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Archive for the ‘Preventative Medicine’ Category

Smart toilets could turn your pee into research gold – Mashable

Thursday, November 21st, 2019

Pee could be a health goldmine. And to make the most of it, the world needs smart toilets.

That's what a new, small-scale study published in Nature this month seeks to establish: whether regular urine collection and analysis of the thousands of telling, changing indicators in our pee can reliably serve up information about a person's health.

The study's University of Wisconsin authors, Dr. Joshua Coon and Dr. Ian Miller, say more research is still needed as the 10-day experiment only had two subjects: Coon and Miller themselves. However, they also think that a non-invasive device that could collect and analyze a person's urine like, say, a smart toilet could work as a revolutionary tool for personalized, predictive health care.

Oh, and wouldn't you know it, they're making one such smart toilet themselves. But they're not the only ones.

How Coon and Miller envision the smart toilet of the future.

Image: Dasom (Somi) Hwang

Recently, health-tech companies and even big tech players like Apple and Google have gotten into the business of harvesting health data, mostly from AI assistants, fitness trackers, smartwatches and even the smartphone in your hand. The current drumbeat in healthcare is that big data will be able to help us monitor our health in real time, as well as predict disease and health trends at a societal level in the future. And in this coming era of data-driven medicine, the study's authors think that urine is an untapped resource.

Coon and Miller research metabolic systems at the University of Wisconsin and Morgridge Institute for Research (with work partially funded by the National Institute for General Medical Sciences). They analyze the molecules that reflect what our body has metabolized (called "metabolites"), whether that's something we ingest, or is the consequence of an internal bodily process.

Researchers have already established that there are thousands of metabolites in urine, with many of them linked to our own habits like smoking, drinking, sleep, exercise, and even disease. As our habits change, so do the levels of these metabolites.

"There aren't that many bodily fluids that you can get access to that have a window into health," Dr. Michael Snyder, a Stanford University professor who studies biomedical data for healthcare, and is not involved in the study, said. "Urine is just one of those that it makes sense to be monitoring."

The theory is that, on an individual level, regularly keeping track of your urine could give you information you can act on. For example, it could eventually tell if you have a urinary tract infection brewing before you even display symptoms, or if you're getting enough exercise, drinking too much alcohol, or are registering inflammation that could cause disease down the line.

It could also serve as a compliment to the sort of digital healthcare many people are already doing, such as monitoring heartbeats with Apple Watches. Coon says that analyzing urine for lifestyle information could give a person a fuller vision of the why behind having heart troubles something an Apple Watch alone can't do.

Your pee could turn out to be somewhat of a "fingerprint."

Even beyond what this data can tell about an individual, Coon says we don't yet know what a large batch of this data from many people could tell us about disease outbreak, or other types of medical predictions down the line.

To tap into this potential, Coon and Miller tried to see if they could measure how information in urine corresponds with lifestyle choices, such as sleep or alcohol consumption. By keeping track of their habits, they were able to establish that specific metabolites do fluctuate based on lifestyle.

Your pee could also turn out to be somewhat of a "fingerprint." The metabolic makeup of our urine varies from person to person it looked different even just between the study's two subjects! Knowing a person's "baseline" levels could make personalized healthcare more precise. For example, if a person's baseline changes, Miller says that that could serve as a warning sign, enabling "preventative treatment, instead of dealing with symptoms as they show up."

Regularly comparing that baseline to changes is what particularly intrigues Snyder.

"This frequent measurement lets you really follow changes in [a person's] health state, and that's rarely done in medicine," Snyder said. "Knowing your own personal health state is very, very important. And then finding shifts from that is the key to early detection of disease long before it's symptomatic."

The study presented a third finding: Collecting pee is not only time-consuming and resource-intensive it's annoying. Which is why they say the technology needs to catch up.

"It turns out its not convenient to collect every urine sample you make we found that out," Coon said. "But if you had a toilet that did that for you, that would make a difference."

Coon's research group is working on a smart toilet that does just that. They say they will have a prototype to demonstrate their ideas in Spring 2020, though they declined to share any preliminary images with Mashable. After that, it will be about getting funding, conducting clinical trials, and bringing it to market. It may sound like a long way off, but their vision is clear.

"The device that we are working toward is just the toilet," Coon said. "It looks like a toilet, and it samples [urine] without you having to do anything. That is a way I think to be able to acquire data that will be helpful to people."

Coons' device would sample urine every time an individual uses the toilet, and has a built-in lab tool (called a mass spectrometer) to measure samples. That reading would go to a patient's smartphone, where they could monitor their health in real time, or even send that info to doctors, or healthcare analysis companies.

An early model of Toto's discontinued smart toilet.

Image: YOSHIKAZU TSUNO / AFP via Getty Images

Another company, Toto, built a smart toilet in the early 2000s that would allegedly "analyze sugar levels in urine, check blood pressure, body weight and even measure body temperature and hormone balance." However, Toto discontinued it, owing to low demand.

Other companies including Panasonic and even Google have made moves to develop smart toilets. But they were all limited in function, collecting measurements like blood pressure, body fat, and blood in the urine. Coon sees his device as more far-reaching, with consequences for both the individual and society.

"The fascinating thing for me about this is that there are so many possibilities that one could imagine," Coon said. "It really comes down to if one could build this device, and make these measurements on a large population, it would really, we think, open the doors to changing how we think about tracking health and lifestyle."

Is Coon's vision for his smart toilet realistic?

While Snyder agrees with the theory that regularly monitoring metabolites in urine can deliver health insights, he is skeptical that Coon's 10-day, two-person study lays sufficient groundwork.

"I think we need larger studies to demonstrate utility," Snyder said. "I don't doubt in the long run they will be useful. The question is just how quickly, and I don't know the answer to that."

Other experts (and competitors) are even less gung-ho.

"I just dont think its very practical," Vik Kashyap, the founder of human waste analysis company Toi Labs, said. "They're exploring interesting things, but I dont know if theyre ever going to make their way into the real world."

At Toi Labs, Kashyap and his team have been studying the best way to bring health tech into the bathroom for years. His company is currently conducting clinical trials for their own smart toilet product, True Loo. It uses AI to analyze pictures of stool and urine for health insights (what your poo looks like can apparently tell you a lot about your health!). Kashyap said that the choice to use photography instead of the "mass spectrometer" lab tools like Coon was intentional because he says that the tools and science Coon is relying upon have some major flaws in a commercial setting.

"Weve been working on a smart toilet for more than a couple decades combined," Kashyap said. "For this kind of approach to reach the market, it would be a very slim chance."

Kashyap views mass spectrometers as large, expensive tools that work in the lab, "but don't necessarily work in an everyday toilet environment."

Kashyap is also not sold on Coon's science. He says that mass spectrometers are good at looking for specific things, like in drug testing. But does not believe they are proven as well as they need to be for a true at-home smart toilet.

Other competitors and experts share that skepticism. Raja Dhir, the co-founderand co-CEO of microbiome research company Seed Health, doesn't see the potential for urine testing without also testing blood and poop.

"The concept of continuous measurement of biological data is intriguing," Dhir told Mashable. However, he's not convinced that people will actually get much use of out of it in the real world.

Still, Coon, Miller, and even Snyder are optimistic that, with enough study, time, and investment they can prevent the future of healthcare from just being flushed down the drain.

"Ive been saying that someday, we need a smart toilet," Snyder said. "I think the day is here."

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Smart toilets could turn your pee into research gold - Mashable

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Breaking Down The Invitae Short (Podcast Transcript) – Seeking Alpha

Thursday, November 21st, 2019

Editors' Note: This is the transcript of the podcast we published last week on Invitae (NYSE:NVTA). We hope you enjoy.

Daniel Shvartsman: Welcome to the Razor's Edge. I'm Daniel Shvartsman. I'm joined by Seeking Alpha author Akram's Razor on this show. Each episode we take an investing idea or theme that Akram has been looking at for his personal investing as well as the Seeking Alpha marketplace service he runs, also called The Razor's Edge. We look at the ideas themselves, stress test them, try to figure out where they might go right or wrong, talk about what's been going on, and talk about the research and analysis that led to this take.

The idea to share some current investing ideas here into consideration, but also get the ins and outs of deep fundamental market research today. This week's topic has a lot behind it. The ticker symbol is NVTA. The stock is Invitae. Akram released a short case on the company on Seeking Alpha on October 11th, that went long in terms of breaking down why the genetic testing company was more like a WeWork than an Amazon. In other words, the company has had prodigious revenue growth, but it's come at a cost of increasingly negative cash flows and limited competitive advantage, in Akram's view. Was a thoroughly researched short case and as is often the case it's attracted a lot of attention, both positive and negative.

On today's Razor's Edge, we're going to talk about what brought Akram to this case, what investors are missing, and some of the reactions since he went public on Invitae. We're also joined by a colleague of Akram's, James who can add some insight on this topic based on research he's done on the stock as well.

Before we begin a quick disclaimer and disclosure; The Razor's Edge is a podcast on Seeking Alpha's The Investing Edge channel. The views discussed belong to either Akram, James in this case, or me respectively, and nothing on this podcast should be taken as investment advice. We'll disclose any positions in any stocks discussed at the end of the podcast, though upfront I can say I have no positions in any of the stocks we plan to discuss, Akram is short Invitae and long Myriad Genetics, and James is short, Invitae. We're recording this on the morning of November 4th.

Listen to or subscribe to The Investing Edge on these podcast platforms:

All right, guys. Good morning. Welcome.

Akram Razor: Good morning.

James: Good morning. Thanks.

DS: So let's just go really basic, why Invitae? What brought -- why does your radar get on this stock? Where did they come up?

AR: That's definitely an interesting part of the story. I guess the starting point was, there was people shorting Myriad. So I follow the Southern Investigative Reporter. And they've done a couple short pieces on that. And I kind of have taken a look at it briefly, which caused me to take a brief look at Invitae, and that was probably like, May or June. And then Ilumina missed big time on earnings, and I've traded Ilumina several times of the year. I've never traded any of these other stocks in terms of that. But it kind of got me interested in the space. And I guess what kind of, I mean, like, I think I had pinged James on it a couple times being like this is like this is worth looking into, but like neither of us had really gotten that excited about it.

And then there was a report that came out by a short seller, recommending the stock is an amazing long idea, which I read, because I know the short seller and his work. Once I read that, I was like, I need to look at this company a little closer. And then just the typical process, like pulling up their filings, seeing exactly what's going on financially, and I was just like, wow, this is just an incinerator. What are they doing? Why is -- like, what's the business model?

And that brought me to, there's an author on Seeking Alpha who had published a lot on this over the years, capital markets, laboratories and read their work, and they made these Amazon compares where, obviously, that's where you get a little bit of a heightened radar, when a laboratory diagnostic company is being compared to Amazon, which I mean, I don't know also if you know -- and I had like a brief experience with Theranos in 2000 it was say like, early 2014, like back when it was like -- I was picking on the Decacorns then, my favorite, like when I used to write my market commentary and I'd have a little bit of fun with it.

At the time, the two I was having fun with were Zenefits and Theranos. But I mean in Theranos' case, like I was just curious as far as what like -- I mean, it was a private company, $10 billion, obviously a lot of hype. I was like, wow, do I short Quest and LabCorp, right? I mean, I can't make -- I can't invest in Theranos. But if this company is so revolutionary like it, there's this pretty simple thesis out there in the public markets where I mean, if they're going to stick a lab in a box, I should go short Quest Diagnostics and LabCorp.

And I have, on the medical side, an extensive network of friends and family. So I ended up doing just one call with someone who'd been at Quest and in the laboratory diagnostic space, pretty senior for about 20 years. And like, I mean, it was like a 30 minute conversation. I felt stupid by the time it was over. It was just like, he's like, are you an idiot, you can't stick a Lab-in-a-Box. It was like -- it was literally like that, after like being very polite for a little while. So that type of stuff kind of intrigued me. And Theranos ended up being Theranos. I never really did much more with it after that. And then Wall Street Journal came after it, and it became this cautionary tale. I don't know if James -- did you follow Theranos very closely, I don't even know if we really discussed that?

J: No, I had heard from some VC friends who were very skeptical of it all the way through. But I wasn't that close to the name myself.

AR: Yeah, I mean, neither of us I would say, I would characterize myself as close to it. But I mean, I did take the time to literally be like, hey, do I short these stocks because of Theranos, right? It was like an investment idea at the time.

So yeah, I mean, I guess that's what started it, right. I mean, like Theranos had this -- and then the message was just kind of just like affordable blood testing for all, a social cause being compared more to, like technology differentiating companies and I mean, Elizabeth Holmes like to associate herself when she talked about things, when she compared herself to the Google Founders and Facebook and like, I mean, if you saw the documentaries like here we were at, in Brazil, and this is where we -- who was sitting there, and the Google guys, and the Amazon and Facebook, and we are the stars of the show, right?

And if you look at Invitae, I mean, like on the surface, it's like there's a social enterprise element to it, right? Where it's just like, we have a mission, and this mission is to make genetic testing affordable for all. I mean, like, they don't care, they don't describe themselves as like a laboratory diagnostics company, right?

DS: Well, they --

AR: That was a genetic information company. Go ahead.

