independently. With that additional authority, they could treat patients without a practice agreement from a supervising physician outlining what they can do. It also would allow some nurse practitioners to open their own clinics without a doctor overseeing them.

If it does so, California would join 22 other states and the Veterans Administration. Researchers for the Bay Area Council Economic Institute have found it would also save the state millions of dollars a year.

But Californias powerful doctors lobby has fought the idea since it was first proposed five years ago saying that expanding the role of nurse practitioners would dilute the quality of medical care patients receive, and create a two-tiered system of treatment.

In a letter to the Legislature, the California Medical Association raised concerns about the type of training and assessment required to determine independence. And the association points out that the bill does not require or ensure that nurse practitioners will set up or work in underserved or rural areas.

Instead, the organization, made up of physician members, said it supports continued efforts to graduate more new physicians and to give them incentives to treat patients in underserved areas.

Nurse practitioner Surani Hayre-Kwan, right, examines patient Mary Valesano, center, with her caregiver, Georgia Manolakos-Fraley, Manolakos-Fraley, who herself has been a patient of Hayre-Kwan for nearly 20 years, describes the nurse practitioner as a deeply caring and really rare person. Photo by Anne Wernikoff for CalMatters.

By 2030, California is projected to be short some 8,000 primary care clinicians, including doctors, nurse practitioners and physician assistants, according to a report from the Future Health Workforce Commission and another from Health Force Center at UC San Francisco.

Californians are concerned. More than a third believe there are not enough primary care providers and specialists in their communities, according to a poll released today by the California Health Care Foundation. In the Inland Empire and San Joaquin Valley, that number was nearly half unsurprisingly given that those areas have some of the highest provider shortages.

More than 80 percent of residents polled want the governor and Legislature to make alleviating the shortage of doctors, nurses and other health care providers a priority.

Last week the state Assembly passed Assembly Bill 890, which would free many nurse practitioners from needing to operate under a supervising physicians agreement. It also creates a path for nurse practitioners who want to work independently by opening their own practice. The bill, carried by Santa Rosa Democratic Assemblyman Jim Wood, now goes to the Senate.

Its a piece of the puzzle that will help us to increase the number of primary care providers, Wood said. In many cases, theyre already doing this pretty independently.

A nurse practitioner is someone who has completed a masters degree or a doctorate in nursing practice, as well as additional training. The majority work in primary care.

Already at clinics in low-income neighborhoods or in rural areas, nurse practitioners often hold office hours on their own or have an arrangement with a supervising physician to be available by phone. In larger organizations such as Kaiser Permanente, patients can choose to book with them directly, and may get them a quicker appointment than if they choose to wait for a physician.

The states Medi-Cal program for poorer patients also allows nurse practitioners who are enrolled with the program to bill it directly for work they are allowed to do under agreement with their supervising physician, and for services that would be covered if performed by a physician.

If the bill becomes law, experts say it could help ease the shortage by allowing nurse practitioners to work in rural or inner-city areas and could attract out-of-state nurse practitioners who want to practice more freely. According to the American Association of Nurse Practitioners, 75 percent of nurse practitioners work in primary care.

Physicians are unconvinced. California Medical Association lobbyist Megan Allred told legislators at a hearing last year that the bill would impact safety and called for modifications to ensure lay individuals are not interfering with the practice of medicine.

Physicians note that nurse practitioners have not undergone the same intense, years-long training that doctors go through. Physicians for Patient Protection argues that the bill would put patient safety at risk because nurse practitioners only complete a sliver of the hours of clinical training, especially via online programs, compared to the medical school and residency requirements of physicians.

The American Academy of Emergency Medicine, another opponent of the full independence of nurse practitioners, also argues that their training is not equivalent to doctors.

NPs cost less than physicians, writes academy president David Farcy in a letter to members. Hospitals and urgent care centers that are focused on profits are looking for cost-cutting options. Independent practice for NPs certainly fits that requirement.

Wood stressed that his bill requires additional education and certification before nurse practitioners can assume more treatment authority, and even more training for those who want to set up their own clinic.

Theres a lot of guardrails here, Wood said. This isnt just every nurse practitioner who has ever graduated is going to be able to come in and do this.

California is home to 9,800 nurse practitioners, according to the health care staffing firm Merritt Hawkins. It found that states where nurse practitioners have full scope authority have more of them, per capita.

When states grant nurse practitioners full scope authority, they allow them to evaluate patients independently, order diagnostic tests, manage treatments and prescribe medication. In California, nurse practitioners are restricted, meaning a physician must supervise them and they must have in place a standard protocol for treating patients agreed on with the doctor.

As rural areas and inner-city neighborhoods become health care deserts, advocates say some nurse practitioners are already filling the void but without a physician willing to work with them, some cannot continue to work where they are needed the most.

We dont have the workforce right now to provide the prevention and primary care to everybody who needs it, said Garcia, of La Clinica which operates more than 30 clinics. The only way to bend the cost curve is providing access to everybody, and you are going to need everybody to do it. And the nurse practitioners are a critical part of that workforce.

Nurse practitioners are more likely to work in high-need areas, such as in community health centers providing care for low-income and Latino communities, according to research from the California Health Care Foundation.

It was with the rollout of the Affordable Care Act, which gave more people access to treatment, that providers started to really feel the squeeze, said Jane Garcia, CEO of La Clinica in Oakland.

Our training institutions are more focused on specialists and not enough on primary care physicians, and thats why we are supportive of nurse practitioners, Garcia said.

Medical schools have been graduating more students who choose specialties, which pay more than general practice. Currently, slightly less than one-third of physicians work in primary care, and very few opt to go to rural areas or inner cities.

Meanwhile California has expanded health care access to more residents than ever before. Last year, the state offered Medi-Cal to qualified undocumented people ages 18 to 25. This year, Gov. Gavin Newsoms budget proposes to extend Medi-Cal to some undocumented seniors over age 65.

Nationwide, 22 states and the District of Columbia have given nurse practitioners independence. Half of the states and DC allow them to practice independently once they are licensed and the other 14 require collaboration with a physician for a transition period before becoming fully independent, according to an analysis by the California Health Care Foundation.

And in 2016, the federal Veterans Administration granted full practice authority to nurse practitioners to help ease the long wait times veterans were experiencing.

It didnt happen without some protest. And Rebekah Bernard, president of Physicians for Patient Protection, warns that costs may rise, contending that studies show nurse practitioners order more imaging tests, perform more unnecessary skin biopsies, have poorer quality of referrals, prescribe more medications, and utilize more health resources than physicians.

But if nurse practitioners were able to practice full scope here, California would have 21 percent more of them, according to research for the Bay Area Economic Council. That analysis found that allowing nurse practitioners to practice at their full scope would lead to a 10 percent increase in preventative care visits in the first year and would result in state savings of $394 million on preventative care annually.

Council research director Patrick Kallerman estimates that California would replicate the experience of other states in which expanding the authority of nurse practitioners has increased patient access and lowered costs. it would do the same in California. He estimates that overall primary care visits would cost $17 less, saving the state about $400 million a year.

In no way are we saying that nurse practitioners should replace doctors, Kallerman said. What we are saying is that we have this workforce of highly trained, highly qualified individuals and we should let them practice to the full extent of their training.

Wood, who served on the Health Care Workforce Commission, voted against the idea in the past, but said he changed his mind after seeing in his own district a shortage of doctors and the challenges in attracting them to rural areas.

What weve been doing all these years isnt working, he said. As a matter of fact, thats just the opposite.

###

CALmatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

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Its Time to Start Thinking About Your Heart Health – The Manual

Thursday, February 20th, 2020

Cancer conjures fear, yet many people remain acutely unaware of the silent killer that is cardiovascular disease. It quietly waits and often strikes without warning. Few families are untouched by this disease, including my own.

My family was affected by heart disease long before I was born. My paternal grandfather died in 1961. My dad was only fifteen at the time. Granted, my grandfather did smoke and worked in a highly stressful job that involved long shifts in an iron foundry. He created molds and then poured the molten iron for cast iron cookware and other household items. Each time, while in my own kitchen, I reach for one of the skillets he made, Im reminded of the grandfather I never met.

Cardiovascular disease kills more people than the next seven causes of death combined.

My maternal grandfather, a World War II veteran, died from a major heart attack while sleeping. I also have no memory of him. I was just two years old when he passed away. Again, he had a much different lifestyle and health profile that I do; he smoked and was diabetic. Both factors undoubtedly contributed to his early death.

Both of my grandfathers died in their early fifties and Ive often wondered if that fact weighed heavy on my dad prior to becoming a grandfather himself. Fortunately, my dad is still alive and has seen most of his grandchildren graduate from high school, some from college, and one join the Air Force. He has been afforded the opportunities that his father was denied. My father has always put a huge emphasis on family time. I have a feeling his loss at an early age has given him a deeper appreciation of the time he has.

