StemCell Therapy

Nearly two years into the global pandemic, there remain a handful of approved therapies to treat COVID-19.

Dr. Dermot Kelleher

And with emerging variants threatening the effectiveness of existing vaccines, there is an ever-pressing need to find new treatment approaches to fight the disease.

At UBCs faculty of medicine, researchers Dr. Dermot Kelleher and Dr. Shane Duggan are tackling this challenge head on, redirecting elements of their groundbreaking research on esophageal disease to develop a novel aerosol treatment for COVID-19.

The global effort to intervene in the spread and severity of COVID-19 has produced several effective vaccines, but there is still a pressing need for new treatments for people who contract the virus and to safeguard the health and well-being of those who are most vulnerable to disease transmission, says Dr. Kelleher, dean of the faculty of medicine and vice-president, health at UBC.

The proposed therapyset to be delivered to the lungs as an aerosol using a handheld nebulizerwould be designed to stop the virus from replicating, halting the progression of COVID-19 in an effort to reduce harmful health effects and save lives.

The global effort to intervene in the spread and severity of COVID-19 has produced several effective vaccines, but there is still a pressing need for new treatments for people who contract the virus and to safeguard the health and well-being of those who are most vulnerable to disease transmission. Dr. Dermot Kelleher

The researchers are hopeful that the treatment could help reduce hospitalizations and one day delay or even eliminate the need for mechanical ventilators for patients who contract the disease. They also see great potential for the therapy to be used as a prophylactic, or preventative treatment, capable of temporarily reducing the risk of infection and protecting healthcare workers on the frontlines as well as others at increased risk.

This is an excellent example of the world-class biomedical research taking place at UBCs Academy of Translational Medicine (ATM), says Dr. Poul Sorensen, director of the ATM. The ATM is a powerful innovation hub dedicated to accelerating the translation of scientific discoveries into clinical practice, rapidly solving some of lifes most pressing health challengesfrom COVID-19 and cancer to diabetes and dementiabringing real and lasting hope to everyone.

This research also nicely complements the groundbreaking work underway in Dr. Josef Penningers laboratory at UBCs Life Sciences Institute (LSI), where they are examining the use of an inhalable form of the ACE2 protein to bind the virus and halt COVID-19, adds Dr. Sorensen.

Within UBCs Life Sciences Institutethe largest biomedical research institute of its kind in Canadathe research team is already hard at work in the Kelleher lab, using cutting-edge technology to identify and design molecules to target SARS-CoV-2, the virus that causes COVID-19.

Once inhaled, these specialized molecules, known as GapmeRs, would stick to the virus and degrade its DNA, thereby preventing the virus from replicating further, while limiting infection and further transmission.

Dr. Shane Duggan

Ultimately, by embracing GapmeR technology and a simple delivery system, such as a nebulizer that doesnt rely on specialized equipment, the researchers believe their approach could represent a much more cost-effective means of combatting COVID-19 and saving lives around the worldincluding harder-to-reach regions.

Its our duty as researchers to use every tool in our toolkit to advance knowledge of COVID-19 and rapidly rethink our current treatment approaches to make a direct impact on patient lives both here in Canada and around the world. Dr. Shane Duggan

Treatments based on GapmeR technology are relatively easy to manufacture and require no specialized storage or transport, which make them ideal for distributing to vulnerable communities in need, says Dr. Duggan, a research associate in the division of gastroenterology.

In the coming months, the research team, which has recently grown to include two postdoctoral fellows with expertise in virology, will begin rapidly identifying molecular candidates with the highest chance of success. Following this, they will begin working with the live virus.

In an effort to accelerate the development of the new treatment, the UBC research team will also collaborate with a group of scientists with expertise in GapmeR technologies led by Dr. Navin Verma at the Lee Kong Chian School of Medicine, Nanyang Technological University in Singapore. Through this international partnership, the team hopes to bolster the studies needed to turn their research into a clinical reality, ultimately expediting the path from bench to bedside.

Beyond COVID-19, the treatment approach has the potential to be rapidly mobilized and tailored to fight future viral outbreaksand could one day be used to help tackle other diseases, including some forms of cancer.

The beauty behind this technology is that it holds tremendous potential because its readily translatable and scalable, says Dr. Duggan.

But right now, with COVID-19 forecasted to remain for the foreseeable future, the research team remains focused on the current pandemic and accelerating an aerosol treatment to save lives.

COVID-19 has already claimed the lives of millions and impacted millions more around the world, says Dr. Duggan, who, after losing a family member to a combination of COVID-19 and liver dysfunction last year, understands the high stakes at hand more than most.

Its our duty as researchers to use every tool in our toolkit to advance knowledge of COVID-19 and rapidly rethink our current treatment approaches to make a direct impact on patient lives both here in Canada and around the world.