DS: Yeah. I mean, if you look, I have got their 10-K open, their last one and it's -- our goal is to aggregate a majority of the world's genetic information into a comprehensive network that enables sharing of data among network participants to improve healthcare and clinical outcomes. So it's this.

AR: Yeah, so what does that mean?

DS: Right. You know, it is this very -- it is very big mission, right. It is very big.

AR: Yeah, I mean, James, obviously has some views on this. Like, I mean, what do you think of that part?

J: Well, I think that really comes down to the crux of the investment case here, which is, just because something sounds good as a sound bite doesn't mean that it actually makes sense in business. And so the idea of accumulating the world's genetic information, you would argue, seems like if you could do that would allow you to capture rents on that database. But there are very real issues with that. Namely the company has said that they won't do that. And then when they're pressed about how -- whether or not they will do that, they kind of seem to give non answers what I can tell.

So that's one of the questions right that that I think would be very helpful for the company to lay out there, very specifically, which is, if we gather all this data up, and specifically what data is being gathered? Are they -- is that data, they've also released to a common database, like they say they have been doing, is there additional data that they're not releasing?

AR: Well, I mean, the data that they're sharing with the common database is the variant of unknown significance data, right? So I mean, that's what they're contributing to Clinvar. We don't really know. But like, I mean, I'll be honest, like if I was to go in and have hereditary cancer test, I would have never thought once about, like, who the lab doing the test is or ask the oncologist anything, but like literally now knowing this business, I mean like, make sure you're not using Invitae, because I have no clue what they're going to do with that data.

Like my DNA is a product for them to figure out somewhere down the road just to do something with it, I mean, it's so -- like James just said, it's very bizarrely unclear, which is decidedly convenient when you're running a business model like this.

DS: So step back for a second. So the thesis -- the company's thesis is that they're providing genetic tests. And then they're aggregating that, they provide it at -- arguments are they providing it for below the cost that they actually have to pay to their providers to actually deliver the test but low cost testing that they can then -- if we're going to use the Silicon Valley jargon, that they get the flywheel of more genetic data and improve, they get a lot of volume, and eventually, that's both going to give them scale to lower the costs, but then also they're aggregating this huge genetic database, which as you kind of point out, Akram, they're going to have to do something with to make it reasonable, which raises concerns in of itself. But the idea is that eventually they'll get scale from offering at cost that will allow them to become a profitable business, I think. That's how I understood the company's take and the company's argument.

AR: I mean, like James just said the company hasn't explained that. So if you look at this company's history, this isn't like a startup, number one, right. So this company was founded in 2009. They've been at this for a decade, okay. Initially, they were kind of rare disease focused, right?

Like where they're deriving the revenue, if they were to actually describe themselves accurately, they would be like, we do hereditary cancer testing far cheaper than Myriad, right? And I mean, like, I think that's an important thing to look at this. I mean, there are sources of revenue, which is generally speaking what has attracted people to the stock, it's not science, right. It's not like you've developed a test or you're like Foundation Medicine and you've got this companion diagnostic clinical trials and you are about to do something where you're going to earn a high margin, because you've developed something nobody else has. That's typically, what people get excited about in science and biotechnology, right?

You get rewarded for R&D, okay. These guys have approached the market that Myriad discovered the BRCA mutation in 1994, okay. That's like what the indication of hereditary cancer right? I understand cancer, 90% of it is not hereditary. So you're looking -- when you talk hereditary, there's a less than 10% chance that it's something hereditary. That's helpful from a clinical standpoint, as far as your treatment for cancer diagnosis, whether it's early or late stage or whatnot.

So this company came into this space in the sense that Myriad had a monopoly on this gene, right? They started doing their first BRCA testing lab kit was like 1996. They had the patent on that gene till 2013 when the Supreme Court struck it down, right. So these guys entered this space, essentially, from that standpoint as a competitor against Myriad. And once that space kind of opened up in hereditary cancer testing, I mean like, well, you can't patent these genes, right? Which is great for competition, but what's the flip side of it?

If I make a major discovery on gene X correlates to disease Y, right? And I can't patent it and I'm running like a test that kind of identifies that historically, kind of tough to build a very profitable business around it. So when we go back to like what you were saying about like this whole genetic information and whatnot, the most interesting thing about this business is look at the rest of the landscape. Nobody's selling the story, like Myriad's still the revenue leader in hereditary cancer testing.

The other space the company is in deriving revenue from is reproductive health, carrier screening, non-invasive prenatal screens. And that's the most crowded market ever. It's got Ilumina and Sequenom, which is owned by LabCorp, like pretty much, they control the IP there. And then there's like a half a dozen other competitors owned by large companies.

So like, in hereditary cancer, you've got Myriad. And then you kind of have this like at a huge, huge, huge discount to Myriad prices, Invitae, right? I mean, like now they're running what, $99 tests, okay? So you look at it and you can sit here we can just, like figuring out what they want to do data wise and the fact that it's Vegas kind of important. It's also important in the context of -- well, there's a whole industry here, right? I mean, this is at least what -- we got some heat when we cautioned this like, some of this has attracted obviously a lot of retail investors by using the Amazon compare. And, in the initial thesis it was like a cautionary mention at the end, like that the laboratory diagnostic space doesn't need another Theranos.

And at least in Theranos' case, what they were selling to investors was we're building a better mousetrap essentially, right? Like we've got -- we've engineered something that's going to change the way we are able to do testing. And that's not the story here. The story here, I mean, if you go back to the founder in 2016, there's a couple of interviews with him. And he literally says like, we're providing the same test that everyone else is providing, we're just making them more affordable. That was that's their initial story, right.

So I mean, you do kind of run into something like that, which is where, like some people may think it like, you know, oh, it's very, self-serving or opportunistic to compare this to WeWork. It is, exactly like WeWork from a business standpoint. Like you can't get around that fact. And I think the Amazon like -- and this is not like some guy writing a really bullish Seeking Alpha article and using hyperbole, the management sticks to compares. I mean, they -- literally they have a slide in their investor deck, what we can learn from Amazon, and they make statements like our competitors -- what did they say, James, is like the competitors margin is our opportunity or

J: Yeah, something that effect. Yeah, you've heard a lot of ground there, Akram. I think the important aspect of what you've said and the commonality among all those points is that the management team has made some very high level statements about the promise of this industry and the promise of their company. And they could really answer a lot of these questions if they wanted to, right? They could say, okay, here is our revenue breakdown from cancer or nips [ph], kind of other panels, which don't have necessarily the clinical efficacy.

Or they could say, here's our -- here's what we're getting from the various cost cutting or network effects or economies of scale that we promised. And here's how this is going to develop, but they don't they just say, trust us, it's all going to work out. And the way that it's not [ph] going to work out is that it worked out for Amazon. So it's there's not much transparency, there's a lot of just kind of big picture verbiage I would say.

AR: Yeah. I mean, 100% and like, I mean, you get the Amazon story, Daniel, right. I mean, if you look at it, people like, if you look, well, come on, Amazon was losing money. No, Amazon was improving operating cash flow from literally from day one. I mean, people forget, like, you make money selling DVDs and books online, particularly if you don't pay your suppliers for 100 days, right? I mean, like, where was Amazon after a decade? It was already a behemoth, right?

So when you look at it, Amazon had someone else, i.e., their suppliers funding their growth. It's free, cheap capital. This company went and IPOed in 2015, at $16 a share, had like 25 million shares outstanding. They're at 100 now, four years later, right? I mean, it's like, they keep going back to the well. So if you're an investor and you're looking at it from a return on investment on money, you're giving them. I mean, you have a serious problem. And if you look at it, and you say, hey, I'm going to compare myself to Amazon. Well, Amazon had a cost structure that attacked this cost structure of brick and mortar, okay?

They benefited from so many things. We didn't have sales taxes, if you were paying on Amazon as a consumer. They benefited from the fact that they went into markets with huge existing volume already, books and DVDs. They didn't have to convince people to buy X, Y and Z. They were already huge volume markets. I mean, I'm sorry, but like hereditary cancer testing. It's not something people get excited about to go online or buy as a gift for a friend.

I mean, like, we get the DTC space, and even that has already slowed down drastically, and that's Ancestry. And if Ancestry slowed down at like 30 million tests, right, like, you really think people are going to be super excited as individual consumers to be like, I really need to figure out whether I have a history of cancer right now. I mean

J: Well, and more importantly, more importantly, I think there's a healthy amount of skepticism in the medical community whether or not these tests are useful, right? Like the issue with any test is, if you find something, an indicator of a disease. Does that help you catch the disease? Does it help you catch it earlier than existing testing or physical exams, or other ways of seeing the diseases there? And then can you do anything about it?

So, I think one of the issues here is even if you were to send your saliva [ph] sample out, and you came back with saying indication that you might have liver cancer potentially. A, you wouldn't know, if that were real, because it's really just a correlation at this point. There's not enough data. B, even if you knew, it was real, there's really not much to do except worry about it. And so you have a lot of additional burdens on the patient and the healthcare system in terms of emotional and financial burdens, without any clear benefit.

And so I think within -- as I'm saying, within breast cancer, that there is a clear benefit in terms of efficacy and outcomes. But for the rest of the space, it's really not clear. And that's why, if you look at the treatment protocols for most of the commercial payers, they don't pay for all these tests, because the research doesn't demonstrate that they should.

DS: So one of the things I'm -- as we're throwing around these comparisons. I'm thinking about the -- there's a notion in Silicon Valley and sort of abroad, the market, the idea of tech, tech as a category is becoming less and less meaningful, because companies are adopting online models or tech models to different verticals. And what I think about with Theranos and Invitae, specifically, healthcare is a very complicated sector, both in terms of the way payers work and we can get into Medicare in a little bit, but the way the payment system works.

And I'm not talking even about what might or might not happen in the future with changes to insurance. But just -- that's, I think, always been fairly -- you have to really work through it. And the articles for example, there's looking at the different reimbursement codes and that sort of thing. Like, it's more than you have to do to figure out, well, are they going to buy this software tool or not?

And then also, Theranos is a problem, because they were actually -- there were issues of fraud around people, things that were supposed to help people's health. And so I guess I'm just kind of, I guess, I wanted to hear a little bit more about like, because -- a lot of the response.

AR: Well, I mean, look -- let's, I mean, if you think about Theranos, where really was the fraud. The fraud like, I mean, if you read the indictment, what she's really on the hook for the biggest time is misleading investors, okay. I mean, that's the biggest part.

Yes, correct, like at the end, there was issues with the lab testing and they were getting inaccurate results because by the time she did that deal with Walgreens, and clearly they were at a point where they were desperate for showing meaningful revenue, because they need to raise more cash, right? Because they still haven't made the Edison work, right? They're trying to engineer a problem. They're working on it.

She didn't set out to commit fraud, right? She set out to build -- to stick a Lab-in-a-Box, right? But she had bigger aspirations. She wanted to take -- that she wanted to aggregate your data. She wanted to stick it in this cloud called Yoda, right? I mean, if you look today, you still have people who defend -- I mean, what's his name?

DS: Yeah.

AR: Tim Draper has really defended her. And what does he defend her on the point, and his point is that look, she had this vision to give you a movie of your health, i.e. like look, I get my blood work once a month, and that goes into a cloud, right? And my physician can track it. And I'm building a historical picture of a trend, by having more real time information on my blood work, cholesterol, everything right? So that creates preventative medicine in their view, right? Like your ability to have an earlier and more accurate versus a snapshot, right?

So he's like, look, she had that and was great and I genuinely have discussed this with James. I believe if she had IPOed this company and the company had started out as like, hey, she's got this Edison and this finger stick. It would have been just like binary tech play, right? She either makes it or she doesn't. And people would have debated that and thought that out there would been the believers. And then there would have been the skeptics, but she would have had plenty of time, as she gauged how that was working, okay?

To find something that generates revenue, which investors are willing to pay for, like with her inflated market cap on the Edison optimism, where she could just do regular lab testing like Quest and like LabCorp, but she would obviously do it at a lower price, right? But she would sell you the story that I'm going to stick this in the cloud, and you're going to pay a subscription fee, right? And that subscription fee to that cloud, Yoda, where all your information is and your general practitioner can access it and whatnot, that's the business. That's where I make money.

Of course, what's the problem with that business? And that business is -- well, I mean, that you're going to be like, well, you're losing a lot of money per test, doing your tests at a lower price than Quest and LabCorp or whatever to provide this back end service, why can't they do that, right? I mean, like, that becomes the same thing because you're going to need the same infrastructure. That's where she ran into issues. She's collecting data and she doesn't have the lab infrastructure to do it at the scale that these guys are doing.

If she'd been like these DTC companies, 23AndMe ancestry, she could have actually struck a deal, which is like, I'll be the cloud and I'll outsource the testing to them. And I will take a loss on the tests, because my investors are going to subsidize it, right? I mean, there was -- there would have been many Ways, but of course, she was also trying to kill their businesses. So it didn't work, right, with her engineering. but like, I mean, the bottom-line is, is if you look at it, like, it's something where you had a potential business model in that sense, where we would be asking the same questions that you'd ask about in detail, right? Like what are you doing that's different?