My wife has also been impacted by heart disease for much of her life. At 12 years old, her mother had her first heart episode. She vividly remembers seeing her mother being taken away in an ambulance, but not understanding words like angioplasty. During her senior year of high school, her mother underwent her first heart bypass surgery. She continued to deal with heart-related issues throughout our marriage. She also smoked for much of her life and did not lead an active lifestyle. She had her second bypass surgery while visiting us over the holidays. My wife watched her mother fight this disease throughout the majority of her adult life. In 2018, she lost her battle and passed away at the age of 69.

My family history may resonate with others who read this story. For an expert view, Ive assembled input from medical experts who have weighed in on the science of heart disease and how this disease is largely preventable.

John A. Osborne, M.D., Ph.D, FACC, FNLA: Dr. Osborne is a Harvard-trained MD, PhD (in Cardiovascular Physiology) Cardiologist-Lipidologist. He also has two decades of experience in clinical trials and in running a large preventative cardiology and lipid practice.He is currently studying at the London School of Economics for a Masters Degree in Cardiovascular Health Outcomes, Economics, and Management.

Salim S. Virani, M.D., Ph.D, FACC, FAHA: Dr. Virani is a tenured Professor in Cardiology and Cardiovascular Research Sections at Baylor College of Medicine in Houston, Texas. He is also an investigator in the Health Policy, Quality, and Informatics Program at the Michael E. DeBakey VA HSR&D Center of Innovation in Houston, Texas.

Cardiovascular disease kills more people than the next seven causes of death combined, says Dr. Osbourne. Some other staggering facts provided by Dr. Osborne include:

Its estimated that nearly 18 million people (worldwide) die annually from cardiovascular disease, stated Dr. Virani. That is similar to losing the population of Syria each year.

While the above statistics may seem daunting, both Dr. Osborne and Dr. Virani believe that heart disease can be largely preventable with a few lifestyle changes. The Mediterranean diet has shown some of the best research in reducing risks of heart disease, says Dr. Osborne.

A heart-healthy diet can also reduce the risk of developing diabetes, can help reduce the risk of developing some forms of cancer, improve quality of life, and can help with some forms of depression, adds Dr. Virani.

For simplicity, Dr. Virani also broke it down to the ABCs (actually, ABCDEs) of heart health.

Just as there are screening tools for some cancers, there is now a screening that can help predict risk of heart disease, says Dr. Osborne. A coronary artery calcium test (CAC) utilizes a CT scan to gauge the buildup of plaque within the vessels supplying blood to the heart. This measurement can give a score that can help doctors assess an individuals risk for heart disease.

My wife and I have both chosen to live healthy, active lifestyles which includes not smoking, monitoring our cholesterol levels, and maintaining a healthy blood pressure. We know what a cruel impact that heart disease can have on the body and how it affects the family members of those who battle it. While not all heart-related illnesses can be prevented through these choices, a large number can be mitigated. We are thankful to live in a time where much more is understood about heart disease prevention and all of the additional tools that are available to help us avoid the fate of our family members. And while we cant bring back those already lost, we can work to keep not only ourselves healthy but to also educate the next generation of our family. This is a disease that doesnt have to be inherited.

For more information, the American Heart Association is a great resource for additional research findings about heart disease, heart-healthy eating, and other ways to reduce your risk of becoming a victim of this No. 1 killer.

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Coronavirus Crisis: These 6 Israel-Based Initiatives Are Working To Help China | Health News – NoCamels – Israeli Innovation News

Thursday, February 20th, 2020

China has been grappling with the outbreak of a new coronavirus strain for nearly two months, placing millions of people on lockdown as it tries to contain it. The virus, currently known as 2019-nCoV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread quickly since it first emerged in the city of Wuhan in Hubei province home to over 50 million people in late December.

As of February 19, over 75,000 people worldwide have been infected, nearly all of them in mainland China, and 2,012 people have died from the coronavirus, 2,006 of them inside the country, according to a live-updating map of the outbreak that draws figures from the World Health Organization (WHO) and other agencies. The spread reached some 25 countries and has sparked global travel restrictions and emergency measures to reduce the risk of exposure amid a devastating social and economic toll.

HEALTH NEWS: Israeli Startup Sends Novel Antiviral Tech To China In Bid To Stem Coronavirus Spread

This week, all eyes are on a coronavirus-stricken cruise ship off the coast of Japan that was carrying over 3,700 people from more than 40 countries as governments work to get their citizens home, fueling fears of a global contagion. Aboard the Diamond Princess docked off the Japanese port city of Yokohama since February 3, thousands of people were under mandatory quarantine, including several Israeli passengers. Japanese health authorities have been working to test those aboard and have registered over several hundred confirmed cases of coronavirus infection. Among those diagnosed were three Israeli nationals who have been transferred from the ship for medical treatment. The remaining 12 Israelis are set to disembark on Wednesday when the quarantine period ends after which they will be flown to Israel and placed in hospitalized isolation at the Sheba Medical Center. Other countries including the US, have also evacuated their citizens from the Diamond Princess as well as another cruise ship, the Westerdam, docked in the Cambodian seaport of Sihanoukville.

To help stem the spread, the WHO earlier this month announced a $675 million preparedness and response plan through to April 2020 to help support countries with weaker health systems deal with the outbreak. The organization has also hosted meetings in Geneva with leading health experts to fast-track and fund priority research on the virus. And international health experts are currently in Beijing as part of a WHO-led delegation to help investigate the novel coronavirus and understand its origin, spectrum, spread and impact, and to help inform countermeasures such as case isolation, contact tracing, and isolation.

Meanwhile, pharmaceutical companies and research institutions have launched efforts to develop a vaccine (which will not help those currently affected but may prevent future outbreaks) but these plans may take at least another year. The Bill and Melinda Gates Foundation announced it was donating $100 million to fund research and treatment

Amid the fear, NoCamels is highlighting six initiatives based in Israel aimed at either providing humanitarian aid and relief to China, developing diagnostics and ways to combat the spread, or just showing solidarity.

Earlier this month, Israeli aid organization IsraAID sent a shipment of medical supplies and protective gear to China on the last flight from Tel Aviv as Israels travel restrictions went into effect. The shipment went directly to the Chinese Ministry of Health for its use as it faces a severe shortage of such supplies particularly in Wuhan, the epicenter of the outbreak.

IsraAID said it will continue monitoring the situation and may launch a secondary response including mental health and psychosocial support for humanitarian aid workers and first responders working in the area.

IsraAID CEO Yotam Polizer said in a statement that it was important for the organization to do its part by sending relief supplies and sharing our expertise in the field of stress management and trauma reduction.

We are all very concerned about the spread of coronavirus, and we are grateful for all the courageous work done by Chinese medical teams, he added.

The shortage of medical supplies is a very problematic issue, says Holo Zheng, a representative of Chinese students and the business community here in Israel.

Zheng has mobilized a small volunteer team and has been working to get supplies to Chinese medical workers, sourcing masks and protective gear globally from Israel and figuring out logistics such as flights, clearances, and shipping. Her team has also assisted in gathering donations from donors to advance these efforts.

Zheng tells NoCamels that the most important aspect is getting the supplies to the right places. China is a mega-sized country, asking where do we send the help? is the very first question and a priority is helping the people with the most urgent needs, especially those on the front lines, she explains.

People can choose to stay at home and not move around, but some cannot do so: doctors, medical staff, police officers and so on. So the focus must be there, she tells NoCamels.

Zhengs #StandWithWuhan initiative has so far helped to coordinate and send several shipments to China. Last week, some 30,000 masks, 7,900 protective suits and 380 goggles from Israel were shipped to hospitals in Baoding and Huangshi, in Hebei province and Hubei province, respectively. This week, another 10,000 masks were sent from Israel to a hospital in the city of Yantai in Shandong province. This last shipment was a joint effort with the tech-focused Israeli aid organization SmartAID, and global logistics provider DHL.

SmartAID founder Shachar Zahavi tells NoCamels the organization is working on preparing additional shipments, in coordination with its Chinese partners, and facilitated by its response teams in Australia and the US as well as its partnership with DHL.

Zheng foresees an increased role for Israel and Israeli tech in helping with the aftermath of the outbreak but most will not be applicable immediately as needed. She cites semiconductor companies that may be able to help with detection, tele-medicine systems which China has but which are more developed in Israel, medical robots for remote treatments of infected patients, and field hospitals with advanced technology.

These things will become more available with time and there are post-coronavirus opportunities for Israeli tech, Zheng tells NoCamels.