At UBC, this is hope, accelerated.

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Halting COVID-19 in its tracks - UBC Faculty of Medicine

Preventive medicine is a specialty that bridges clinical practice and public health. Specialists work in diverse settings and tap into a broad skill set to prevent disease and promote the health of individuals, communities and populations.

Physicians completing a preventive medicine residency gain a breadth of skills that opens many potential career paths in population health system management, public health and epidemiology, clinical care, health informatics, public health policy development and much more. Preventive medicine physicians work in a variety of settings including state and local health departments, Fortune 100 companies, health systems and all levels of government.

Click HERE to download a full list of Preventive Medicine Residency Programs.

Completion of residency training in preventive medicine is an essential step to become certified in one or more of the preventive medicine specialty areas: Public Health and General Preventive Medicine, Occupational Medicine, and Aerospace Medicine.

There are currently 72accredited preventive medicine residency training programs in the United States. Programs are administered by schools of medicine, schools of public health, state or local health departments, or in federal government agencies or branches of the uniformed services. They take an individualized approach to training, with approximately 350 residents in training every year.

Residency program accreditation and ongoing compliance reviews are performed by the Preventive Medicine Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME).

Prospective residents must contact their desired residency programs directly for information and application instructions. Program directors may connect residents with program match specialists who can provide additional information and guidance. Many programs participate in the Preventive Medicine Electronic Residency Application Service.

ACPM administers a voluntary standardized acceptance process for General Preventive Medicine and Public Health residency programs. This centralized service provides the participating programs with a uniform method of selecting residents. ACPM opens registration in October and application review begins the following January.

Prior to an appointment in a preventive medicine residency program, applicants must have successfully completed at least 12 months of clinical education in a residency program accredited by the ACGME, Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians of Canada.

Experience must include at least 11 months of direct patient care, in both inpatient and outpatient settings, where residents developed competency in the following clinical skills:

In addition to the base skills related to clinical practice, preventive medicine residency programs feature competencies in the following areas:

Two-year training programs include didactics, clinical training, research, public health and other population-based experiences. The didactic training includes both residency-lead seminars, as well as the acquisition of a Master in Public Health or equivalent degree. Those residents entering with an appropriate degree can enhance their didactics with additional coursework. Whether through a Master in Public Health or other equivalent degree, all residents must complete graduate level courses in epidemiology, biostatistics, health services management and administration, environmental health and the behavioral aspects of health.

Practicum experiences can take place across the two years of the residency and include acquisition of skills in clinical and population prevention medicine. Examples of practicum experiences include appointments in: local, state and federal health departments; health maintenance organizations; peer review organizations; community and migrant health centers; occupational health clinics; industrial sites; regulatory agencies; NASA; OSHA; research settings and many more. Reference the Examples of Preventive Medicine Training Opportunities for a comprehensive listing.

Combined residency training is designed to lead to board certification in two medical specialties. Combined programs may reduce the overall length of required training by as much as one year. Residencies that offer combined training programs must maintain their accreditation status through each specialty Residency Review Committee.

The ABPM and the American Board of Internal Medicine have formal guidelines for a combined 4-year residency training program, which leads to board certification in both Preventive Medicine and Internal Medicine.

Several institutions also offer 4-year programs with combined training in preventive medicine and family medicine.

The preventive medicine Standardized Acceptance Process (SAP) is a service offered by ACPM to aid in matching prospective preventive medicine residents with available positions at residency programs across the country. The SAP helps to create homogeneity in residency program acceptance timetables, and ensures programs and candidates have adequate time to complete interviews and make and accept offers.Since 2018, nearly three quarters of all General Preventive Medicine and Public Health residency programs have participated in the SAP match.

SAP policy information, program guidelinesand resources for 2022 will be posted soon.

October - November - Programs Register for the SAP

October- January, 2022 - Applicants Register for the SAP

November 12 - Program InformationalSession

November 19 - Applicant Informational Session

January 24 - 28,2022- Applicants submit ranked lists

February 1- 4,2022- Programs submit ranked lists

February 7 - 11, 2022 - SAP pairing period

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Preventive Medicine Residency Programs | ACPM

Preventive medicine services, or well visits, are evaluation and management (E/M) services provided to a patient without a chief complaint. The reason for the visit is not an illness or injury (or signs or symptoms of an illness or injury), but rather to evaluate the patients overall health, and to identify potential health problems before they manifest.The CPT code book includes a dedicated set of codes to describe preventive medicine services:

99381 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)99382 early childhood (age 1 through 4 years)99383 late childhood (age 5 through 11 years)99384 adolescent (age 12 through 17 years)99385 18-39 years99386 40-64 years99387 65 years and older99391 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year)99392 early childhood (age 1 through 4 years)99393 late childhood (age 5 through 11 years)99394 adolescent (age 12 through 17 years)99395 18-39 years99396 40-64 years99397 65 years and older

Code assignment is determined by the patients age (as detailed in the code descriptor), and whether the patient is new (99381-99387) or established (99391-99397). CPT applies the three year rule to determine new vs. established status. A patient is established if any physician in a group practice (or, more precisely, any physician of the same specialty billing under the same group number) has seen that patient for a face-to-face service within the past 36 months. The Decision Tree for New Vs Established Patients in the Evaluation and Management Services Guidelinesportion of the CPT code book can help you to select the appropriate patient status.Service Content Varies by Patient CircumstancePreventive medicine services must include a comprehensive history and examination, and age-appropriate anticipatory guidance. In the context of preventive medicine services 99381-99397, a comprehensive exam is not the comprehensive exam as defined by either the 1995 or 1997 Evaluation and Management Documentation Guidelines. Instead, the exam should reflect an appropriate assessment, given the specific patients age and sex. For example, the specifics of the exam will differ for a 4-yr-old male and a 22-year-old female.Services for a young child will assess physical growth (height, weight, head circumference) and developmental milestones such as speech, crawling, and sleeping habits. Anticipatory guidance may include use of car seats and other safety issues, introducing new foods, etc.An adolescent preventive service may include scoliosis screening, assessment of growth and development, and a review of immunizations. Anticipatory guidance may focus on developing positive health habits and self-care, including discussion of drug, alcohol, and tobacco use, and sexual activity.A comprehensive preventive visit for an adult female patient will include a gynecologic examination, Pap smear, and breast exam. An adult males exam would include an examination of the scrotum, testes, penis, and the prostate for older patients. Anticipatory guidance may focus on issues of health maintenance, such as alcohol and tobacco use, safe sex practices, nutrition, and exercise. The patients employment status and other family issues may be discussed. As patient age advances, cholesterol levels, blood sugar, and prostate-specific antigen(PSA) testing may become increasingly relevant.Diagnoses Must Support Preventive Nature of the VisitEvery billed service must be supported by an ICD-10-CM code(s) that describe the reason for that service. In the case of a well visitbecause there is no patient complaintyou should turn to so-called Z codes (Factors influencing health status and contact with health services). For example:

Z00.110 Health examination for newborn under 8 days oldZ00.111Health examination for newborn 8 to 28 days oldZ00.121 Encounter for routine child health examination with abnormal findingsZ00.129Encounter for routine child health examination without abnormal findingsZ00.00 Encounter for general adult medical examination without abnormal findingsZ00.01 Encounter for general adult medical examination with abnormal findingsZ01.411 Encounter for gynecological examination (general) (routine) with abnormal findingsZ01.419 Encounter for gynecological examination (general) (routine) without abnormal findings

You also should code for any abnormalities found, regardless of whether the finding requires an additionally reported service.Testing and Problem-Focused Testing Are SeparatePer CPT coding guidelines:If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, and if the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the office/outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day as the preventive medicine service.To determine whether a problem requires significant work, consider whether the available documentation is sufficient to support each service (the preventive service and the problem-oriented service), separately.Additionally, per CPT coding guidelines, as supported by CPT Assistant(April 2005):

The codes in the preventive medicine services include the ordering of appropriate immunization(s) and laboratory or diagnostic procedures. The performance of immunization and ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately.

Payer Coverage May VaryThe Affordable Care Act (ACA) requires insurers to cover recommended preventive services without any patient cost-sharing, but exact coverage and reporting requirements may vary from payer to payer. As CPT Assistant(April 2005) notes:

Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient. For example, E/M preventive services for a 28-year-old adult female may include a pelvic examination including obtaining a pap smear, breast examination, and blood pressure check. Counseling is provided regarding diet and exercise, substance use, and sexual activity.

Based upon this information, it is not be appropriate to separately report for a pelvic exam including obtaining of the pap smear, nor the breast exam as these services are considered part of a comprehensive preventive medicine E/M services.Although this reporting method reflects the intent of CPT coding guidelines, third-party payers may request that preventive medicine services be reported differently. Third-party payers should be contacted for their specific reporting guidelines.Authors Note:Although the CPT Assistantarticle cited pre-dates the ACA, the advice to contact your payers regarding their reporting requirements remains valid.Be aware, as well, that Medicare reporting requirements, as stipulated by the Centers for Medicare & Medicaid Services (CMS) often differ from CPT guidelines. For more information about Medicare Preventive Medicine Services and Screenings, visit the CMS website.