If you look at them today, Quest and LabCorp, they've entered into direct-to-consumer testing. I can go online and order my own tests and schedule the appointment and go pick them up, right? I'd like it's really, like, it's something where I don't even need to go through my medical practitioner if I want to get tested. And I don't know, to the degree I mean, I've discussed this with other people in the medical community on the testing side and I'm just, why isn't there a VIP service like, if I'm an extremely wealthy individual, where they come to my house, do the work, store in a cloud. And there's access to my blood work, on let's say -- but we don't have to do a monthly but let's say every three months, right?

These -- I mean like these are obviously options. So when you look at something like that and you see what went wrong with this company, her biggest mistake was being private. It's like -- because with her turtlenecks and Steve Jobs and Stanford dropout, I mean, the benefit of doubt, she would have gotten, if you look at the benefit of doubt, for example, that this company, Invitae has gotten. I mean, their CEO says one thing, and then he does the other three months later and nobody has cared like, at all. No one's asking questions. I mean, I don't know if you -- have you watched the CNBC, the Invitae interview with him on CNBC, Daniel?

DS: No. No, I haven't pulled that up.

AR: If you watch that, you would not understand what the company does. It's like we are the company the key opinion leaders turn to and this -- like, he does not say I'm a laboratory diagnostics genetic testing company, who derives primarily its revenue from doing these types of tests. And we're doing them at a significant discount to a competitor, who has had a monopoly in the space for ages. And we're using that to generate volume and we're hoping to parlay that into other sectors. And this is like -- this is our business model. Because to be -- to tell you the truth, if you look at this closely, I don't think they figured it out. They are trying to figure it out as they go along and that's part of the problem here.

DS: Isn't -- you said, if Theranos that they could have arguably sold tests below costs, but then put the -- like, isn't that essentially what the Invitae has? They haven't maybe laid out that vision but they're essentially selling below cost to get into -- like they could build that into the cloud sort of approach like?

AR: Okay. No, let's not make that mistake, okay? I'm saying that Theranos, if they wanted to, okay, and wanted to pivot for a story to sell, that sells well, when you're dressed like Steve Jobs, and you dropped out of Stanford, and you're a unique character and you're -- you've got a Board that has these people on it. And you've convinced Tim Draper and Larry Ellison to invest in you and whatnot, right? When you've dressed something like that, and you've ticked all those boxes, okay, you could just be like, hey, I'm going to do the same blood work everyone else is doing, I'm going to do it cheaper. So come to me. And how I'm going to make money off of it down the road, is I'm going to store that data, and it's going to give you a real time picture.

Now if you were to compare this on genetic information, my DNA isn't constantly changing, right? So if I'm doing -- if my focus is hereditary screening, i.e., what's been passed on to me, and what does that indicate?

What is the usefulness of that sitting there, right? Number one. And number two, in her case, it would be like, well, you still need to build the lab infrastructure to do the tests. You're going to have to do huge volume. So any business that -- like I mean, if you listen to the CEO, he literally sits on conference calls. And he's like, we hope to do half a million tests this year and reach a million people next year, and on our way to billions across the world. Well, what kind of infrastructure, you need Amazon infrastructure for that, right? I mean, how many geneticists do you need, genetic counselors? The industry doesn't even have the employees. I mean, we were discussing this, like, how big is that industry James.

J: It's well smaller than then I thought it was. I think it's in the thousands of genetic counselors. I forget it, 10,000 or 15,000.

AR: So you're going to need lab technicians, genetic counselors, you're going to need the physical footprint. You're going to need logistics. I mean have you looked -- like part of the thing that like -- we found kind of interesting is just look at Quest Diagnostics. I mean, there was a $100 price target slapped on this thing. That's the market cap of Quest, okay? They have 3,500 trucks like 26 planes, 6,000 patient access points, right? They have infrastructure to test everybody.

The internet bull on this stock, he's been close to management. He's done a lot of write ups on it. One of his write ups was just recently, and I read it and he's like, I visited the company and the CEO told me that they're actually paying for the trucks to go to FedEx, to pick up the samples and bring them back instead of waiting for FedEx to bring them to the lab. And he's like, I've never seen a company who cares about the customer so much. And I am like -- I mean, sorry, logistics are part of his business. Collecting the samples and the turnaround time and what the infrastructure you need to do it, right?

Like that's not something of like, hey, I really care about my customer. It's something you have to do and unfortunately, Quest and LabCorp are sitting there with huge economies of scale and scope and infrastructure and the same machines available to them, and the lab technicians and the geneticists and everything to flip this switch on, and they're not flipping it on. Why?

DS: Right.

AR: It doesn't make money, because the volume isn't significant enough and the cost isn't at that point. So when this company talks about driving down costs, no, they're not driving down costs. Everyone else has a lower cost per test already established, because they have higher volumes in the space, right? If you look at it Myriad's cost per sample is in the $140, $150 range. If you look across all these other labs, who are doing the stuff and the testing on the reproductive health they're all far lower, right?

So this is a last person in the space coming and trying to get to the volume, trying to get to the economies of scale and trying to drive it down, right? But they still are subject to the same cost infrastructure limits. It's not amazon.com. They haven't eliminated the blockbuster employees sitting, that when they're competing against in DVDs like a Netflix or an Amazon or whatnot, they haven't eliminated the huge physical retail footprint that a Barnes & Noble needed, right? Like, they still have the same limitations, from a cost standpoint. They're relying on Ilumina machines, consumables, Agilent, Read [ph] everybody -- like it's the vials from, what's the company that sells the vials?

J: OraSure

AR: OraSure, right, like you're buying the same stuff from the same people. So it's when you look at it from that standpoint, like if they were to sell you a story about data or whatever, it's like, well, everybody else can sell us a story about data. Why are they selling it to us?

J: It's an interesting dynamic here, because when there was the rebuttal by this bullish commentator/endorsed analyst of the company, there was a comment that, hey, it's not just the raw data, it's not just the genetic information that is useful, because genetic information in and of itself doesn't tell you enough about the disease. And I think that's a partial indictment of the whole process. But more importantly, what the analyst said is, what the company does is they take that information and they combine it with a patient's medical record. That includes all of their scans, their CTs, their MRIs, all their historical blood tests, all their physical exams, and then it takes that data. And if you get enough of that data, then you can start running effectively very large statistical relationships and figure out, okay, which genetic mutations might be associated with which diseases.

The problem with that is, as far as we know, that's not what's happening. And yet the company, again, they've kind of endorsed this, this guy is an analyst of record, the company hasn't come out and said that. But that's not what's happening. Because if it is what is happening, I think they're serious privacy concerns. So I think it's very different, if you as patients and [indiscernible] into 23AndMe, you might sign a paper, some paperwork somewhere, but if they're actually signing away the rights to all their medical records. Again, I don't believe they are, but again, this is what would need to happen in order for this data to be proprietary and useful. Then I would imagine the consumers are not aware of that.

And so you kind of have this catch 22, if you're getting the data, whatever, this guy refers to it as the golden data, whatever it is, if you're getting that data, such that it's useful, you're probably in violation of some privacy laws, whether or not you are in terms of you're covered legally, I think just patients don't understand that's what's happening. And if you're not getting that data, then there's a very real question as to what exactly is the use of just this genetic information without putting it into -- in context without kind of correlating it to these other disease markers?

And again, this is a question that could -- that's very answerable by the company as far as we know, has decided not to answer.

J: I mean, look, there's also two elements of that, right. If you remember also, in his rebuttal, he pointed out to a subscription model, right ,where he was even saying that this should be looked at from a dollar-based retention standpoint like a SaaS company. So I mean, again, if he's saying this, it's something that well was spoon fed to him, okay? And that's part of the element here, when you're dealing with something like this, and you look at that, it's like, all right, so like, I go in, I do a test for cancer, but you know, a BRCA screen. And you're saying -- are you essentially saying that, in year one, you generated revenue off of the actual testing, but then in year two, and year three, supposedly, my DNA is something that just sits there, and they can find ways to make money off of, by farming it for some sort of data that they can sell to pharma.

And it's tenuous at best to even understand how that model would work, because if you look at the rest of the industry, you just have to assume, they're all idiots. I mean, how many tests has Myriad done? I mean, look, when you go back to this thesis, Daniel, one of the most important things here is, when I put this on, this company was bigger than Myriad, literally in enterprise value, it was bigger than a company with $850 million in revenue, 20 years of testing. They've done 6 million tests through some -- to that effect I think it is at this point.

They have a database that they've made a trade secret since 2004, as far as variant data. They have four times the employees of Invitae. I mean, if you were to look at this company from there -- one notable institutional bull in the space, like this bull doesn't own any Myriad, okay. And they have a genetic spawn, and they did like kind of throw like a little bit of a shade at this thesis when it came out. And I mean, I can imagine they got a lot of questions because they own a lot of the stock and they were like, these are the companies leading in AI.

And then they like -- they listed Invitae like two other names. And then they put in their tweet, which was almost essentially directed, not my gen [ph], which I mean, for someone like me, I just -- I didn't even really spend much time getting into the AI nonsense. But if you look at Myriad how many people with machine learning backgrounds and data scientists do they employ, plenty.

You could just go on LinkedIn, look at it, and draw your conclusion. But they're not out running around saying, hey, we got AI, we're doing stuff. We're literally running machine learning models on your DNA. We're figuring out better ways, a secret sauce. Like who would advertise that? If you actually have made the data a trade secret, and you refuse to share it and they've gotten a lot of heat for it, literally the whole industry had to band together to contribute data freely to Clinvar, because Myriad won't share, because they're like, hey, fine, you took away our patent, but who cares about that. Our ability to interpret this is better than everybody else at this juncture.

So again, you look at it, at something like that, and you're just like, well, there's companies who've been doing this for decades. And you're just supposed to assume that like data science is completely irrelevant to them. But the company that acquired an AI startup in July, by September is a leader in this space. I mean what, you know.

DS: Solet me -- so there are a few directions to go here. But let's quickly touch on Myriad. It's -- you're using it as a payer here, as I think you mentioned, it's -- short sellers have kind of had their eyes on it. Somebody like Southern Investigative Reporting Foundation has reported about it. Why are you comfortable with that as the other side of this trade given the fact that they've also come under fire?

AR: I mean, I don't know James, you want to tackle this? I'm obviously a lot more bullish on Myriad then most people. I would say, like, I can't really get my head around the short thesis, and I can't get my head around the short thesis in a relative context. I mean, if you've looked at the space there are some companies with some pretty crazy valuations. Myriad is not a hard business to understand. They have a cash cow in hereditary cancer. They've used that to diversify into companion diagnostics, into carrier screening, now into these pharmaco-genetic tests, psychotropic like for depression, which is a very controversial area.

A lot of a lot of volatility around Myriad lately, let's say the last six months, has been tied to this gene site division, and the way the FDA wants to treat these tests, where I get a DNA test that like tells me, I'm more tolerant for Zoloft over Prozac. And no science has shown any clinical efficacy yet, and it's a controversial area, because there's obviously some doctors, and they've been doing -- they've been running clinical studies to try to get this approved. And they missed the primary endpoints on it. But there's also an argument that in depression, which is like opioids, a national crisis, essentially speaking, and it's not going to get better, that there's nothing, and something is better than nothing. I mean, two-thirds of antidepressants are prescribed by general practitioners. Not -- you're not talking about the psychiatry side here. These are not experts on these drugs or on mental health.

And the argument is that maybe you give them something that starts this out with a little bit more direction, however little incremental it is. Now when the stock got hammered in the summer, on its last earnings, was because they said the FDA is pushing back on them on the labeling. And then recently, there was another genetic psychotropic-related test company where the FDA allowed them to resume sending the test information, but to the doctors. So the patient just gets this, like here's what your genetics say, but nothing about the drugs. But the doctor actually gets the drug indications. And then that doctor can see that and that doctor can use that as part -- like as a helpful part of his treatment.

But again, you go back to -- they haven't been able to show scientifically and it's hotly debated. I mean, there was just recently something in -- two Harvard doctors had published something in one of the big journals on mental health, same thing with oncology, like outside of BRCA, like there was a recent paper basically like these other genes are like no better than a placebo.

So this is part of the problem in the space but I mean, I haven't -- I don't have the numbers in front of me. I mean, James do you remember off the top of your head, but I mean, I think it's like $850 million in revenue and like $150 million in EBITDA, something like that against a company with -- that did what, like $144 million in revenue last year and lost what $100 million.

J: Yeah, but larger now.

DS: Yeah, $850 million, trailing 12 months revenue, looks like EBITDA of over $100 million at least.

AR: Yeah. So like, you can look at that, I mean, and this is something when you look at stocks, I mean I was long, some Pinterest against the Snapchat short. And I thought about closing it before earnings. And the reason I thought about closing it is that you know, Snap is $16 billion and Pinterest is 15 billion and Twitter after its 35% decline is 18.2 billion AV. Yeah, Twitter's growing slower than the other two. But it's like three to four times the revenue base. And you got to kind of adjust for that, when you get to that point.

And you're like, this is a company that is in the advertising space, and it's doing -- it's going to do whatever issues its got, it's going to do 3.5 times what this is going to do and their enterprise values are a hair apart. So when you -- like this wasn't -- this is a case where if you would look at an Invitae, you'd be like, this has got to be like a quarter a fifth of the size of like, even if you are a believer and you're willing to buy into the speculation of a Myriad.