She also pointed out that Israel is at work on a vaccine after Israeli Prime Minister Benjamin Netanyahu instructed the Health Ministry and the Israeli Institute for Biological Research this month to launch efforts. The latter is a governmental research institute specializing in biology, chemistry and environmental sciences and which falls under the jurisdiction of the Prime Ministers Office.

Zheng tells NoCamels that more awareness and education is needed on the unfolding epidemic and on the preventative measures required to protect ourselves and our families from viruses, including wearing masks.

Perception surrounding mask-wearing, which is common in Asia, should be changed, she says. People here see it as a cost and dont want to wear them but people who do should be respected because they are protecting others.

Meanwhile, Israels Bar Ilan University said this week new technology developed by Dr. Amos Danielli of the Alexander Kofkin Faculty of Engineering, could significantly reduce the diagnostic time of coronavirus.

The test, based on a combination of optics and magnetic particles, can rapidly test 100 samples of patients potentially infected with the virus and reduce the diagnostic time to approximately 15 minutes, the university said in a press statement. The test has been proven to reduce the diagnostic time of Zika virus and is currently being used in the Ministry of Healths central virology laboratory at Tel Hashomer Hospital, the university added.

Dr. Danielli is working with MagBiosense, a medical device company, for a device the size of a coffee machine that will be based on his technology and is searching for an investor to accelerate the development of the coronavirus test, so it can rapidly be introduced in hospitals, according to the statement

Dr. Danielli and his team are also collaborating with European universities to identify antibodies that the immune system produces against coronavirus.

Last week, NoCamels reported on Israeli startup Sonovia Ltd, which says it may help stop the spread of the new coronavirus through novel technology for an anti-pathogen, anti-bacterial fabric and textiles. The company sent samples to two medical labs in China the Shanghai branch of the Chinese Academy of Sciences and a medical lab in Chengdu earlier this month and is awaiting results on whether their tech is effective against the virus.

We have identified the methodology to determine the fabrics ability to eliminate viruses and bacteria. We sent a number of fabrics to China and it would require a few days to colonize the coronavirus on the fabric and evaluate if our technology can destroy it, Sonovia co-founder Shay Herscovich told NoCamels.

Based in Ramat Gan, the patented technology that Sonovia aims to commercialize was originally developed as a bacteria-fighting nanoparticle finishing technology by Israeli scientists at the lab of Professor Aharon Gedanken from Bar Ilan University. The technology mechanically infuses metal oxides nanoparticles onto textiles during an ultrasonic-assisted impregnation process with the specialized chemical compound turning the textiles into highly effective blocks against bacteria and fungi.

Sonovia scientist Dr. Jason Migdal tells NoCamels this week in a follow-up interview that additional fabric samples were sent to Singapore for lab testing against the novel coronavirus. Simultaneously, Migdal says Sonovia has partnered with a Singapore-based company developing anti-viral tech based on zinc oxide and that the two entities have applied for a grant to advance research.

Broadly speaking, metallic nanoparticles such as zinc oxide have strong antiviral potential because of their multiple interactions with the viral envelope, deactivating the virus through the formation of free radicals or inhibiting viral replication once internalized, says Dr. Migdal.

For our treated textiles the first mechanism is that of relevance to fixed nanoparticles inside the fibers of the textile. Our clinical studies will focus upon ensuring that the nanoparticles work in harmony with the human respiratory system through an in vitro study, he added.

Sonovia is also getting closer to finalizing a prototype for a mask that will be treated with its technology and is sourcing mask manufacturers, Migdal says.

At the OurCrowd Global Investor Summit last week, NoCamels met with Israeli scientist Dr. Gilly Regev, an entrepreneur with a rich background in anti-infectious research and the co-founder of Vancouver-based company SaNOtize, in which OurCrowd is invested. The company developed a patented platform technology that allows for the topical delivery of nitric oxide (a colorless gas with the formula NO, hence the name) to destroy bacteria, fungi, and viruses.

SaNOtize found a way to deliver the gas in a gel or cream form as well as a liquid.

Dr. Regev says one platform currently being worked on is a nasal spray that uses nitric oxide to kill bacteria and viruses, including the flu which may also work against the coronavirus. The key is in the dosage, she explains.

The tech is undergoing two clinical trials at the moment, Regev says, one for fighting nail fungi and a second for chronic sinusitis. Both conditions currently dont have treatment, Dr. Regev points out.

The technology may also be useful for treating respiratory conditions and there is currently a Phase II clinical trial for cystic fibrosis, an inherited, progressive disorder that causes severe damage to the lungs, digestive system, and other organs.

SaNOtize also licenses its tech for cosmetic applications in treating acne and related inflammatory skin conditions.

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Precision Medicine funding announced in Perth could save NHS Scotland 85m in next five years – The Courier

Thursday, February 20th, 2020

Taysiders are being invited to take part in medical trials which could save NHS Scotland tens of millions of pounds over the next five years.

Deputy First Minister John Swinney MSP was in Perth yesterday to announce Scottish Government backing for the next phase of a precision medicine initiative.

The practice focuses on improving clinical efficiency by profiling groups of patients and developing more tailor-made treatments.

Supporters say the project could improve the quality of medical care while saving money NHS Scotland up to 85 million over the next three to five years.

The Scottish Funding Council is investing 7.5 million in the project and another 3 million is coming from Scottish Enterprise.

It is being spearheaded by Precision Medicine Scotland, which brings together academics, health professionals and others with an interest in the field.

The body is seeking to attract another 4.2 million from other sources.

Precision Medicine Scotland chief operating officer Marian MacDonald: We could actually make a considerable saving to the NHS.

We have such a unique opportunity. We [Scotland] are almost the perfect study size. We have a pretty stable population and a very well connected health service.

Sadly though, we also have a high instance of complex diseases. It makes it good for research purposes but we want to change that.

Announcing the scheme in an event at Perth Theatre, Mr Swinney said:We want to make sure that patients experience the benefits by having preventative healthcare interventions right across the country.

Theres people who experience a number of similar medical conditions and the more we can understand those and support individuals, the better.

Some of those people will live here in Tayside and what we want to make sure is that they have the opportunity to participate in clinical trials that will be undertaken to advance this research.

Mr Swinney, who is also cabinet secretary for education and skills, added: The precision medicine investment the government is making is about supporting a collaboration between our world-leading university research, the clinical expertise of the NHS and work of life sciences companies in Scotland.

By joining all of them together, we have a preventative approach which helps us to personalise medicine and anticipate the circumstances that people might experience.

The beauty of that will that it will help to save the NHS money but it will also improve the clinical outcomes for individuals. The fact that its been launched here in Perth is an indication that this must be an approach that reaches the whole of Scotland.

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Protein that Prevents Tau Clearance Linked to AD and Other Tau Tangle Proteinopathies – Clinical OMICs News

Thursday, February 20th, 2020

Studies by researchers at University of South Florida Health (USF Health) Morsani College of Medicine have found that a protein known as -arrestin2 increases the accumulation of the neurotoxic tau tangles that cause several forms of dementia, by interfering with the process that cells use to remove excess tau from the brain. The studies demonstrated that an oligomerized form of -arrestin2, but not monomeric -arrestin2, disrupted the process of autophagy, which would normally act to help rid cells of malformed proteins like disease-causing tau.

Encouragingly, in vivo studies showed that blocking -arrestin2 oligomerization suppressed disease-causing tau in a mouse model that develops a form of human frontotemporal lobar degeneration (FTLD) with dementia, a form of neurodegeneration that is characterized by tau accumulation and the formation of neurofibrillary tangles. Our research could lead to a new strategy to block tau pathology in FTLD, Alzheimers disease, and other related dementias, which ultimately destroys cognitive abilities such as reasoning, behavior, language, and memory, said Jung-A (Alexa) Woo, PhD, an assistant professor of molecular pharmacology and physiology and an investigator at the USF Health Byrd Alzheimers Center. Woo is lead author of the teams published paper in theProceedings of the National Academy of Sciences(PNAS), which is titled, -arrestin2 oligomers impair the clearance of pathological tau and increase tau aggregates.

FTLD, which is also called frontotemporal dementia, is second only to Alzheimers disease (AD) as the leading cause of dementia. This aggressive form of dementia is typically earlier onset, in people aged 4565, and is characterized by atrophy of the front or side regions of the brain, or both. The two primary hallmarks of Alzheimers disease are clumps of amyloid-beta (A) protein fragments known as amyloid plaques, and the tangles of tau protein. Abnormal accumulations of both proteins are needed to drive the death neurons in Alzheimers, although recent research suggests that tau accumulation appears to be required for the toxic effects of A in AD, and correlates better with cognitive dysfunction than A. Indeed, tauopathy correlates significantly better than A with cognitive deficits in AD, the team noted, and drugs targeting A have been disappointing as a treatment.

Like Alzheimers disease, FTLD displays an accumulation of tau, which results in the formation of tau-laden neurofibrillary tangles that destroy synaptic communication between neurons, eventually killing the brain cells. There is no specific treatment or cure for FTLD. However, in contrast with AD, A aggregation is absent in the FTLD brain, in which the key feature of neurodegeneration appears to be the excessive tau accumulation, known as tauopathy. In contrast to AD, where amyloid is an integral part of the tangle, there is no accumulation of A in FTLD neurons , the authors noted.

Previous studies have pointed to an association between G protein-coupled receptors (GPCRs) and AD pathogenesis, and have linked the activation of several, diverse GPCRs with A and/or tau pathogenesis in animal models. While it isnt clear how these very different GPCRs can impact on A and tau pathogenesis, and neurodegeneration in AD, one potential commonality among the receptors is their interaction with arrestins, the researchers noted. Interestingly, previous studies have shown that one of the family of -arrestin proteins known as -arrestin2, is increased in AD brains, and genetic studies have shown that endogenous -arrestin2 promotes A production and deposition, linking -arrestin2 to A pathogenesis. Despite this evidence, the authors acknowledged, prior to the current work, however, it was not known whether, or how, -arrestin2 pathogenically impinges on tauopathy and neurodegeneration in AD, or in FTLD where there is no accumulation of A. As Woo commented, Studying FTLD gave us that window to study a key feature of both types of dementias, without the confusion of any A component.

-arrestin2 in its monomeric form is mostly known for its ability to regulate receptors, but -arrestin2 can also form multiple interconnecting units, called oligomers, and the function of -arrestin2 oligomers is not well understood. While the monomeric form was the basis for the laboratorys initial studies examining tau and its relationship with neurotransmission and receptors, Woo said, we soon became transfixed on these oligomers of -arrestin2.

The teams studies confirmed the presence of elevated -arrestin2 levels, both in cells from the brains of TFLD-tau patients, and in a mouse model. This model expresses disease-associated tau in neurons, and displays FTLD-like pathophysiology and behavior and, like FTLD in humans, doesnt accumulate A.

The researchers also found that -arrestin2 acts to increase tau stability via scaffolding potein:protein interactions. Their results indicated that when -arrestin2 is overexpressed, tau levels also increase, suggesting a maladaptive feedback cycle that exacerbates disease-causing tau. As the authors commented, the data suggested that increased tau increases -arrestin2, which in turn acts to further potentiate tau-mediated events by stabilizing the protein, thus indicative of a vicious positive pathogenic feedback cycle.

To determine the effects of reducing -arrestin2 levels, the team crossed a mouse model of early tauopathy with genetically modified mice in which the -arrestin2 gene was inactivated. They demonstrated that genetic knockdown of -arrestin2 also reduced tauopathy, synaptic dysfunction, and the loss of nerve cells and their connections in the brain. Importantly, experiments confirmed that it was oligomerized -arrestin2, and not the proteins monomeric form, which was associated with increased tau. By blocking -arrestin2 molecules from binding together to create oligomerized forms of the protein, the investigators demonstrated that pathogenic tau significantly decreased when only monomeric -arrestin2, which does bind to receptors, was present.

Further experiments indicated that oligomerized -arrestin2 increases tau by impeding the ability of cargo protein p62 to help selectively degrade excess tau in the brain. In effect, this reduces the efficiency of the autophagy process that would otherwise clear toxic tau. The resulting accumulation of tau clogs up the neurons. Blocking -arrestin2 oligomerization also suppressed disease-causing tau in the mouse model that develops human tauopathy with signs of dementia.

Specifically, our results indicate that -arrestin2 oligomers increase tau levels by blocking the self-interaction of p62, an initial step essential in p62-mediated autophagy flux, the team commented. Genetic reduction or ablation of -arrestin2 significantly decreased sarkosyl-insoluble tau and mitigated tauopathy in vivo. Furthermore, -arrestin2 mutants incapable of forming oligomersactually reduced insoluble tau.

It has always been puzzling why the brain cannot clear accumulating tau, said Stephen B. Liggett, MD, senior author and professor of medicine and medical engineering at the USF Health Morsani College of Medicine. It appears that an incidental interaction between -arrestin2 and the tau clearance mechanism occurs, leading to these dementias. -arrestin2 itself is not harmful, but this unanticipated interplay appears to be the basis for this mystery We also noted that decreasing -arrestin2 by gene therapy had no apparent side effects, but such a reduction was enough to open the tau clearance mechanism to full throttle, erasing the tau tangles like an eraser. This is something the field has been looking foran intervention that does no harm and reverses the disease.

The results point to a potential therapeutic strategy for tauopathies such as FTLD, based on partial inhibition of -arrestin2 oligomerization. For gene therapy of human FTLD-tau, mutants with a somewhat decreased capacity for such inhibition might be desirable, so that some levels of the oligomer are present to carry out other functions Similarly, small molecule inhibitors of -arrestin2 oligomerization, given for treatment or prevention of FTLD-tau, could be designed to spare complete loss of the oligomer in the cell, they suggested. Based on our findings, the effects of inhibiting -arrestin2 oligomerization would be expected to not only inhibit the development of new tau tangles, but also to clear existing tau accumulations due to this mechanism of enhancing tau clearance.

This treatment strategy could be both preventative for at-risk individuals and those with only mild cognitive impairment, and therapeutic in patients with evident FTLD-tau, by decreasing existing tau tangles. Beyond tauopathy, it is conceivable that this strategy could also prove to be beneficial in other neurodegenerative diseases bearing proteinopathies that are cleared via p62, the scientists concluded.

This study identifies beta-arrestin2 as a key culprit in the progressive accumulation of tau in brains of dementia patients, added co-author David Kang, PhD, professor of molecular medicine and director of basic research for the Byrd Alzheimers Center. It also clearly illustrates an innovative proof-of-concept strategy to therapeutically reduce pathological tau by specifically targeting beta-arrestin oligomerization.

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Harvard professor says global coronavirus pandemic ‘likely,’ infecting 40-70% of world this year – The Hill

Sunday, February 16th, 2020

Harvard epidemiologistMarcLipsitchtold The Wall Street Journalthat "it's likely we'll see a global pandemic" of coronavirus, with 40 to 70 percent of the world's population likely to be infected this year.

"What proportion of those will be symptomatic, I can't give a good number," addedLipsitch, who is theDirector of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health.

Two other experts have recently given similar estimates.

Ira Longini, a biostatistician and adviser to the World Health Organization, has predicted that two-thirds of the global populationmay eventually contract COVID-19.

Prof Gabriel Leung, the chair of public health medicine at Hong Kong University, says if the transmission estimate of 2.5 additional people for each infected rate is accurate, that would result inan "attack rate" that wouldaffect 60 to 80 percent of the world's population.

The Centers for Disease Control and Prevention (CDC) has already saidthat it is preparing for the coronavirus to have a greater impact in the U.S. than the 15 confirmed cases currently.

In an interview withCNNon Feb. 13,Robert Redfield, director of the Centers for Disease Control and Prevention (CDC), said,Right now we're in an aggressive containment mode. He addedthat this virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission."

Dr. Nancy Messonnier, the director of the CDCs National Center for Immunization and Respiratory Diseases, recentlyconfirmedthat the CDC is taking steps to prepare for the coronavirus to take a foothold in the U.S.

Along with communicating with health care facilities and resources, Messonnier says that the CDC is in constant talks with the medical supplies manufacturers, distributors and other health care partners to ensure there are plenty of preventative devices like masks and gloves available in the U.S. in the event of a larger outbreak.

Some of these partners have reported higher demand for N95 face masks and respirators.

She also took the time to explain the CDCs recommended use of any preventative supplies, especially face masks. Because the virus isnt spreading through the communityin the U.S., Messonnier only advises using face masks if you are sick or under investigation and not hospitalized, before one enters a health care providers office, or when caring for a potential infected patient.

When alone and at home, however, Messonnier says that people do not need to wear a mask.

She also confirmed that 195 people from Wuhan have completed the 14 day quarantine and left the March Air Reserve Base to be self-monitored with the help of state and local health authorities.

Additionally, amid reports of poor treatment of quarantined individuals and the military staff tending to them, Messonnier stated that the individuals discharged pose no health threat to their surrounding communities or the community they will return to.

After the CDC confirmed that a lab error led to the accidental discharge of an infected patient from a San Diego hospital, Messionnier told reporters that the CDC and other health officials are adding additional quality controls to keep patients organized.

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February’s Noontime Knowledge event focuses on heart health – Times Tribune of Corbin

Sunday, February 16th, 2020

CORBIN Baptist Health Corbin in collaboration with the Corbin Public Library held its monthly Noontime Knowledge at the library on Thursday.