And then the other problem you have with it is that they're interrelated. All the revenue growth that is coming for Invitae is coming because Myriad hasn't come down in pricing. They've been fighting this price decline, because they've had the luxury to fight it as the leader in the space and they're extracting a premium for their testing, because they -- like there's a compelling argument, at least from their end, that based on the data we have in the history, our tests can more accurately predict what you have, as far as a likelihood of a hereditary cancer and indication reliably.

And it's ironic, and we were discussing this when we were working on this, like this company throw shade at who -- I mean, they throw shade at the DTC companies. Like they literally just gave a scientific presentation at this Houston Cancer Conference with Genetics or whatever, just like two weeks ago, where they were like, here's 23andMe's tests, okay, and this is what's wrong with it. Like 23AndMe gives you a BRCA test, that only is designed to detect three variants. Basically, if you're not an Ashkenazi Jew, it's useless.

But it's literally a report that is bundled in with the ancestry, with the health with the 50, 60, 70 reports, you get for $100 okay. It's not like you're going into buy this or you're going to your doctor and you're like, okay, I had breast cancer, I'm worried about a potential recurrence. Let's see family history. Do I need to get a mastectomy early because I have this mutation and that's a good preventative measure, et cetera, et cetera. They're not looking at 23AndMe. Like, it's -- you're competing in the clinical grade medical diagnostics market. But here's this company attacking the DTC companies who are not really their competitors.

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Homeless with HIV: A lack of housing makes a preventable disease deadly in Oregon – OregonLive

Monday, November 11th, 2019

Every month, Tim Menza receives reports about new HIV diagnoses and compares them to previous years. As a doctor and data analyst for the Oregon Health Authoritys sexually transmitted disease and HIV program, hes familiar with how the HIV epidemic has waxed and waned.

Oregon is four years into a five-year, federally sponsored program to end HIV transmission by testing vulnerable Oregonians, alerting them of their HIV status and providing them with treatment and preventative medication. Menza had been optimistic Oregon was on track to eliminate future HIV transmissions.

But a year ago, he noticed a troubling trend that Oregon was ill-prepared to tackle an HIV outbreak exacerbated to a deadly pitch by the harsh living conditions of the street.

While the uptick in new cases is driven by drug use, it is difficult to contain because of homelessness.

Few places nationwide have seen such a wave of new HIV cases as Multnomah County, where the number has more than tripled to 71 over the past two years. In this year alone, 37 people have been diagnosed close to equaling the total for 2016 and 2017 combined.

The virus has historically targeted marginalized communities, devastating an entire generation of gay men in the U.S. in the 1980s and 90s, and later taking hold in communities of color. But in the past few years, the outbreak has surged among intravenous drug users who are or who soon become -- homeless, and their sexual partners.

Public health officials have had to start envisioning their work as tied to the homeless services system, actively canvassing camps to seek out those who are sick. While health care providers have become homeless service providers, troubleshooting patients needs beyond medication.

People who have homes can fairly easily survive HIV, a pill taken once daily allowing them to live nearly symptomless. Yet it remains a potential death sentence for homeless people, who have their medication stolen, lack clean shelter facilities and suffer poor nutrition and sleep -- leaving their immune systems unguarded against the deadly virus.

A compounding factor

When Menza looked at the data a year ago, he found that across the state -- in both rural and urban areas -- new HIV cases were popping up among people who inject drugs and didnt have access to stable housing.

It wasnt necessarily a surprise. He had seen reports of syphilis and Hepatitis C rising in those populations often precursors to an HIV infection.

He knew the state needed to take immediate action, but the traditional path wouldnt work this time.

HIV cases among people who use heroin and methamphetamines jumped to 30% in the last two years, more than double the percentage of years before, according to state data.

Drug users typically separate themselves into social and sexual networks based on their drug of choice. But recently, those circles seemed to overlap more than ever. Officials say cheap, high-quality meth has flooded into the state over the past few years, a popular drug for people who live outside and want to stay up through the night to avoid being assaulted or robbed. The spike in meth use coincides with an existing opiate crisis, and many people have turned to using both the depressant and stimulant.

On top of that, Menza said that there is growing evidence that homelessness is a compounding factor.

Every time a campsite or group of people who use drugs together is dispersed through sweeps or clean-ups, the people there move and form new networks. Single-sex shelters split heterosexual couples up, making it hard to stay with one partner long-term.

That slowly extends the number of people who are capable of spreading the disease geographically and demographically.

A public health worker trying to contain an outbreak in a small group of people now must navigate ever-expanding networks.

If youre trying to do an intervention in a camp, Menza said, you have to work fast.

Taking healthcare to camps

In Multnomah County, many people who are homeless or on the brink of it receive HIV care from the publicly funded HIV Clinic, housed in the gleaming new health department headquarters near Union Station.

From that outpost, public health workers are adjusting how they mobilize around the HIV outbreak nearly on the fly.

Jaxon Mitchell leads the countys disease investigation team and field outreach. Hes used to tracking people down. Usually he can look up someones cell number or send them a message on social media. But that doesnt work with this outbreak.

To locate people, Mitchell and his team must search camps, scour social media profiles for clues and trace leads from hospitals and friends. Thats made even harder by strict health privacy laws that mean Mitchell often cant tell neighboring campers why he is looking for a specific person.

The rise in HIV -- and its accompanying diseases of syphilis, shigella, hepatitis A and C mean that Mitchell often receives test results for homeless people who went to an ER for short-term treatment but were discharged to the street before the results came back.

When he does find the person he is looking for, he often has to work quickly to identify anyone else who might be infected sexual partners or people that have shared needles and get them tested or into treatment.

Out of a van designed for such field work, the county offers on-the-spot medical help, testing and provides other necessities like clean socks, snacks and tampons.

The public health department has faced smaller scale outbreaks before. For instance, Mitchells team is dispatched when a homeless person is diagnosed with tuberculosis and they must make sure the patient takes several months worth of pills to contain it.

But this is a much larger undertaking than ever before.

Its all based on being able to find people, said Jennifer Vines, the countys deputy health director. Now suddenly were in a new situation of having to figure out how to use our tools when people are hard to find -- or not wanting to be found.

Training the front lines

In his role at the county, Chris Hamel must train service providers on how to talk to their clients and patients about getting tested for HIV.

He seeks out homeless service agencies, primary care doctors, detox centers, parole and probation officers anyone who might interact with people at risk of HIV to try to make that step easier.

County officials have found that if they can get someone who is newly diagnosed into HIV care within 30 days, they are more likely to stay in care long-term. So field workers try to keep in contact through the first few appointments.

Were trying our hardest now to go to people, Hamel said. But I would like to see us continue to build a public health system that people feel comfortable enough that they will come to us.

Public health workers face the challenge of being as focused on those who havent yet contracted HIV as they are on people with positive test results.

Pre-exposure prophylaxis, or PrEP, is a daily medication that is highly effective at preventing transmission of the disease. Mitchell and his team also track down everyone they can who might be in the orbit of a someone with HIV to make sure they have access to the medication.

Thats a new sell to many. The pill has largely been targeted at gay men because it works even without use of a condom. But state data shows a 600% increase in women getting syphilis a sure sign that HIV will parallel that rise.

In this outbreak, the people most at risk are women, sex workers and intravenous drug users who tend to be straight men -- all people who likely never considered needing the preventative medicine.

Its the art of public health, Vines said. Were thinking about the individual, but we also have to think about the persons social circle.

Hard to help

In 2014, Indiana had more than 200 cases among intravenous drug users in one county. Last year, West Virginia experienced 80 new HIV cases tied to intravenous drug use.

Officials are seeing the HIV resurgence across the country, but the West Coast is unique in its profound lack of housing affordable to sick or addicted people.

In 2018, a cluster of HIV cases in Seattle caught the federal governments attention. The outbreak was within a distinct group of people who hadnt before been a driving force among new cases: Heterosexual people who were homelessness and using intravenous drugs.

Twenty-one homeless people in Seattle were found to have passed around HIV sharing needles and sex. The cluster bumped King Countys rate of HIV among homeless heterosexuals who inject drugs by 286%. Months after the cluster was identified, seven of the 21 people were still not receiving HIV care.

The King County outbreak demonstrates how difficult it is to engage the most socially marginalized persons with medical care, said a U.S. Centers for Disease Control and Prevention report.

San Francisco has seen a steady increase in deaths among this growing population. Someone with HIV who is homeless is 27 times more likely to die than a person with HIV who is housed, said Elizabeth Imbert, the doctor who oversees a new private clinic at Zuckerberg San Francisco General Hospital.

The citys homeless people account for 14% of all new HIV diagnoses, despite making up only 1% of the citys population, according to the local public health department.

The hospitals Ward 86 served at the forefront of a burgeoning AIDS crisis in the 1970s. Now its launched the POP-UP Clinic, a program designed to get homeless people in the door and in treatment.

Imbert knew from local data that only one-third of San Franciscos infected homeless population has been able to lower the amount of HIV in their blood stream to the point where they cant transmit it anymore what health officials call viral suppression. That is well below the average rate of 74% for all people with HIV in San Francisco.

The hospital launched its own survey to find that of 1,200 patients, the amount of the virus in their body increased as their housing situation became more unstable. And, as the amount of virus in their body went up, the more they missed primary care appointments and ended up in the emergency room and urgent care.

So leaders of Ward 86 created a new way to treat those patients. They had to find a way to get sick people in the door who dont trust institutions like hospitals.

Ward 86 employs people who focus on non-medical needs in hopes that it will help patients stabilize enough to stay on their medication. They also work with housing specialists from the state health department and community organizations to connect patients to services and ask that those workers come into the health clinic to do so.

The clinic is open four hours daily on Monday through Friday, and patients dont need appointments to see a doctor. Currently, about 180 patients are eligible for the program, which targets people who have missed an appointment in the last year.

Once they do come in the door, they are offered financial incentives to keep coming. The hospital offers a $10 gift card for every week theyre in the program, a $10 gift card to have blood work done and $25 if the patient achieves viral suppression.

Nearly a year in, 60 people are enrolled. Most have started on medication and Imbert said that shes already seen some in the program whove had their virus become undetectable. About half of the patients come regularly, while a quarter visit a few times a week.

We are using essentially every resource in the city, Imbert said, to get them indoors, housed, on a waiting list.

-- Molly Harbarger

mharbarger@oregonian.com | 503-294-5923 | @MollyHarbarger

Visit subscription.oregonlive.com/newsletters to get Oregonian/OregonLive journalism delivered to your email inbox.

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November is not only known as the start of the holiday season, it’s also known for Open Enrollment – WZZM13.com

Monday, November 11th, 2019

GRAND RAPIDS, Mich. When it comes time to enroll in a health insurance plan, there are often many questions or misconceptions.

Dr. Kristen Brown, president of Mercy Health Physician Partners, stopped by to talk us through what Open Enrollment means and which details should not be overlooked.

Open enrollment is the period of time where you select your health insurance coverage. This is generally the only time, outside of a qualifying life event, when you can add or drop a coverage plan or make changes to your coverage.

The choices you select during open enrollment set up how you will be managing your health care in the coming calendar year. One of the important, but sometimes overlooked, pieces of open enrollment is selecting your Primary Care Provider.

Primary Care is a relationship with a health care provider that is focused on taking care of you with your whole well-being and health history in mind. They are your first contact for undiagnosed health concerns, as well as preventative and continuing care of medical conditions.

PCPs offer a variety of services from annual wellness visits to vaccines and minor surgical procedures. They will also refer you to specialty care when needed.

There are several types of Primary Care Providers what is the difference?

Primary Care can also be referred to as Internal Medicine, Family Medicine, Geriatric Medicine or Pediatric Medicine.

When choosing a provider, your goal should be to build a lasting relationship. This individual will be your first medical contact and the health provider who knows you best. Some things to consider while select your PCP include:

In-Network vs. Out-of-NetworkStart by referencing your health insurance coverage, which typically publishes a list of providers who are In-Network. These providers will offer the best rates and work seamlessly with your health insurance.

Meeting Your NeedsNarrow down the list of providers in your area by reviewing their health care specialty, education and experience.

ConvenienceYou may want to consider the location of the office and office hours when choosing a provider. The following questions may be helpful when choosing a physician.

Research and Ask QuestionsTo find the best fit for you, we encourage you to research providers by reading online reviews, checking if your health insurer offers quality ratings or asking friends and family for referrals. You can ask to see if the provider is available for a simple meet and greet to assess your comfort level with the individual.

Mercy Health Physician Partners offers more than 90 locations in West Michigan. You can search for a provider atMercyHealthPhysicianPartners.com

Your wellness visit is an important step in maintaining good health. Taking part in regular screenings, routine preventative care and scheduling visits for minor acute issues can help you get ahead of illnesses and health conditions and help reduce health care costs.

Find a physician at MercyHealthPhysicianPartners.com or 844-BeRemarkable

Make it easy to keep up to date with more stories like this.Download the 13 ON YOUR SIDE app now.

If you would like more information about advertising with 13 ON YOUR SIDE, please contact Jeff Olsen at jolsen@wzzm13.com.

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Tucsonans who have been moved, promoted or appointed in July-December 2019 – Arizona Daily Star

Monday, November 11th, 2019

Elizabeth R. Betsy Cantwell has been appointed as senior vice president for research and innovation for UA.

Cantwell will lead the UA Office of Research, Development and Innovation, which includes the Corporate Engagement Program, Tech Launch Arizona and the UA research parks.

She will be responsible for expanding the universitys capacity for knowledge creation and discovery; integrating efforts by faculty, students, staff and executive leaders to move inventions and technologies to the marketplace; increasing the UAs connectivity with external collaborators; spearheading industry and public partnerships; and increasing total research funding.

She joins the UA after serving as the CEO of Arizona State University Research Enterprise.

Cantwell moved to higher education after working for the Lawrence Livermore National Laboratory, where she was director for economic development and currently serves as a guest scientist.

Cantwell earned a masters in business administration from the Wharton School at the University of Pennsylvania after earning a doctorate from the University of California, Berkeley, in mechanical engineering and a bachelor of arts in human behavior from the University of Chicago.

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Animal Planet’s ‘Crikey! It’s the Irwins’ features Oregon Coast Aquarium – The News Guard

Monday, November 11th, 2019

Animal Planets 'Crikey! Its the Irwins' will feature the Oregon Coast Aquarium in an upcoming episode on Saturday, November 23 at 5 p.m.

The non-profit Aquarium in Newport, invited the Irwin family to learn first-hand about the extensive animal care that the AZA-accredited facility provides.

The Animal Planet film crew documented Bindi Irwin assisting Aquarium husbandry staff in veterinary procedures and health checks for a wide variety of animals.

Boots, a harbor seal at the Oregon Coast Aquarium, is especially loved by visitors for her friendly demeanor. She found her home at the Aquarium after stranding on a beach in Mexico in 1988 as a pup.

At 31 years old, Boots is living much longer than she would in the wild. As a result, she needs increasingly specialized care to treat geriatric-related issues like arthritis. On the episode, Bindi works with Oregon Coast Aquarium Curator of Mammals, Brittany Blades, and Oregon Coast Aquarium Head Veterinarian, Dr. Dan Lewer, to provide a health check, laser therapy and chiropractic care to Boots.

It was great to meet and share information about animal care with Bindi, said Blades. She clearly has a good animal sense about her, and Boots responded very well to her, even interacting with her in the water after the exam.

"Bindi also mentioned that she had been considering using laser therapy at the Australia Zoo, so I think it was great for her to get this experience.

Laser therapy is just one example of the state-of-the-art medical care that the Aquarium provides for its animals. During her day at the Aquarium, Bindi also helps conduct an ultrasound on Dotty, the female dogshark, to check for pups and assists in annual health checks on a giant Pacific octopus and Japanese spider crab.

The Oregon Coast Aquarium is committed to providing the best quality care for its animals, which serve as ambassadors to the public for their wild counterparts. Restaurant quality seafood diets, highly trained staff, animal enrichment, and functional, natural habitats all contribute to this commitment, which is highlighted on the Crikey! episode. The Aquarium also partners with Willamette Veterinary Hospital to provide highly specialized veterinary care, including surgery, eastern medicine, preventative care and physical and laser therapy.

Terri Irwin, a Eugene, Oregon native, has visited the Oregon Coast Aquarium with her family for many years. The Irwins currently live in Australia where they own the Australia Zoo, a global zoological destination and world leader in wildlife conservation.

The entire Oregon Coast Aquarium team was ecstatic to host the Irwin family and Animal Planet and share our passion for wildlife. I think for many of us, it realized a lifelong dream, said Sally Compton, Oregon Coast Aquarium Communications and Marketing Manager. These relationships are essential because even from opposite sides of the world, we can work together to learn best practices for animal care. Ultimately, we share the same mission to educate people about wildlife and protect the planet.

If you are interested in watching the episode, tune into Animal Planet on Saturday, November 23 at 5 p.m. or catch it after it airs on http://www.animalplanet.com/tv-shows/crikey-its-the-irwins.

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Laughter Therapy: 11-10-19 – West Hawaii Today

Monday, November 11th, 2019

Aloha all! Responding to several readers, I will start with some one-liners as a warm up. Then well get to some serious LOLs.

Why are math textbooks so stressed? They deal only with problems.

Why was the farmer upset? His cows were very moo-dy.

Why are movie stars so cool? They have so many fans. One more?

What happened when the wheel was invented? It caused a world-wide revolution! Duh!

The Texas sheriff was looking for a deputy. So, Chad, the new recruit who was a blonde man wanted the job.

OK, the sheriff drawled, Chad, what is 1+1?

Chad replied, 11.

The sheriff thought it was not what he expected for an answer, but it was correct. Then he asked, What two days of the week start with the letter T?

Chad answered, Today and tomorrow.

Again, the sheriff was surprised and thought that maybe Chad had a creative mind.

Now Chad, listen carefully, Who killed Abraham Lincoln?

Chad looked a bit surprised, thought for a few minutes, then responded: I dont know!

The sheriff said, Well, why dont you go home and work on that one for awhile.

So, Chad wandered over to the pool hall where his pals were waiting to hear about the results of his interview.

Hey Chad, How was it?

Chad responded, It went great. First day on the job and Im already working on a murder case! (Did you forget that Chad was blonde?)

Why did the snail get a giant letter S painted on his Ferrari? So people will say, Look at that S-car go!

A man and a dog walk into a talent agents office. The agent says, OK, lets make this quick. Im busy. Whats your talent?

The man says, Its not me sir, its my dog. He talks!

Yea right, says the agent. Get out! Im busy.

No wait, says the man, Ill prove it. He turns to the dog and asks, What do you normally find on the top of a house?

Roof! says the dog, wagging its tail. Then the man asks the dog, How does sandpaper feel?

Rough, exclaims the dog.

The agent again says, Youre wasting my time!

Just one more, pleads the dogs owner. He then asks the dog, Who was the greatest baseball player ever?

Ruth, barked the dog!

OK, thats it, and the agent forces them out the door. Turning to the man, the dog sighs and says, Maybe I should have said Joe DiMaggio?

A man tells his doctor that he cant do all the things around the house that he used to do. After a thorough exam and some blood test, the doctor says to the man, Well, in plain English, I think you are just lazy.

With a smile, the man says, OK, now give me the medical term so I can tell that wife of mine. Maybe shell even have some sympathy for me.

Yes, it is almost winter time. So remember, you know its a cold day when your teeth start chattering and theyre still on the night stand.

Now to close, looking at my medical career, I can honestly say that impeachment is like the emergency room. We need to practice preventative medicine. Last LOL, my friends, be well, do good deeds.

Aloha, a hui hou.

Shay Bintliff, MD, writes a monthly humor column for West Hawaii Today.

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New Hays business brings traditional office therapies to the door – Hays Post

Monday, November 11th, 2019

By JAMES BELLHays Post

Physical therapy is typically something a person does not think about until it is needed and then finding time during a workday when offices are open is often a challenge.

ButAimee Riegel opens to change that with her new business Fit PT and Physical Therapy.

What I have done is created a mobile concierge physical therapy practice where I can come to the client, Riegel said.

And she offers different services than what you might see in a traditional physical therapy office such as working with employers to develop programs for their employees to help them before therapy is needed.

A lot of them are simply because we sit too long during the day, she said. There is a lot of things I can teach people and employers to show their employees.

Working directly with the public can be beneficial for the individual as well in both well being and pricing, she said. Not being contracted with insurance companies means she can offer a flat rate sometimes lower than out-of-pocket costs after a traditional office setting.

You know what you get up front,Riegel said.

Working outside of insurance she said also allows her the flexibility to work with what the client needs regardless of the mandates of an insurance company.

We can make a plan and really follow through without having insurance dictating (care), Riegel said.

When the range of motion is recovered, insurance companies will often stop covering treatment thats where her new service can come in.

Working with people to maintain a range of motion can help stop problems from occurring that can happen when not seeking treatment.

She launched the business in September and has been gaining clients through word of mouth and continues working at Progressive Physical Therapy two days a week in order for clients who are going through insurance companies to be able to use her services as well.

But through the new business, she offers flexibility in scheduling that a regular office normal will not.

Im available evenings. I can be available weekends. I try to be as flexible as I can for my clients, Riegel said.

Ive gotten some really great responses from the community, she said, adding many have told her this service is much needed in Hays.

And while the service is new, many will already know Riegel as she has been a long-time practitioner of physical therapy.

I have been practicing physical therapy for about 12 years and decided I wanted to branch out into something a little different, she said.

Using her services can help maintain motion and stay pain-free, and utilizing physical therapy prior to a specific incident is becoming more popular.

The American Physical Therapy Association is actually pushing really hard for preventative wellness and medicine, Riegel said.

By doing so, they hope to keep insurance costs lower, she said, by engaging people before they have an issue.

Wellness services can also more personally directed than insurance-mandated treatment.

Its more than developing exercises for an individual. Its very personal, Riegel said.

She helps see how people move and can direct their treatment to address their specific concerns.

Riegel offers a free discovery consultation where she can hear problems and see if her services would be a good fit.

An initial full consultation is $150 for approximately an hour and a half and includes a full evaluation and treatment during the visit.

A regular session is $125 for wellness or physical therapy.

She also offers a half-hour session for $70 or stand-alone dry needling for $45.

Health Spending Accounts and Flexible Spending Accounts can be used and if multiple sessions are needed she offers discounted rates packages.

For more about the business or to set up a consultation, visit http://www.fitptandwellness.com, Facebook or call (785)261-1772.

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Gene Tech Company Claims to Have Found a Cure for HIV/AIDS – NewNowNext

Monday, November 11th, 2019

by Sam Manzella 11/8/2019

A group of medical researchers in Maryland believe the answer for curing HIV/AIDS may be gene therapy.

American Gene Technologies (AGT), a Rockville-based medical research company, has submitted a Investigational New Drug (IND) application with the FDA to begin gene therapy trials that researchers believe could eliminate HIV in people already living with the virus.

The drugan HIV treatment program called AGT103-Tis a single-dose, lentiviral vector-based gene therapy that AGT says could remove infected cells from the body and decrease or eliminate the need for lifelong antiretroviral treatment in HIV-positive patients.

If approved, the company hopes to begin a Phase 1 clinical trial that will examine the safety of AGT103-T in humans.

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In a press statement, AGT chief science officer C. David Pauza, PhD, said the companys objective is to treat HIV disease with an innovative cell and gene therapy that reconstitutes immunity to HIV and will control virus growth in the absence of antiretroviral drugs.

AGTs approach differs from other medical researchers attempts to cure HIV. As NewNowNext reported earlier this year, researchers in Europe made headlines when two separate HIV-positive patients no longer had the virus after obtaining bone marrow transplants from donors with an HIV-resistant mutation to treat unrelated cancers.

Those patients marked the second and third time doctors were able to effectively cure patients living with HIV via bone marrow transplant in the history of modern medicine. However, HIV/AIDS activists and medical professionals were quick to raise concerns about the feasibility of curing HIV with bone marrow transplants on a more widespread basis.

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Kenneth Freedberg, MD, a professor of medicine at Harvard Medical School and Massachusetts General Hospital, told NewNowNext in March that the method is not a remotely plausible strategy for HIV treatment for the vast majority of patients.

A bone marrow transplant is an extraordinarily toxic and life-threatening intervention, which you do if someone has an illness thats clearly going to be fatal, Freedberg explained. There must be no other treatment options available. It puts people at massive risk for infections and toxicity complications.

As the fight against HIV/AIDS wages on, communities at risk of contracting the virus continue to take preventative measures against new infectionsincluding daily use of Pre-exposure prophylaxis (PrEP), a potentially life-saving HIV prevention drug that is massively popular among gay, bisexual, and queer men.

In the United States, PrEP is pretty much exclusively available as Truvada, its brand-name version manufactured by Gilead Sciences with a very high retail markup. That may change soon, though: Earlier this week, the government filed a lawsuit against Gilead alleging patent infringement on PrEP, which was patented by public health researchers at the Department of Health and Human Services years ago.

Brooklyn-based writer and editor. Probably drinking iced coffee or getting tattooed.

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Living Longer Is All About Chemistry and the Miracle Molecules – Qrius

Monday, November 11th, 2019

Lizzy Ostler, University of Brighton

Given the opportunity to live much longer lives, many of us might feel less than thrilled at the prospect. After all, you might think, who would want to live an extra 20 years dealing with arthritis, dementia or heart problems?

But what if those years could be filled with youthful vigour or at least middle-aged comfort?

The ability to reverse, or slow down, the degenerative processes that come with increased age has been a long held human aspiration. Indeed it has provided a consistent focus for decades of scientific research on ageing.

But it is only in the last ten years that the replacement of palliative treatments (which suppress the symptoms of age-related diseases) with genuine anti-degenerative medicines (which prevent and repair) has become more than a pipe dream.

This paradigm shift stems from recent research that shows that just a few biological root causes underpin almost all the diseases of old age. Such a discovery is an opportunity to address a wide range of illnesses simultaneously with treatments that target single biological mechanisms. For the first time, ageing has become druggable.

One leading cause of age-related changes, including illness, is known as cell senescence. This is a consequence of evolution that only really comes into play when organisms outlive their normal reproductive age, or are subjected to a very damaging environment. When cells become senescent they can no longer divide, and typically behave in a way that damages the tissue around them.