In honor of American Heart Month, this months Noontime Knowledge focused on heart health and heart attacks. More specifically, heart attack signs, symptoms and how to react if you or somebody you know is having a heart attack.

Heart attacks are the number one killer of adults here in the United States, said cardiovascular educator at Baptist Health Corbin Tracy Bruck. Over 735,000 Americans have heart attacks every single year. 525,000 people have their first heart attack every year, a lot of people have more than one.

Heart attacks kill 116,000 Americans each year.

Heart attacks are a community problem with a community solution. That community solution is education because if a community knows early symptoms of a heart attack, then you can seek medical treatment early, explained Bruck.

When it comes to symptoms, Bruck said the most common are chest pain and discomfort. Other symptoms include pain in your back, shoulders, arms, neck, throat or jaw; abdominal discomfort; shortness of breath; weakness and fatigue; nausea; and sweating.

According to Bruck, early signs of a heart attack are present in about half of all patients that have suffered one.

Symptoms can suddenly accelerate just before somebody has a heart attack. Most early symptoms happen around 24 hours before someone suffers one. However, some symptoms can occur two to three weeks before someone suffers a heart attack.

Bruck says that men are more likely to suffer heart attacks on their first symptom than women are. Men normally feel pain and numbness on their left arm or side of their chest, while women will typically feel it on their right side.

A womans risk of suffering a heart attack increases four times after going through menopause. Women are also more likely to have what are known as silent heart attacks, which can result in a person having a heart attack and not even realizing it. Women are also more likely to suffer a fatal heart attack.

According to the CDC, heart attacks are more common in men, smokers, people who are obese or overweight, those with family histories of cardiac issues, and people aged 55 or older.

Bruck says knowing your family's personal history with heart disease can help in preventing a heart attack. She also recommends knowing and modifying those things in ones control that can attribute to a higher chance of heart attack.

Those factors one can modify to lower the chance of suffering a heart attack include keeping your blood pressure under control, maintaining an active lifestyle (getting at least 20-30 minutes of physical activity three times a week), stopping the use of tobacco, and keeping an eye on metabolic diseases like diabetes.

If you or someone you know is showing signs of a heart attack, Bruck says its important to seek medical attention right away.

We have a tendency as human beings to delay recognizing and responding to these early symptoms. Were our own worst enemy.

Some of the most common excuses people make are that theyre too busy or that theyre too healthy to be suffering a heart attack. Bruck says some try to pass it off as something else or ignore it all together. This could be dangerous because although the symptoms may subside, theyll come back and thats when it may be too late.

Along with medicine, modifications to lifestyle and preventative measures, the medical community has also created the Life Vest to help those who suffer with a heart related medical condition.

Kim Deering with Zoll Life Vest explained that the vest is a wearable cardioverter defibrillator that can be used to detect sudden cardiac arrest and defibrillate its wearer.

Available to the public since 2003, the vest was designed for those with a compromised heart function, a heart functioning at less than 35% of full capacity.

The Life Vest can be worn under clothing and can be hidden from public view. The vest monitors its wearer the entire time it is worn through the use of four dry electrodes that are placed around ones chest.

The vest senses an arrhythmic beat in its user's heart and activates a vibrating alert. A siren will then sound from the vest and continue to get louder. If the vest were to malfunction or have a bad reading, the wearer can press two buttons simultaneously to cancel the treatment. If the treatment isnt canceled, the vest will perform a treatment shock and release a blue gel.

The blue gel is released in case the wearer were to wake up alone after suffering cardiac arrest and receiving shock treatment. The blue gel would notify them of what had happened and the person could seek medical treatment.

Its saving about three patients a day all across America, said Deering, who added that the vest has a 98% success rate after the first shock.

According to Deering, the Life Vest is meant to be used as bridging tool. If a patient is able to get their heart working above that 35% threshold, then they are no longer at as great of a risk for sudden cardiac arrest, and the device is no longer needed.

The Life Vest is available all over the world, and is accepted by Medicare and all Kentucky Medicaid, as well as most private medical insurances.

The next Noontime Knowledge will be held March 6 at the Corbin Library from noon-1 p.m.

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Heart Health Month Lesson learned: Be aware of any signs – The Independent

Sunday, February 16th, 2020

Heart disease is the No. 1 cause of death in the United States, and heart-related issues affect hundreds of millions of people worldwide. There are many factors that contribute to heart disease or put individuals at risk for developing heart disease. These factors include both those that can and cannot be controlled.

Many individuals, both male and female, have a genetic predisposition to heart disease and related health problems, and will need to consult their physician or care provider on treatment and/or preventative options. Preventable factors include changing ones diet to lower sodium and lower fat content, getting plenty of exercise, maintaining good hydration and sleep patterns, avoiding stress and quitting (or not starting) tobacco products.

Lack of knowledge on the subject often contributes to the challenge of maintaining good heart health and avoid different types of vascular diseases. The American Heart Association is a good source of information. There are various links on their website that point out the signs of heart health risk as well as preventative measures that can be taken. But keep in mind that there are times when, even if a few signs are present, heart conditions take one completely by surprise.

Mandy Hime, of Ashland, knew there were health issues in her family, but said she had no reason to believe she was at any immediate risk. But after the birth of her son in 1999, Hime began to develop high blood pressure. At the time, she was told many women develop high blood pressure during pregnancy, but usually the blood pressure in such cases returns to normal levels fairly quickly.

About six months later they checked me out again, and found that my blood pressure was still remaining high, Hime said. I developed gall stones, and needed surgery. But my blood pressure was so high they had to put me on medication to lower it before they could operate.

Hime said since her blood pressure remained so elevated, and considering her family had a predisposition for high blood pressure and heart related issues, her doctor decided medication to regulate it was her best option.

They changed my medicine on a regular basis, Hime said. And I was afraid I was going to run out of medicines that would still work. During this time other changes manifested themselves such as headaches and changes in her vision, but her blood pressure was holding its own at the high end of the acceptable spectrum.

This changed in 2019. After experiencing a headache that spanned eight days, Hime decided to go to the hospital. She was diagnosed with an aneurysm and immediately hospitalized.

The doctor told me he was surprised that I was still alive, Hime said. Id had a brain bleed, and it had been so long that my brain was trying to reabsorb the blood. They wouldnt release me until the headaches were completely gone. And for days, every time I would wake up they would give me medicine to put me to sleep.

Hime survived her ordeal, and came through it with information and insight into her condition. Her heart was able to pump blood to her extremities, but due to small veins it was having trouble cycling the blood back. This led, she was told, to her high blood pressure, hypertension and the aneurysm that nearly killed her. Now she is on different medicines and her blood pressure is somewhat under control, but she has to monitor it regularly.

I didnt even know I was at risk until it was almost too late, Hime said. Now she urges others to pay attention to even the smallest warning signs and to take better care of themselves.

Although Himes condition was a result of a genetic disposition that was complicated by a medical condition, not all heart disease or other heart health issues are the result of genetics. Some, as in the case of Boyd County man Daniel Rice, are either caused or affected by what most would consider an unrelated health issue. Rice was being treated for COPD when he had, and unwisely ignored, his first heart attack.

The family used to say my Dad had a mild heart attack years and years ago, but there werent any actual records of it, Rice said. And I had always been pretty active, so a heart attack was the last thing on my radar. In fact, I had taken a wellness test at the VA Hospital just a few years before, and they said my heart was fine.

Rice admits that he should have paid more attention to the signs, but there was always a ready-made excuse for why the occasional pains werent related to his heart.

Looking back, I would say that I had two mild heart attacks before, he said. I thought one was just like angina, a pressure on the chest. And the other passed pretty quickly, so I just wrote it off.

Later, while on vacation in Gatlinburg, Tennessee, his wife was sick and decided to stay in for the day. Rice said he stayed in with her and he began to have pains in his chest.

The weird thing was, it was my right arm that hurt. And since I had always heard it was your left arm that would hurt or go numb when you were having a heart attack, I thought it was probably something else,he said.

Rice said he made excuses and put the episode out of his mind because the pain went away. A few days later, he experienced more short-lived pains, and ignored those as well.

But just after Labor Day in 2018, I was using the weed eater around the house and the pains came back,Rice said. My chest began to hurt, and I got really lightheaded. And my stomach was really upset. I couldnt ignore it anymore, and I called for help around 11:30 a.m. By 2:30 p.m., I woke up with stents.

Rice was taken to the hospital at KDMC, and when a doctor looked at him, he decided to send him straight to the Cath Lab. The decision saved his life, and this was when Rice found out that the other pains he had ignored had been milder heart attacks, and could have gone much worse. Still, he said he had more to learn.

I am pretty hard-headed, Rice said. After I started feeling better, I got a little lazy about taking my medicine. That was a bad move because I ended up having another mild heart attack. That was a wake-up call, and definitely got my attention. These days Im trying to take a little better care of myself.

Rice said he now makes a conscious decision to eat healthier food. He said he doesnt always eat right, but he makes sure to get in a lot of fresh vegetables and limit his sodium intake as much as possible. And though his COPD prevents him from doing much in the way of exercise, KDMC is starting him on Pulmonary Rehab with high expectations for positive results. His advice to others is simple and straight-forward.

If you are hurting, go see your doctor. Even if the pain goes away, the problem isnt gone,Rice said.

Both Hime and Rice were fortunate in that they survived putting off treatment; many are not so lucky. Heart health is far too important, they both now know, to leave to chance.

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cromans@dailyindependent.com

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The Hist: 250 years of self-indulgent theatrics and transformative debate – The Irish Times

Sunday, February 16th, 2020

During a meeting of Trinitys College Historical Society on Wednesday March 1st, 1961, the British peer, Lord Windlesham, admitted that apartheid was immoral and wrong but suggested that it would take time to remove it because of the tremendous task in educating the African masses.

This view was immediately challenged by Oladele Olusiji Kale, a young Nigerian student studying medicine in Trinity, who argued that this evil called apartheid is the greatest evil since Nazism. Kale would go on to become professor of preventative and social medicine at the University of Ibadan and a leading public health expert.

When the motion was put to a vote, the system of apartheid was rejected by 35 votes to eight and the result was widely reported. Apartheid condemned in TCD debate was the headline on page 3 of The Irish Times the next day.

Two years later, Nelson Mandela and other leaders of the ANC were put on trial for sabotage and other crimes, in what became known as the Rivonia Trial, and the South African government pressed for the death sentence. Behind the scenes, another former Trinity debater, the Nigerian foreign minister, Jaja Wachuku, persuaded the British and US governments to intervene.

Wachuku, who wore his Trinity College tie at cabinet meetings, had been a leading member of the College Historical Society in the 1940s, where he won a medal for oratory.

In this instance, he used his powers of persuasion to convince the British and Americans that the execution of the leaders, and Mandela especially, would destabilise African politics. The intervention proved decisive and when Mandela was convicted in 1964 he was sentenced to life imprisonment.

Wachuku was honoured posthumously as a hero of the struggle for Nigerias independence who helped persuade competing factions to press for independence in 1957. The Times of London noted that it was Mr Wachukus oratory which brought a compromise.

This year the College Historical Society celebrates the 250th anniversary of its founding. It is the oldest student debating society on these islands and perhaps the oldest student society in the world. The rival University Philosophical Society in Trinity claims an older lineage, going back to 1683, but it was actually created in 1853 as is well documented in the college records.

Throughout its existence, the College Historical Society has been place where different generations of Trinity students have seen the democratic ideal in action, the belief that ideas should be contested in a public sphere, debated by speakers on different sides, and then put to a public vote.

It has provided a forum for members from different backgrounds and beliefs to come together, test their ideas and develop their oratorical styles. Many of its members have gone on to significant careers in Ireland and around the world, including in politics, literature, law, science, business and intellectual life.

They include: Theobald Wolfe Tone and Robert Emmet in the 18th century; Thomas Davis, Isaac Butt and Edward Carson in the 19th; Jaja Wachuku, Mary Harney and Leo Varadkar in the 20th; and Sally Rooney in the 21st.

Called the Historical Society from 1770 to 1815, it dissolved itself rather than submit to restrictions imposed by the college authorities over what it could and could not discuss. Reforming outside the walls, it continued to provide a forum for new ideas to be presented and challenged, before returning Trinity as the College Historical Society in 1843.

Known popularly as The Hist since the 1920s, it continues to meet on Wednesday nights during term time. Today, its meetings are live streamed online.

Ireland changed significantly over the course of this period, from being a subordinate part of the British empire, to an independent state, self-confident about taking its place among the nations of the Earth.

Trinity also changed significantly in this period, admitting Catholics in 1793, women in 1904 and transforming itself into a national institution with an international reputation.

Despite the many changes throughout this period there has been a remarkable continuity in the story of the society. It has consistently been a sphere of ideas, championing free debate and democratic principles, sometimes attracting controversy.

It has also been an arena of ambition where members have tested themselves against their contemporaries and honed the skills that would serve them later in life, a place where great ideas were contested and opposing viewpoints (for the most part) treated with respect.

Over the 250 years oratorical styles have gone through many fashions, motions for debate have changed considerably and even the format of meetings and events has evolved significantly.

Nonetheless, there is a remarkable continuity. For example, every generation suspects that its successors are not as serious, not as impressive, not as good. This attitude was there from the beginning. At the start of the sixth session, in 1775, the chair criticised the society for already being in decline and regretted that it was no longer producing wits and poets and orators. Similar criticisms have been made in later generations and yet wits, and poets and orators, and more besides, continue to come through its ranks.

Some criticisms are more justified. For far too long, the biggest weakness undermining the society was its exclusion of women. It will surprise many people to learn that women sometimes attended meetings of the society in its early years, although this was a controversial issue.

In 1931 the society voted to admit women but unfortunately the change was never implemented. Every year the issue was debated and The Irish Times in 1964 condemned the refusal to change calling it, this traditionally misogynist society.

The exclusion eventually became untenable and was dropped in 1968. Women played a decisive role in bringing about this change and the controversy stands in contrast to the societys role as a driver for change in so many other areas.

For many, the image of debating societies in general, and perhaps The Hist in particular, is one of elitism and exclusivity. By the nature of their activities they attract only a subset of the wider college community, but it is a self-selecting group who get involved and there are no barriers to who can join.

However it is not easy to stand up to speak in the chamber in the Graduates Memorial Building, especially if one is aware of its history. Many find the prospect intimidating or off-putting, or are just not interested.

The talented novelist Sally Rooney came to prominence with an article she wrote about her competitive debating career. She remarked: College debaters are just students wearing ill-fitting formal clothes, and most of them arent even very good. But, crucially, some of them kind of are.

Rooney herself was one of those debaters who excelled in the society, described as eerily clever and stunningly eloquent in equal measure by one of her debating partners. Her subsequent success as a novelist continued a literary tradition in the society, which included Sheridan le Fanu, Bram Stoker, Oscar Wilde and Oliver St John Gogarty.

There are other literary connections. James Joyce, himself a brilliant student debater in UCDs Literary and Historical Society (or L&H), has a passage in Ulysses where one character discusses the finest display of oratory I ever heard and attributes it to a speech made by John F Taylor at the college historical society.

This bestowed a kind of literary immortality on the society, bringing it to the attention of scholars around the world although, as it turns out, the speech it is based on actually took place somewhere else. WB Yeats often spoke and chaired meetings of the society and his son, Michael, was later was elected auditor, the title given to the societys head. It was The Hist that chose this unusual designation in the 18th century and it would bequeath it to other student societies on the island.

Attracting high-profile guest speakers is a long tradition of the society, which in the past has welcomed figures as diverse as Winston Churchill and Michel Martin, John Hume and Mary McAleese (when president of Ireland), Colin Parry (whose son, Tim, was killed in an IRA bombing in Warrington and who delivered many moving appeals for peace in the 1990s) and Hilary Mantel.

Sometimes the focus is on celebrities and this goes back to the origins of the society, when there was some tension after some members proposed presenting a medal to Sarah Siddons, the most famous tragic actress of the 18th century, who was visiting from London.

Ten years ago I was approached by the society to write an official history for its 250th anniversary. Having never been a student in the university, though I occasionally attended debates with the L&H in UCD and then later as a member of staff in Trinity I approached the records with a critical eye.

Not all meetings were historic, not all speeches were profound and the society had its share of self-indulgent theatrics and tedium. It has also been transformative. By providing a peaceful forum to speakers representing every shade of opinion, it has been a place where great ideas have been contested and where national and international figures have been shaped.

Today, in the 21st century, it still serves the same vital function.

Prof Patrick Geoghegan is an historian at Trinity College Dublin and is a vice-president of the College Historical Society. He is the author of The College Historical Society: Oratory and Debate, 1770-2020, to be published by Lilliput Press and Hinds in March.

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Health officials in Chester County urge caution over coronavirus – Daily Local News

Sunday, February 16th, 2020

WEST CHESTER Medical professionals in Chester County are confident that international quarantine procedures are keeping Americans at home safe from coronavirus, and most doctors are taking extra steps to ensure their patients stay safe.

While we are investigating any suspected cases of coronavirus, so far no one in Pennsylvania has tested positive for the virus, said Jeanne Casner, director of the Chester County Health Department. The threat of someone from Chester County being infected with the coronavirus is low, unless you have traveled to China or been in contact with someone from China who has been ill with suspected symptoms of novel coronavirus while symptomatic or confirmed positive.