For many years, much of the gerontological community had considered cell senescence to be a symptom rather than a cause of age-related decline. However, recent groundbreaking research showed that removing senescent cells from mice not only prevents normal ageing, but actually reverses many of the symptoms. This proof that senescent cells cause ageing finally provides us with the potential to develop a cure.

Follow up work has revealed that the positive effects of senescent cell removal in mice extend to myocardial infarction (which causes heart attacks), Alzheimers disease and metabolic dysfunction. The challenge now is to translate these findings to treatments in ageing humans.

To that end, major investors have now joined researchers in the search for ways to kill, remove or rejuvenate senescent cells. And they have made exciting progress.

For example, when combined, dasatanib (a leukaemia drug) and quercetin (a natural product found in vegetables), show improved health and lifespan in mice. And early results from clinical trials of this combination have demonstrated the first ever alleviation of physical dysfunction in patients with idiopathic pulmonary fibrosis, a progressive degenerative lung disease with no current effective treatment.

The list of common side effects associated with dasatanib means it would likely be restricted to only the most seriously ill patients. But the trials give hope for medicinal chemists to develop a more palatable second generation of similar drugs.

An alternative strategy is the rejuvenation of senescent cells. Resveratrol, found in red wine and chocolate, was shown to be able to rejuvenate senescent cells in the lab, restoring their molecular fingerprint and growth to that of normal youthful cells.

Importantly, this work also demonstrated that small synthetic modifications were able to tune the effects achieved - again demonstrating that a medicinal chemistry approach to the problem is highly likely to be successful.

Elsewhere, Fisetin, a natural product found in strawberries, apples and onions, was recently shown to confer both improvements in health and a reduction in the senescent cell load in old mice. It is now also the subject of clinical trials.

Interestingly, Fisetin also interacts with other key ageing mechanisms, such as nutrient sensing the biological mechanism that underlies the well known health and lifespan increasing effects of calorie restriction.

It is not yet clear whether this is a new kind of super-therapeutic that simultaneously targets more than one cause of ageing, or whether it will reveal a new piece of the jigsaw that allows us to integrate the known paths to morbidity into a coherent whole.

The research conducted so far, just using natural products and existing drugs, has shown unequivocally that small molecules can produce a broad spectrum of anti-degenerative effects.

Drug discovery for ageing is moving beyond its infancy, and preventative medicine that will revolutionise 21st-century healthcare is now genuinely possible. Now we need to add synthetic medicinal chemistry to the mix to develop safe and effective drugs that will help us all into a healthier and more active future.

Lizzy Ostler, Head of Chemistry, University of Brighton

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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13 Unexpected Reasons Why You Might Have A Fever – HuffPost

Monday, November 11th, 2019

Feeling a little heated? Its typically nothing to worry about especially if youre sick. However, other issues can cause your temperature to rise.

A normal body temp is typically around 98.6 degrees Fahrenheit (37 degrees Celsius) but can vary slightly for each individual, and even fluctuate depending on the time of day.

It can be lower in the morning and higher in the late afternoon and evening, said Michael Hall, a physician based in Miami. But when your temperature gets to 100.4 degrees Fahrenheit or higher, and lasts more than a few hours, youre getting into fever territory something that can be caused by a number of conditions.

Most of my patients understand that a fever is a common symptom of cold and flu, said Christopher Dietz, an area medical director at MedExpress Urgent Care. However, what some people might not realize is that a fever isnt always just a sign that youre coming down with something.

Heres what could also be at play, according to medical experts:

PhotoAlto/Frederic Cirou via Getty Images

Infections

If you are looking for the reason behind your elevated temperature, start here. Experts note that infections are commonly associated with a fever.

When the immune system detects a threat such as bacteria or virus, a substance known as pyrogens is released into the bloodstream to reach the hypothalamus, which regulates body temperature, said Diana Gall, a general practitioner with Doctor4U in the U.K. When the hypothalamus detects pyrogens, it raises body temperature and causes fever in an attempt to kill off bacteria and viruses.

She noted that a high fever is one of the ways your body is responding and fighting the infection but a body temperature that is too high can also be dangerous.

If the fever is persistent and isnt coming down with home remedies, you should see a doctor, particularly if the fever is accompanied by a severe headache, difficulty breathing, blood in your urine or stool, redness of the skin or rash, or vomiting, etc. The infection may be serious and your body temperature may not reduce without medical treatment, she said.

Overexerting yourself outdoors

Hot outdoor temperatures and internal heat generation from exercise and mechanical movement of the body can heat you up, said Phil Mitchell, national medical director at DispatchHealth.

Under normal circumstances, your body will function well enough to cool you down through sweating and dilation of blood vessels. But if these basic systems are overcome and you cannot cool down, your body will continue to increase in temperature.

This typically does not happen from exercise alone, but exertion in a hot environment can cause this under the right circumstances, Mitchell said. He noted that you should immediately remove yourself from the heat and try other methods to cool your body down if this is the case.

Heatstroke can occur if heat exhaustion is not treated promptly. You need immediate medical attention if you become confused, lose consciousness or if you have an elevated temperature in this situation, said Steven Reisman, a cardiologist and director of New York Cardiac Diagnostic Center.

Vaccinations

Vaccines to prevent a bacterial or viral infection prepare your body to come in contact with that infection later, said Erik A. Larsen, assistant director of EMS and emergency preparedness at White Plains Hospital in New Yorks Westchester County.

So when you get the vaccine, your bodys immune response is stimulated and the body says, Whoa, what is this? It then mounts a fever, he said.

Larsen added that when you get a vaccine, youre not really invaded by an active infection, but it tips your body off that sometime in the future you may come across this.

tommaso79 via Getty Images

Alcohol withdrawal

Low-grade fevers can occur during the first few days of alcohol withdrawal as the central nervous system, which has been suppressed by alcohol, readjusts, said Holly Phillips, a board-certified general internist in New York and a medical expert for RxSaver.

Alcohol withdrawal also causes tremors, which can affect your heat, Larsen said.

The body is reacting to the loss of not receiving alcohol, which creates muscle contractions. This makes the body shake like a tremor, and it raises the bodys temperature, he said.

Inflammatory conditions

Certain inflammatory conditions, like rheumatoid arthritis and lupus, can cause fevers, said Lisa Alex, a physician at Medical Offices of Manhattan. This also occurs because the body is producing pyrogens, which raises your temperature. So if you have underlying inflammatory conditions and have a flare-up of any sort, the result may be a fever.

Certain medications

Many medications like antibiotics [and] antimalarials can also cause drug-induced fever. Anticonvulsants and some herbal medications can also do the trick, said Soma Mandal, a New Jersey-based physician.

You should monitor your bodys reaction when taking any new medication.

Look for a fever that starts a week after starting a new medication and goes away once you stop taking the drug, said J. David Gatz, an assistant medical director of the emergency department at the University of Maryland Medical Center.

Blood clots

Blood clots are an under-discussed source of fevers, according to Nate Favini, medical lead at preventative primary care service Forward.

If youre experiencing fever along with pain, swelling and redness in your leg or shortness of breath, that could be a sign of a blood clot, he said.

Endometriosis

While rare, several of my patients have had fever and flu-like symptoms every month at the start of their periods, likely due to severe pelvic inflammation caused by chronic bleeding into the stomach from wide-spread endometriosis, said Kenneth Ward, director of Predictive Laboratories and a scientific advisor for Predictive Technology Group in Salt Lake City.

If you experience this, Ward suggested making an appointment with your physician to get screened for the condition. Additional symptoms can include debilitating cramps during your period or pain with sex, urination or bowel movements.

Recent surgery

If youve recently gone under the knife, especially for a chest or abdominal procedure, you may experience an elevation in temperature in the days to follow, known as postoperative fever.

The body produces inflammatory proteins in response to the trauma surgery ... This causes fever as a reaction for the first few days post-operatively, said Laurence Gerlis, CEO and lead clinician at SameDayDoctor in London.

Studies show that this is a common side effect from surgeries, with up to 90% of patients reporting elevated temperature after the fact. In most cases, this resolves on its own.

Fevers could also be a side effect to anesthesia, although thats more rare, said Erin Nance, an orthopedic surgeon and hand and upper extremity specialist in New York. This is called malignant hyperthermia.

When this happens, according to Nance, its because of your bodys response to common anesthetic agents used during surgery. This can present as a high fever, muscle rigidity and rapid heart rate. The condition can be fatal and is treated with a medication called Dantrolene and ice packs.

If you have a family history of malignant hyperthermia, it is critical to tell your anesthesiologist before proceeding with surgery, she said.

STIs

Rina Allawh, a board-certified dermatologist with Montgomery Dermatology LLC in Pennsylvania, said that certain sexually transmitted infections may cause a higher-than-normal temperature.

Initially, syphilis presents with a non-tender chancre (i.e. an ulcer). However, if left untreated, may result in high fevers, joint pain, lymph node enlargement and fatigue, he said.

Gonorrhea, if left untreated, may result in high fevers associated with a rash, Allawh said. To prevent life-threatening consequences, prompt recognition and treatment of the condition is essential, he said. Additionally, practicing safe sexual practices and sexual-transmitted disease testing is equally as important.

Traveling to another country

Depending on the area of travel, a rise in body temperature can often be attributed to tropical bacteria and protozoa not often seen in developed countries, said Amna Husain, a board certified pediatrician and founder of Pure Direct Pediatric in New Jersey.

For this reason, I recommend travelers consult with their physicians and refer to the (Centers for Disease Control) guidelines for safe food and water recommendations, she said.

laflor via Getty Images

Hormone disorders or changes

Hyperthyroidism itself does not cause a fever, but we can see a very dangerous and fatal disorder associated with a large influx of thyroid hormone into the body called a thyroid storm, which does have fever, along with rapid heartbeat, fluctuations in blood pressure, and tremors associated with it, Husain said.

She noted that thyroid storm can occur because of a major stressor such as trauma, heart attack, delivery of a baby or because of an infection in people with uncontrolled hyperthyroidism.

In rare cases, it can be caused by treatment of hyperthyroidism with radioactive iodine therapy for Graves disease, she said.

Hormonal changes that occur during menopause can also cause you to feel warmer than normal, which are typically known as hot flashes.

Cancer

Keep in mind that a fever isnt necessarily the first sign or a major sign of cancer. However, it could be one of many symptoms.

Several cancers are associated with fever, which are most commonly leukemias and lymphomas, although other cancers can cause this as well, said Timothy S. Pardee, chief medical officer at Rafael Pharmaceuticals and an oncologist and director of Leukemia Translational Research at Wake Forest Baptist Health in North Carolina.

Pardee said this occurs because, in some cases, cancer cells create an inflammatory response, which then causes the body to respond with a fever. In other cases, the cancer cells themselves secrete cytokines or substances in the body that can cause a fever. And, according to Pardee, cancers like leukemia can impair your bodys ability to fight off infections resulting in prolonged illnesses and fevers.

Additional symptoms to look for are unintended weight loss and drenching night sweats (where you have to change your shirt or sheets when you wake up). These symptoms should prompt a call to your doctor for further evaluation, he added.

When you should be concerned about a fever

A fever may not be cause for alarm, unless there are some specific situations, said David Cutler, a family medicine physician at Providence Saint Johns Health Center in Santa Monica, California.

He added that medication to reduce fever when there is an infection like a cold, flu or pneumonia can help minimize bothersome symptoms like headache, body aches and dehydration from excessive sweating.

But if the fever is caused by hormonal effects, such as menopausal hot flashes or muscular activity like strenuous exercise, these medications will not be effective. In these instances, Cutler said to use measures like cooling fans to lower the bodys temperature.

According to Amesh A. Adalja, senior scholar at Johns Hopkins Center for Health Security in Maryland, a person should be concerned for fever above 101 degrees Fahrenheit (38.3 degrees Celsius) when it is unremitting, when it is associated with other symptoms such as dehydration, extreme fatigue, shortness of breath and severe rash.

Additionally, someone suffering who has a compromised immune system should have a low threshold for seeking medical attention. Same goes for those who are pregnant, have heart or lung disease, or who are very young, he said.

That said, if youre ever concerned about a fever, its always worth it to call your doctor. Thats what theyre there for, after all.

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UCT medical volunteer organisation to cut back activities after funding cuts – News24

Monday, November 11th, 2019

The Students' Health and Welfare Centres Organisation (Shawco) at the University of Cape Town (UCT) is set to cut back on some of its work after the institution reduced funding in October.

The university announced in a statement last week that Shawco would continue to provide its normal range of medical activities on the Cape Flats, but certain educational activities would be reduced.

Shawco has more than 3 000 student volunteers, but the number has dropped in recent years, placing the programme on a short list for UCT's tightening budget.

The organisation lost several members of its leadership after the cutbacks, leaving university officials and students unsure of its operating status.

"The current situation at Shawco requires an immediate response, and the executive leadership is committed to finding a viable solution that will ensure that its legacy is preserved," said UCT spokesperson Elijah Moholola.

Shawco has been operating for more than 75 years, providing free medical services to under-served communities in Cape Town. During apartheid, the organisation became well-known for providing medical services to protesters during conflicts with the police.