Around the region and across the nation, the medical community is on high-alert as a precaution to combat the virus from harming the general population of Philadelphia and beyond. Coronavirus is a new ailment which recently sprang from the City of Wuhan, located 500 miles west of Shanghai in China.

Ninety-seven people died from the coronavirus on Sunday, a new daily record since the new coronavirus was first detected in December, as the death toll rose to 908, Chinas National Health Commission said on Monday.

That new total surpasses the toll from the SARS epidemic of 2002-3, according to official data.

Last week, Pennsylvania Secretary of Health Rachel Levine said that the threat from 2019 novel Coronavirus (2019-nCoV) remains low. While there have been 11 confirmed cases in the United States, none were documented within the Commonwealth of Pennsylvania.

In Chicago, a woman in her 60s was diagnosed after she returned from Wuhan on Jan. 13. The CDC said the Chicago woman had transmitted the virus to her husband, who had not traveled to China. But he was in close contact with his wife during a long period of time when she was symptomatic, the Illinois Department of Public Health said.

Other U.S. cases of Wuhan coronavirus include a student at the Boston campus of the University of Massachusetts. In Arizona, officials said, an "adult member" of the Arizona State University community was infected. And in Washington state, a man in his 30s sought treatment after returning from Wuhan.

There is limited direct impact on people in our area other than the possible need to change or cancel travel plans, said Charleen Faucette, director of infection prevention at Chester County Hospital. However, this is an evolving situation and people should stay informed so they will be aware if things change.

Faucette continued, While there have been no confirmed cases in Pennsylvania to date, out of an abundance of caution to protect our patients and staff, we are following Centers for Disease Control and Prevention (CDC) recommendations for evaluation of patients who may be at risk of developing the 2019 novel coronavirus.

She said Penn Medicine is working closely with leaders of the CDC, the Pennsylvania Department of Health, and local health officials to monitor this evolving situation and are prepared to quickly adjust our procedures as more information about the virus becomes available.

This is a fluid and rapidly changing situation with extensive local and national attention we are all learning new things every day, said Shafinaz Akhter, assistant clinical professor of medicine, University of Pennsylvania School of Medicine and director of Antimicrobial Stewardship at Chester County Hospital. The most effective personal interventions are optimizing individual health, including management of chronic diseases and making sure vaccinations are up-to-date.

Regional, national and international organizations are taking containment actions to prevent coronavirus from becoming a global crisis. In fact, the situation is not an epidemic in America, officially.

This situation is currently labeled as a public health emergency, Casner said.

We have been monitoring the coronavirus outbreak in China with information from our federal and state partners and are preparing our response teams in the event of an outbreak here, said Casner per proactive steps the Chester County Health Department is taking. We have communicated with clinicians through our health alerts about the potential for coronavirus cases to spread into the United States, and into Pennsylvania, treatment guidelines and collection of lab specimens of potential coronavirus cases.

Pertinent information is also continuously posted on the Chester County Health website as well as on its social media channels.

Casner added, The (Chester County) Health Department in collaboration with the Department of Emergency Services exercise and prepare frequently for a potential infectious disease outbreak.

There are nationwide efforts to limit travel to and from affected areas, according to Akhter. Locally, prompt recognition, testing, and isolation of patients with concerning clinical presentation and exposure history, Akhter said.

As a large academic health system and a national leader with deep experience preparing for and caring for patients with communicable diseases, Faucette said, Penn Medicine hospitals are always at the ready to respond to global public health issues and collaborate with local, state, and federal health agencies.

The impact of coronavirus to the Philadelphia region includes modifications of travel plans to and from areas with wide-spread transmission, Akhter said.

The Centers for Disease Control and Prevention has expanded the number of airports screening travelers to include the Philadelphia International Airport, Casner said. Philadelphia International Airport is a U.S. Quarantine Station that is a part of a comprehensive national quarantine system that serves to limit the introduction of infectious diseases into the United States and to prevent their spread.

The novel coronavirus spread is certainly an outbreak and meets some characteristics of an epidemic, Akhter said. That being said these are words and definitions and say little about the impact of the illness.

Vince Schaller, a doctor at American Family Care in West Chester, said residents should be proactive about healthy lifestyles during the outbreak.

Here we have a global scare, Schaller said, yet hopes this situation becomes an opportunity to educate the public on best health practices. He continued, Educate on what we really need to better on, like the flu, another virus like the coronavirus. To use any situation like this (with historic significance considering the World Health and CDCs involvement) as an opportunity to allay peoples fears, the science, to make them aware, and educate them. This is a wonderful opportunity to educate.

The symptoms of the coronavirus are resolvable by healthy people. The public needs to know that, Schaller said.

Schaller said, We can actually improve peoples health with influenza by paying attention to coronavirus and explaining the difference.

As we continue to contain the coronavirus through quarantine, said Schaller, who advised people to take key steps if feeling unwell. He said, If youre getting suddenly sick, with high fever, body aches, he advised people to seek medical help sooner rather than later. Additionally, he noted that the CDC has made an identification test of coronavirus available to doctors.

Coronavirus can look like the flu, Schaller said. He added that, as such, it is far more deadly to the sick, the elderly or the young.

Because this is a newly identified illness, there is definitely heightened attention and concern related to coronavirus at this time but, there are no confirmed cases in Pennsylvania, Faucette said. We are seeing thousands of cases of influenza in Pennsylvania and across the U.S. with some cases leading to serious illness. People should always be following steps to keep themselves healthy, perform frequent hand hygiene, and get immunized for influenza to help prevent respiratory infections, now and throughout the year.

Coronavirus is similar to the flu, and even the common cold, as respiratory ailments.

Understandably, the media attention to the novel coronavirus may make influenza seem less significant, Akhter said. However, it is important to know that there are currently 19 million cases of influenza reported in the U.S. this season with 10,000 deaths. In Pennsylvania, we have 45,000 diagnosed influenza cases and over 30 deaths so far. Despite this, vaccination coverage is only 62 percent for children younger than 17 years old and 45 percent for adults over 18 years old.

He added that the, influenza vaccination is safe and effective.

Casner said human coronaviruses are spread, just like the flu or a cold, through the air by coughing or sneezing as well as via close personal contact, such as shaking hands or even touching an object or surface that is contaminated.

The flu season is still active and there is a higher risk of getting the flu, Casner said.

Medical professionals recommend for people to cover any coughs or sneezes using their elbows rather than their hands.

It is also recommended that people should stay at home when not feeling well.

Additionally, people are advised to clean surfaces frequently, including countertops, light switches, cellphones, and other frequently touched items.

Akhter stressed the importance of optimizing general health as a key step to combat illness. This includes taking care of chronic medical conditions including diabetes and hypertension which can lead to immunosuppression if left untreated. Part of this is preventative medical care, including routine vaccinations when indicated."

Akhter advised people to take care when ill. This means following your doctors instructions on medications and follow up, he said. This should include avoiding work or crowded settings and excellent hand hygiene.

To stay healthy generally during the winter months, and year-round, doctors recommend drinking plenty of water and maintaining a healthy hygiene, which includes washing ones hands frequently.

Good hygiene practices such as washing hands, proper hydration, covering your coughs or sneezes with your elbow and not your hands, cleaning frequently touched surfaces, good sleep and healthy foods, said Casner.

We deeply appreciate the Department of Healths efforts to educate the commonwealth about the very real public health issue coronavirus presents, as well its commitment to combating misinformation about its origins, said Mohan Seshadri, executive director of the Governors Advisory Commission on Asian Pacific American Affairs on Feb. 3.

Too often, national security and public health crises have led to the demonization of particular groups of people, Seshadri continued, and we are committed to ensuring that that does not happen here. Our thoughts and prayers are with our fellow Americans and those in China fighting the virus, as well as with our Chinese-American community members worried for their families.

While this is a worrisome public health situation, CDC believes that the immediate health risk from 2019-nCoV to the general American public continues to be low at this time, Casner said.

"People should stay informed by monitoring reliable sources like the CDC and other public health websites, Faucette said. They can be assured that local, state, and national public health agencies are monitoring the situation closely and updating guidance as needed. Also, health care facilities across the region are collaborating with these public health partners so we can best inform, protect, and care for members of our communities.

On Feb. 7, the Pennsylvania Medical Society, held a press conference via telephone on novel coronavirus. It confirmed that no one in the commonwealth has been diagnosed with the virus.

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Swine vets play new role in preparing producers for on-farm procedures – The Pig Site

Sunday, February 16th, 2020

Last month Swine Health Professionals officially opened its new Sheridan Room Education and Training Facility, a biosecure space in which the practice can provide swine barn workers hands on training in the husbandry and veterinary skills that will help them in their work.