Today, Shawco runs 15 health and education projects across the Cape Metropole.

UCT medical students work at mobile clinics to provide services like screenings, testing for sexually transmitted infections, and preventative care.

The educational programmes are designed to better community understanding of health, wellness, and medicine, as well as reduce stigma toward diseases like HIV and tuberculosis.

These are the programmes that will be reduced over the summer holidays.

GroundUp contacted several members of Shawco's executive board for answers, including CEO Crain Soudien, to no avail.

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Medical Wellness Market with Leading Players are: Massage Envy, HEALING HOTELS OF THE WORLD, Steiner Leisure Limited, Fitness World, Universal…

Monday, November 11th, 2019

The latest research Medical Wellness Market both qualitative and quantitative data analysis to present an overview of the future adjacency around Medical Wellness Market for the forecast period, 2019-2024. The Medical Wellness Markets growth and developments are studied and a detailed overview is been given.

Get Sample Copy of this Report at https://www.reportsintellect.com/sample-request/602270

A thorough study of the competitive landscape of the Medical Wellness Market has been give presenting insights into the company profiles, financial status, recent developments, mergers and acquisitions, and the SWOT analysis. It provides a refined view of the classifications, applications, segmentations, specifications and many more for Medical Wellness Market. This market research is an intelligence report with meticulous efforts undertaken to study the right and valuable information. Regulatory scenarios that affect the various decisions in the Medical Wellness Market are given a keen observation and have been explained.

Some of the leading market players include: Massage Envy, HEALING HOTELS OF THE WORLD, Steiner Leisure Limited, Fitness World, Universal Companies.

Reports Intellect projects detail Medical Wellness Market based on elite players, present, past and futuristic data which will offer as a profitable guide for all Medical Wellness Market competitors. Well explained SWOT analysis, revenue share and contact information are shared in this report analysis.

Segmentation by Type: Complementary and Alternative Medicine, Beauty Care and Anti-Aging, Preventative & Personalized Medicine and Public Health, Healthy Eating, Nutrition & Weight Loss, Rejuvenation, Other.

Segmentation by application: Franchise, Company Owned Outlets.

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Table of Contents

2019-2024 Global Medical Wellness Market Report

1 Scope of the Report1.1 Market Introduction1.2 Research Objectives1.3 Years Considered1.4 Market Research Methodology1.5 Economic Indicators1.6 Currency Considered

2 Executive Summary2.1 World Market Overview2.1.1 Global Medical Wellness Market Size 2014-20242.1.2 Medical Wellness Market Size CAGR by Region2.2 Medical Wellness Segment by Type2.2.1 Complementary and Alternative Medicine2.2.2 Complementary and Alternative Medicine2.2.3 Preventative & Personalized Medicine and Public Health2.2.4 Healthy Eating, Nutrition & Weight Loss2.2.5 Rejuvenation2.2.6 Other2.3 Medical Wellness Market Size by Type2.3.1 Global Medical Wellness Market Size Market Share by Type (2014-2019)2.3.2 Global Medical Wellness Market Size Growth Rate by Type (2014-2019)2.4 Medical Wellness Segment by Application2.4.1 Franchise2.4.2 Company Owned Outlets2.5 Medical Wellness Market Size by Application2.5.1 Global Medical Wellness Market Size Market Share by Application (2014-2019)2.5.2 Global Medical Wellness Market Size Growth Rate by Application (2014-2019)

3 Global Medical Wellness by Players

Continued.

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Are you exercising too much? | Weekend – The Times

Monday, November 11th, 2019

Long, gruelling workouts may do more harm than good, especially after 45

Its increasingly common for midlifers to be the most ferocious exercisers at the gym. We relish brutal bootcamp-style classes, spin ourselves silly and push ourselves to ever more extreme challenges marathons, triathlons and week-long cycling races. We all want to live longer, healthier lives.

However, some experts believe that for the over-45s in particular, exercising at high intensity for more than 45 minutes at a time is detrimental, putting chronic stress on the body and accelerating ageing. So are you training too hard for too long? And could doing less give you a better body and health?

A study published this week in the British Journal of Sports Medicine found that one brisk jog weekly no faster than 6mph (about 9.5km/h) and no longer

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The Most Important Things Women Should Know About Heart Health – StyleBlueprint

Monday, November 11th, 2019

A sudden pain, starting in your chest and radiating down your left arm. Pressure, as if an elephant suddenly sat upon your upper torso. Shortness of breath. Cold sweats. These are the classic signs of a heart attack for men. But what about women? Are the symptoms the same? Join us as we talk to a heart health expert at Norton Heart & Vascular Institute, to find out common heart attack signs and how men and women differ. Well also hear the stories of two women who survived unexpected heart problems and lead healthier, more active lives today.

First, a little background information: The term heart disease refers to several different heart conditions. In the United States, it usually means coronary artery disease, which affects the flow of blood to the heart. A heart attack happens when a part of the heart muscle doesnt get enough blood. Heart disease, left untreated, can cause a heart attack.

One in every five deaths in women is caused by a heart attack.

Current statistics from the Centers for Disease Control and Prevention and the American Heart Association show:

Although heart disease is the leading cause of death for women, heart attacks and heart disease have traditionally been perceived as a mens health issue. In fact, says cardiologist Dr. Janet Smith, that is why the so-called classic symptoms are typically symptoms men experience. For years, all the studies focused on men, so the symptoms they listed were what everyone came to recognize as symptoms of all heart attacks, explains Dr. Smith, who specializes in internal medicine and cardiovascular disease at Norton Healthcare.

Women can present the classic signs of a heart attack, she continues. Chest pressure or pain is the most common symptom for both men and women. But women are more likely than men to feel some of the other symptoms like shortness of breath, nausea, and fatigue. Many describe to me a feeling that something is very wrong, almost a feeling of impending doom.

Women should seek medical attention immediately if they notice*:

Some women may have no symptoms, or may not recognize them until too late. Brenda Burney was 63, healthy, active, and working when a stress test sent her reeling. Formerly in the military, Brenda has always known the importance of exercise, though she switched from running her miles to walking. A single mother of two grown sons, she relishes her role as Grammy to four granddaughters. And as a hospital chaplain, she is always busy. The job was (and is) stressful, however, and her doctor had become concerned about her blood pressure. I took a routine stress test on August 19, 2018, says Brenda. The doctors realized that something was wrong and sent me immediately to Norton Audubon Hospital where I was diagnosed with heart disease. Three days later, I had triple bypass surgery.

Looking back, Brenda says the warning signs were there. She has a family history of heart disease; her father had triple bypass surgery, her mother underwent a quadruple bypass. High blood pressure is another indicator. Brenda recalls experiencing a burning feeling in her chest when she exercised, a strange grabbing pain across her back, and fatigue. What does she want women to know? You are in control of your bodies. Listen to your body and allow it to tell the story of how you are.

Brenda was not aware she had heart disease until she took a stress test. She later underwent triple bypass surgery to improve her heart health.

Brenda attributes her survival to the quick intervention of her health providers and the support of her family. They were just as shocked as I was, but my extended family became my primary caregivers. They met to figure out a schedule and took off work to be with me.

Today Brenda is back at work as a palliative care chaplain. She eats well and continues to exercise, even introducing a Lets Move line dance group for seniors at her church. Most importantly to her, shes become a champion of womens heart health, sharing her story with others, promoting healthy diet and exercise, and actively participating in a support group at Norton.

After an event, its all about lifestyle, Dr. Smith explains. Making necessary changes is critical. Eating a heart-healthy diet, getting regular exercise, maintaining an optimal weight, not smoking, and taking prescribed medication are all important factors to recovery a lesson it took Chloe McClure two heart attacks to learn.

One of five daughters, Chloe has lost two sisters to colon cancer. One sibling had to have a colon resection, one sister is a breast cancer survivor, and her father died of a stroke in 1956. Her only brother died of a heart attack, but with so much cancer in her familys health history, Chloe says heart health was not really on her radar.

Single with two grown daughters, Chloe was a year from retirement as an administrative assistant when she had her first heart attack in January 2011. Like Brenda, Chloe also experienced intense fatigue, sometimes falling asleep in her work clothes right when she got home and sleeping until morning, but she chalked it up to her job. When her heart attack happened, it was sudden and surprising.

I leaned over to put paper in the copier and felt a huge, heavy weight in my chest, she says. It passed long enough for me to get help. I had an angioplasty with a stent at Norton and then I went right back to my same lifestyle. I didnt pay attention to diet or start exercising. My attitude was, Im fixed, so Ill just get on with my job.

Chloe has survived two heart attacks, and now appreciates the importance of leading a healthy, active life.

Two weeks after her April 2012 retirement, Chloe had her second heart attack.

I was having my morning coffee and noticed my shoulder bothering me. At first, I thought Id slept on it wrong, but then my jaw began hurting, almost like I had a toothache. I began to feel faint, then had chills and nausea. I realized what was happening so I called my daughter and she got me to the hospital quickly. The EKG showed I was having another heart attack. I had a second angioplasty with a stent.

She paid more attention to what her cardiologist told her this time. I started walking, she says. I participated in a mini-marathon this spring, I do Pilates, yoga, and water aerobics.

An ovarian cancer survivor, Chloe knows the importance of support groups. She also participates in the monthly group offered by Norton Healthcare and is on the Norton Patient and Family Advisory Council. She is an active volunteer in her community and with cancer support groups. Her best advice? Do not ignore what the doctor tells you!

Both Brenda and Chloe found help within Norton Healthcare, which provides some amazing preventative and after-care programs to help women get healthy and stay that way:

And lastly, what do cardiologists want women to know? Dr. Smiths parting advice echoes both Brendas and Chloes:

*Source: Norton Healthcare

To learn more about Nortons heart health programs and to find a physician, visit nortonhealthcare.com.

This article is sponsored by Norton Healthcare.

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This study seeks to find out why recruits get injured and what can the Army do about it – ArmyTimes.com

Monday, November 11th, 2019

NATICK, Massachusetts Researchers at an Army institute are more than halfway through a major study of what causes injuries in new recruits and what can be done about it.

Army Research Institute of Environmental Medicine, or USARIEM, Research Physiologists Julie Hughes and Stephen Foulis recently spoke with Army Times about the effort, which has so far studied 2,291 recruits with a goal of tracking 4,000 recruits for two years from basic training forward.

Some early findings show that, on average, the overall body weight of recruits didnt change dramatically during basic training. But both body fat and muscle mass did.

Early data shows that Army recruits through basic training increase their lean muscle mass by about 4 percent and decrease their body fat by about 15 percent.

While women make up less than 20 percent of enlisted recruits, according to a 2018 study on demographics of the U.S. military released by the Council on Foreign Relations, the study is trying to overrepresent the female population in order to answer questions on female soldier injury rates, Hughes said.

But, there are already promising data being analyzed that shows that recruit training benefits female recruits, resulting in lower body fat and higher lean muscle mass than their civilian counterparts in a just a few weeks of training.

The body composition and bone/muscle measurements will continue. But the next step will be a sleep study starting early next year, researchers said.

Hughes and Foulis are in the institutes Military Performance Division and worked with a team of about 20 researchers have traveled to both Fort Jackson, South Carolina and Fort Sill, Oklahoma to take bone scans and other tests to see what effects basic training is having, both positive and negative, on recruits.

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The aim is to determine, based on a host of characteristics, which recruits are more susceptible to injury and what interventions Army leaders might be able to take to prevent those injuries.

Ultimately, the goal is to put their data together and create algorithms that can better predict what part of the recruit population my have injury risks or problems in training.

Both researchers emphasized that the work is not to exclude anyone from training due to risks, but instead to identify factors they can adjust to prevent injuries, whether thats better nutrition, different types of events at different times of the training cycle or other ways to better prepare recruits for periods in which injuries might occur, such as progressive loading for ruck marches.

How do you alter the training environment for that person or for everyone to do better? Hughes said.

An added bonus is to push further with the research and find ways to optimize training to increase performance through better preventative steps.

The most recently released data from January showed that the study had conducted 2,000 tibia scans and collected more than 37,172 results from blood tests.

Subjects of the study had to do balance testing and vertical jumps so that researchers could also measure their strength and flexibility.

While there have been many theories behind some of the prevalence of basic training injuries, it wasnt until recent years that technological advances allowed for detailed measurements to take place.

Scientists can now measure intricate levels of bone density and see how it changes under stress through the nine-week basic training cycle.

The study began in 2017 at Fort Jackson and has expanded to Fort Sill since then, researcher said. Testing throughout the study measures bone density measures and body composition.

In early 2018, the Army introduced the Performance Readiness Bar to add more calcium and other nutrition supplements. Recruits are given the bar as an option to eat but researchers in this study will track if theyre actually consuming it and if there are effects of the extra calcium on injuries.

But what contributes to injury is far more complex than the density of bone or the composition of muscle and fat. Thats why researchers are looking at nutrition, fitness, sex, genetics, menstrual history, neurobehavioral social factors and sleep.

Neurobehavioral factors can be boiled down to somewhat subjective terms such as grit or resiliency, which are hard to measure but could play large roles in success.

Maybe somebody whos really getting after it has more of a risk injury, Foulis said. Or maybe because of that theyre at a lower risk of injury.

The sleep portion of the study will begin early next year, researchers said.

Another question researchers are trying to answer is why female recruits currently suffer higher injury rates than their male colleagues.

The study came from a partnership with the Armys Training and Doctrine Command and the Center for Initial Military Training.

Both of which had been involved with USARIEM in past work such as the Physical Demands Study. That study and another, the Occupational Physical Assessment Test Validation Study helped inform the OPAT in use today.

An estimated 1,200 trainees took part in the two studies, Mallory Roussel, USARIEM, spokeswoman told Army Times.

Foulis was a part of that project. In the study, researchers took three groups of an estimated 50 soldiers. Those groups completed eight simulated tasks four times over a two-week period.

Some of the tasks included a sandbag carry, casualty evacuation from a vehicle turret, casualty drag, movement under direct fire, stowing ammunition on a tank, loading the tanks main gun, transferring ammo from field artillery supply vehicles and finishing a 4-mile foot march.

The hands-on collection of initial entry information from recruits should wrap up by late 2020 and the two-year tracking will then end by late 2022. Researchers expect to release the full five-year study results by 2023.

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Kick the can of soda addiction for better health. – Bedford Bulletin

Monday, November 11th, 2019

If youre needing to start kick your day with a can of soda or two, and then find that you need that kick all over again to keep on going, you are addicted to soda.

So, what makes soda so addictive?Both regular and diet?

A few factors come to mind. Sugar, caffeine, the sound of that snap opening when opening that can and the fizz factor.

According to Gary Wenk, who is the director of the Neuroscience Undergraduate Programs at Ohio State University and who also wrote the bookYour Brain on Food,becoming addicted to soda is all in the design of the beverage. Soft drinks are designed with just the right amount of sweetness, caffeine and carbonation to make you crave a continuous gulp of it.

The sugar kick. A 12 oz. can of Coca-Cola has 39 grams of sugar which is equal to 10 teaspoons or over 3 tablespoons of sugar. The rush one gets from all that sweetness activates the rewards center in our brain in the same way that drugs do. All that sugar releases the brain chemical dopamine and gives us a sense of euphoria.

But what happens is that the feeling of euphoria is gone almost as fast as it happens, leaving the brain craving more.

And if you are drinking diet sodas, it leaves the brain thinking its getting the real thing but doesnt and increases the craving for more hoping for thereal thing.

Cordialis Msora-Kasago, who is a registered dietitian nutritionist and the spokesperson for the Academy of Nutrition and Dietetics, says that the more soda you drink, the bigger the reward and as with most things that are rewarding you develop a liking to it and then crave even more of it.

Then there is the caffeine kick.

Caffeine is a stimulant. It stimulates our brain and our brain likes anything that stimulates it, Wenk says.

Dr. Marilyn Cornelis, who is an assistant professor of PreventativeMedicine at Northwestern University in Evanston, IL, says one of the most widely consumed

psycho-stimulant in the world is caffeine. When you couple sugar with caffeine you get a double high which contributes to the desire to have it more often.

Now the fizz factor. Carbonation makes any drink more addictive, according to Wenk.

The fizz adds a small amount of acidity and when combined with sugar it intensifies the euphoric feeing of reward. This acidity also does something else. It somewhat blunts the sweetness of the sugar just enough to make you want more of it.

Kicking the soda addiction is important to your health especially if you are having more than one can a day. It can lead to obesity, type 2 diabetes, heart disease, increased risk of stroke and dementia.

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A woman had a tiny pinworm laying eggs in her butt for 2 months, and it’s more common than you might think – INSIDER

Monday, November 11th, 2019

After experiencing two months of anal itching and bleeding, a 32-year-old mother visited a medical clinic for a workup. A colonoscopy revealed that she had a 1-centimeter pinworm living and laying eggs in her butt, according to a report in the New England Journal of Medicine.

The woman's 5-year-old daughter had the condition too, which was eventually traced to the child's school, where a number of the girls' classmates got the same diagnosis.

Pinworms, or Enterobius vermicularis, are actually pretty common especially among children. While even just reading about the condition may lead you to feel queasy, the infection typically comes with few symptoms, and rarely leads to serious health issues.

Once diagnosed, it's fairly easy to treat, and families can protect against it with some basic hygiene practices.

As many as 50% of children pick up pinworms, the most common worm infection in the United States, according to the Centers for Disease Control and Prevention.

Infections from pinworms is most prevalent among children between the ages of 5 and 10 who may not wash their hands properly. Getty

While anyone can develop the infection, it's most prevalent among children between the ages of 5 and 10 who have a tendency to touch everything and may not wash their hands properly. Since it's such a contagious condition, family members and caregivers are prone to developing it as well.

So, what exactly are pinworms and how are they contracted?

As the name suggests. pinworms are small, thin, pin-shaped worms about the size of a staple, which can live in a person's colon and anus.

When an infected person scratches their anus due to an inflammatory response, the eggs cling to their fingers and easily spread from there. Someone can accidentally swallow or breathe in the eggs through contaminated food or beverages. They can also ingest the eggs by putting their fingers in their mouths after touching infected surfaces. Children are known to pick up the infection from playing in sandboxes, too.

After taking up residence in a person's body, female worms exit through the butt while the infected person is asleep, and deposit their eggs on the surrounding skin.

Common symptoms include itching around the vagina and anus, irritability and nausea.

How can parents take preventative measures to protect themselves and their children? Basic hygiene is key.

"Prevention of pinworms includes good hand hygiene, like washing hands with soap and water before eating and after using the bathroom," Nadia Sabri, a pediatrician at Austin Regional Clinic, told Insider. "No nail-biting, and keep fingernails short and clean."

Sabri recommends families wash linens, towels, and clothes in hot water and be vigilant about vacuuming play areas especially if there is an outbreak in a child's class.

Pinworms are highly contagious and can be transferred a number of ways, even from playing in a sandbox. Getty

She also advises parents to instruct their children to avoid scratching around the anus.

But parents shouldn't feel stigmatized if pinworms befall their family, as it can happen to anyone even A-list celebrities.

During an interview on the "The Joel McHale Show" last year, actress Kristen Bell opened up about how she caught pinworms from her 3-year-old daughter.

When Bell noticed her daughter scratching her bottom, she immediately knew there was a problem.

"You have to monitor it and you have to look in their poop," Bell told McHale. "Sure enough, I wiped and saw a little white worm."

Pinworm infections are easily detectable and treatable. Eggs will become visible by pressing pieces of tape to the skin around the anus, a process aptly called, the tape test. Shining a flashlight on the butt at night, when the parasite is more likely to show up, is another way concerned parents can check.

The condition is typically treated with oral medication, and medical experts recommend that an entire household seek treatment, even if just one person gets a diagnosis.

As they say, the early bird catches the worm.

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Impeachment is the ER. We need to practice preventative medicine. – The Week

Friday, November 8th, 2019

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If the impeachment inquiry against President Trump moves to a trial in the Senate, Sen. Cory Booker (D-N.J.) told reporters this week, his role there must take precedence over his presidential campaign. "We are doing something that is with the gravity of removing the sitting president from office," Booker said. "I will be there. I will be focused. And I will do my work."

Insofar as any member of Congress deserves plaudits for promising to prioritize duly representing his constituents over seeking greater personal power, that's dandy. But Booker's framing of his work as remedying a crisis of presidential misconduct evinces a too-common misconstruction and one which helped us into this mess in the first place. It makes the legislature's restraint on executive power entirely ex post facto, letting lawmakers skip the more necessary work of trimming the imperial presidency back to its basic administrative roots.

Impeachment is necessary and sometimes unavoidable, but it is not prophylactic. Partisanship keeps it from functioning as a reliable protection against future wrongdoing, because even the worst presidents can expect near-lockstep support from their own party in Congress, and almost every president in the last half century has had at least a few years of a friendly majority in one house or both.

Divided government likewise offers no guarantee of accountability, as House Majority Leader Nancy Pelosi's foot-dragging on this very impeachment inquiry has revealed. Political considerations, chiefly alienating independent and swing voters, will often outweigh ethical concerns. "High crimes and misdemeanors" are significantly in the eye of the beholder, and the beholder is looking at the next election cycle.

That reality makes impeaching the president rather like a trip to the emergency room. Yes, it might save your life. It's also mostly unconnected to the day-to-day of responsible, healthy living except if it's your own fault that you're in the emergency room, in which case the visit should prompt some changes to whatever part of your lifestyle is the culprit.

The congressional Democrats spearheading this impeachment have no apparent intention of making such a change. They'll bandage a broken skull and send the patient right back to biking without a helmet. They'll try to oust this president and leave the very same tools of corruption and abuse for the next one. They'll let him claim, in deed if not in word, that he has the "right to do whatever he wants as president," armed with pen and phone.

This state of affairs can only be acceptable to the selfish or naive. It appeals to politicians and partisans because the power they persistently leave unchecked will sometimes fall to them. Why melt the crown if it may yet rest upon your head? And it appeals to those who retain a civics class credulity about American politics, clutching against all evidence to the belief that we may yet develop markedly better and broader electoral tastes. Unless Mr. Rogers rises from the grave with a hankering for the campaign trail, I wouldn't count on it.

The safer and more certain option is massive structural reform. Congress must put meaningful restrictions on the power of the presidency. The executive branch has for decades crept beyond its proper administrative function to usurp congressional authority, dictating the priorities of state well beyond the vague leeway of executive discretion.

Incidentally, it is this very pseudo-lawmaking which made Trump's alleged quid pro quo possible. Reform could indicate to foreign leaders that the president is an administrator with no power to refrain from disbursing funds Congress told him to disburse. It could place stricter limits on national emergency declarations, ensuring the president cannot unilaterally move money around in direct contravention of Congress. It could significantly curtail presidential immunity, making the president subject to indictment. Perhaps most importantly, it could limit the scope of executive orders, the favored method for presidents of both parties to exercise unconstitutional policy-setting authority.

This is a difficult and unlikely ask in that it requires sacrificing short-term partisan advantage for a long-term shot at more functional and congenial governance. I get the implausibility here.

Still I recommend it, and will continue to recommend it forever, because impeachment is confusing, uncertain, retroactive, narrowly targeted, and politically fraught. It may censure or remove a bad president, but it does so only in connection to a small selection of provable misdeeds and via a process that will always be subject to accusations of injustice. The best impeachment remains a contributor to political rancor and fails to stop further executive overreach. It's an ounce of cure when we need a pound of prevention.

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What is Osteopathic Medicine and OMT? – CapeGazette.com

Friday, November 8th, 2019

You may have seen DO at the end of a physicians name but not known the meaning behind this degree. It stands for doctor of osteopathic medicine, and these doctors are trained in modern medicine as well as holistic medicine based on the philosophy that the body is an integrated whole. They receive special instruction in the musculoskeletal system and osteopathic manipulative therapy (OMT), a hands-on approach to diagnosing and treating patients. Bayhealth Primary Care PhysicianVincent Lobo, DO, DACFP, who has been performing OMT in his practice for over 40 years, discusses its uses and benefits.

The premise behind osteopathic or holistic medicine is that the mind, spirit, and structure and function of the body are interdependent. Essentially, if your body is structurally healthy, it heals itself. Pain or other problemsoccur when there are somatic dysfunctions of different levels of the spine, said Dr. Lobo. Somatic dysfunction is defined as a restriction in the bodys framework. This may originate in the skeletal system or fascia, the bodys connective tissue, and may alter the circulatory, lymphatic or nervous system.

If theres a lesion in the back or the spine is out of alignment, for example, the nerves that connect from that area to the internal organs send abnormal nerve impulses that will, in turn, affect those organs, he said. The opposite can also occur when a disorder of an internal organ manifests as a spine problem, such as an inflamed gall bladder causing back pain.

Osteopathic physicians aim to restore the normal mechanics in the body. In an osteopathic structural exam, I typically examine for posture, spinal motion, joint restriction, tissue spasms, spinal curvature, leg lengths, and conditions of the feet, said Dr. Lobo. With OMT, gentle pressure is applied or manual manipulations are done on the muscles, joints or nerves that are the source of the dysfunction. This can improve posture, relieve pressure and reduce pain.

Dr. Lobo said that some of the more common ailments for which he performs OMT are chest wall pain, tension headaches, thoracic pain, sinus problems, neck and low back pain, temporomandibular joint dysfunction (TMJ), and some abdominal pain. There are a variety of OMT techniques, and these are dependent upon the specific problem and a patients age. Two types are muscle energy techniques, involving muscle stretching and contractions, and myofascial release which is like a soft tissue massage.

A critical element of osteopathic medicine is preventative medicine and education, said Dr. Lobo. This includes encouraging patients to maintain healthy diet and physical activity, and teaching them what they can do on their own to help with their medical issues, such as using correct form when lifting, wearing orthotics in shoes, or doing certain exercises.

All DOs have the knowledge, but not all DOs perform OMT, Dr. Lobo said. Its another modality of treatment but like anything else, including physical therapy or acupuncture, nothing is 100%. I think its good for people to know that Bayhealth has this resource through some of its doctors.

To learn more about osteopathic physicians and those who use OMT in their practice, visitBayhealth.org/Find-A-Doctoror call 1-866-BAY-DOCS (229-3627).

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