Dr Blaine Tully, a Veterinarian and partner with SHP, observes the role of veterinarians and their relationships with their farms continue to evolve.

"What we've observed over three decades of swine veterinary practice is a shift from what was termed emergency medicine where veterinarians were busy kind of putting out health fires to more of a preventative role," explains Dr Tully, speaking to Farmscape.

"Certainly we still do those on a daily basis within our practice but the shift has really been to having swine farm workers become more adept at some of the husbandry practices that are a part of them.

"As the world around us changes with some of the antimicrobial regulations and welfare regulations that put more pressure on farms to kind of do the right thing, we find it really helps to have an open discussion in some of our workshops to enable workers to understand some of those principles of husbandry and how they can apply them in a better way on their farms."

Dr Tully says the new education and training facility will accommodate programmes SHP has developed over the years as well as several new programmes including euthanasia training to help swine barn workers be more comfortable with performing that job and programmes to help workers become more familiar with disease pathogens on swine farms and the medication and vaccine protocols in place to address them.

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Ageing should be classed as a disease in itself, say leading academics – Telegraph.co.uk

Sunday, February 16th, 2020

Ageing should be classified as a disease to provide better treatment of the elderly, says an international group of leading medics and academics.

They are urging the World Health Organisation (WHO) to rethink the way it classifies illnesses so ageing is no longer seen as a natural process but a disease in its own right that leads to frailty, disability and ultimately death.

They say the WHOs current bible which defines and lists all diseases focuses doctors on individual critical conditions rather than the wider range of degenerative changes as people age.

The 30 experts - from Harvard, Stanford and MIT to Cambridge, Imperial and UCL - said their inclusion would encourage doctors to diagnose and prescribe treatments including drugs, diet and exercise that could prevent age-related conditions developing into critical illnesses.

The WHOs health bible - known as the International Classification of Disease (ICD) - determines what doctors around the world diagnose, treat and record.

However, Dr Stuart Calimport, one of the lead authors, cited inconsistencies such as sarcopenia, an age-related muscle-wasting, which was included in the ICD while age-related wearing out of other organs was not.

Critical to ageing is a process known as senescence in which cells throughout the body age, releasing inflammatory factors and enzymes that the immune system can no longer destroy

When senescent cells build up in the skin causing wrinkles it is considered a natural change. Yet when senescent cells build up in the heart and blood vessels, causing blood vessels to calcify, we call it cardiovascular disease, said Dr Calimport, of Liverpool University.

This is an error of logic and categorisation and not due to the intrinsic nature or complexity of pathology or disease.

An ageing disease classified and assessed for the level of severity in one organ can be unclassified in another.

With a lack of classifications and staging, pathological ageing changes may not be logged. This means that treatment needs may be overlooked, such as atrophy, calcification and ageing in organs and tissues where these are not classified or assessed for severity.

Dr Calimport did not believe the classification of more diseases would provide a bonanza for drug firms to develop treatments that would push up the NHS bill.

He said there were already cheap drugs such as Metformin, which was used to treat diabetes and had been shown to be effective in countering age-related conditions.

It would allow for preventative medicine such as social prescribing or the prescribing of exercise. It might not totally prevent ageing but at the moment we are not even recognising ageing in a way that it can be properly recorded and tracked said Dr Calimport.

If you cant track it, how can you prevent it, or slow it down?

The WHO is currently considering submissions for changes to the ICD which will be published next year. There are major updates every decade.

The proposals comes as the number of elderly are expected more than double from 900 million worldwide aged over 60 to two billion by 2050.

By 2030, one in five people in the UK (21.8 per cent) will be aged 65 or over, 6.8 per cent will be aged 75-plus and 3.2 per cent will be aged 85-plus.

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Here’s how to avoid getting sick on a cruise Viruses and bacteria spread quickly on ships – msnNOW

Sunday, February 16th, 2020

Photograph by Carl Court, Getty Images

The Diamond Princess cruise ship (shown docked in Yokohama, Japan, on February 10) was quarantined in the city after passengers tested positive for coronavirus.

When passengers booked their vacations on the ill-fated Diamond Princess, they were likely looking forward to hanging out in a hot tub, not a hot zone. Now most of them are quarantined off the coast of Japan, hoping to avoid testing positive for the 2019 novel coronavirus, which has already infected more than 200 people on the cruise ship.

Health officials in protective gear removed suitcases from the Diamond Princess cruise ship in Yokohama, Japan. Its believed they belonged to passengers evacuated and taken to hospitals after testing positive for coronavirus.

The fact that the largest outbreak of COVID-19 outside of mainland China is happening on a cruise cant be reassuring to travelers who are already skittish about health issues on boat-based trips, which are well known incubators of gastrointestinal illnesses. The Center for Disease Control and Prevention (CDC) offers a helpful database of cases, broken down by year.

The vast majority of cruises dont experience any problems. But confined spaces mean that even one sick person can create a serious situation, explains Tullia Marcolongo, executive director of the nonprofit International Association for Medical Assistance to Travelers. Its the domino effect, and you have nowhere to go, she says.

Cruise companies work to minimize the risk of illness by maintaining cleanliness and monitoring health on board their ships. In response to the coronavirus outbreak, Carnivalthe parent company of Princess Cruiseshas introduced expanded protocols, including enhanced onboard sanitation measures with non-toxic materials and pre-boarding medical evaluations, as needed. On its website, Royal Caribbean Cruises touts its health and safety program, such as internal and external inspections, frequent water systems testing, and strict food handling rules.

Passengers can do their part, too. The first thing I would say is that the power is in your hands, Marcolongo says. She means that literally. Frequent hand washing can be a critical preventative measure for norovirus, colds, and other yucky things circulating on a ship. To make sure you scrub long enough, sing Happy Birthday twice, she suggests, and dont miss the spots between your fingers. If theres no soap and water nearby, use an alcohol-based hand sanitizer. Many ships make sanitizer stands readily available to passengers, Marcolongo adds.

David Parenti, director of the George Washington University Travelers Clinic and professor of medicine at the George Washington University School of Medicine and Health Sciences, advises being aware of when youve held handrails and touched other surfaces. Until you can wash your hands, dont stick them in your eyes or mouth.

Unfortunately, Parenti says, there are lots of other ways to get sick, both on ship and on land. It all has to do with luck. If youre on a ship with norovirus, thats bad luck. If you are on a cruise ship, you will need to eat. Those risks are something you dont have a lot of control over, he says.

This is where you should sit on the plane to avoid getting sick.

To be proactive, travelers can set up a pre-vacation doctors appointment to make sure their immunizations are up to date. Depending on your destination, that flu shot might be important even if youre taking off in the middle of the summer. Keep in mind that the U.S. influenza season is the opposite of the Southern Hemisphere, Parenti notes. He recommends getting the vaccine for Hepatitis A and checking on your immunity to measles; you could possibly use another shot. (A measles case was responsible for a different cruise quarantine in May 2019.)

Because of the limited number of medications on board, its smart to pack whatever you think you might need, Marcolongo adds. That includes first-aid basics as well as some standard over-the-counter supplies, which for gastrointestinal issues include Loperamide (Immodium) and oral rehydration salts.

Miami-based attorney Jack Hickey once represented cruise companiesand now sues them over personal injury claims. His advice? What I tell people is get trip insurance and make sure it covers an air ambulance. Travelers who experience emergencies and need to pay for transportation will be in for some serious sticker shock otherwise.

Be realistic about what kind of care you can actually expect on board a ship. If you get sick or injured, get back to the U.S. as quickly as possible, Hickey advises. Although cruises undoubtably excel at hospitality, he says, they tend to be lacking when it comes to medical care. Its not a hospital, but a ship carrying 3,000 to 6,000 people and going to isolated areas of the world, says Hickey, who thinks there typically arent enough doctors and staff to handle a heavy workload, and that the facilities arent adequately equipped. Almost uniformly, they have X-ray machines. But [ships] do not have good machines or people who know how to read films well, he says.

The coronavirus quarantinewhich is keeping people cooped up in tight cabins for weeksis a reminder that mental health problems could also arise, especially for anyone with issues around anxiety or claustrophobia. Travel insurance doesnt necessarily cover that, Marcolongo notes.

Learn how the coronavirus compares to Ebola, flu, and other outbreaks.

As scientists learn more about the virus and how its transmitted, there may be more scrutiny of ventilation systems on cruise ships, Parenti adds. In a hospital, its possible to put a patient in a respiratory isolation room with frequent air exchanges.

Thats not an option for most cruise accommodations. The next best choice, according to Parenti? I would take a window, personally. At least you could open it and get a breeze that way.

Vicky Hallett is a Florence, Italy-based health and travel writer. Follow her on Instagram.

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