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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Preventive Medicine Services Reporting - AAPC Knowledge Center

Scope & Importance

Vision

We work hard to improve the lives of our patients and their families by collaborating with the healthcare community. We offer clinical experience to both allied health professionals and patients.

We focus on the right to comprehensive, high-quality primary care for individuals and populations.

To provide the most safest, ethical, and effective medical care possible. Practice the safest, most ethical and effective medical care possible. Breakthrough research can lead to the discovery of new treatments and therapies. Promoting healthy and reducing health disparities. Educate and inspire faculty, healthcare developers, policy makers and leaders of the next generation. Build a philanthropic culture for patient care and research.

Mission

Our objective is to disseminate healthcare information and innovations that will guide in a new era of medicine.

Healthcare Market Forecast

Healthcare is one of those industries that has never seen ups and downs, particularly since technology has taken over its progress.Even throughout the pandemic, technology was important in advancing healthcare to a higher level.

In 2019, the global home healthcare market was valued at USD 281.8 billion, with a compound annual growth rate (CAGR) of 7.9% predicted from 2020 to 2027. Market growth is expected to be increased by global population ageing and rising patient preference for value-based healthcare. In 2019, the World Health Organization (WHO) estimated that 703 million people aged 65 and up lived in the world. By 2050, the number of elderly people is expected to increase to 1.5 billion. The ageing population necessitates more patient-centric healthcare services, which in turn raises demand for healthcare personnel and agencies, drive market growth.

Medicare is the largest single payer of home healthcare services in the United States. Medicare accounts for more than 40% of all home health care expenses.

Healthcare Market Overview in USA

The home healthcare market is divided into two components: equipment and services, wherein the services segment dominated the market with a share of 80% in 2019. The demand for home healthcare agencies is increasing as the world's population ages, resulting in better patient outcomes. Furthermore, the rising frequency of chronic diseases among the elderly is a prominent factor contributing to market growth.

In 2019, therapeutic devices dominated the equipment market. The growing number of patients with chronic or severe respiratory infections, urinary infections, or end-stage renal disease (ESRD) necessitates the use of innovative devices for treatment. Another important element driving the therapeutic equipment market is lower service rates for in-home healthcare when compared to hospitals or nursing homes. End-stage renal diseases (ESRD) affects roughly 750,000 persons in the United States each year, and 2 million patients worldwide, according to the University of California, San Francisco

The diagnostics equipment market is expected to develop at a healthy rate over the projected period, owing to the rising prevalence of diabetes and cardiovascular illnesses, both of which necessitate constant monitoring. Furthermore, increasing patient awareness of the screening process and technological advancements, such as the integration of microfluidics, sensors, the Internet of Things (IoT), smartphones, and wearables, provide point-of-care testing to patients and represent a significant opportunity for providing sensitive, low-cost, rapid, and connected diagnostics.

In 2019, North America dominated the home healthcare industry with a 42% share. In 2019, the United States had the greatest market share in North America, due to changing trends towards in-home healthcare from nursing homes, technology advancements, and the presence of modern medical infrastructure. In addition, the region's market is being driven by high patient awareness levels, rising healthcare expenses, and the deployment of a streamlined regulatory framework. Profits in the U.S. healthcare industry are expected to grow at a 5% annual rate through 2024, with medtech and healthcare IT experiencing the fastest growth. Profits in healthcare information technology are expected to rise from 14 billion US dollars in 2019 to 28 billion US dollars in 2024.

Healthcare Market Overview in Japan

Japan is the world's second-largest market for medical devices and healthcare. Japan is open to innovative and high-quality products and technologies, with nearly 45% of medical devices imported.

By nearly 180,000 medical facilities, including hospitals and clinics, Japan has the world's second largest healthcare market. In fiscal FY 2010, national medical expenditure was 37.4 trillion (approx 249 billion @150 = 1), a 3.9 percent increase over the previous year. This was a record-high in terms of both level and rate of growth, driven by the implementation of cutting-edge medical technologies as well as one of the world's fastest ageing populations. As a result of the ageing population, demand for assistive and care products has increased. However, the market is already crowded with a wide range of products, making it extremely difficult for new entrants lacking unique selling points.

The Japanese medical device market is also the world's second largest, valued at 2.4 trillion yen (approx. 16 billion) in 2011, with foreign manufacturers accounting for 44.4 percent of the products. Japan has long been known as a high-tech nation, but the market for medical devices is still heavily reliant on imports.

Healthcare Market Overview in Europe

Despite rising global trade tensions and a sluggish global economic outlook for 2020, the global healthcare market is expected to surpass $2 trillion in 2020. BREXIT is expected to have a significant impact on the United Kingdom, Europe's largest digital healthcare market.

In the forecast period of 2020 to 2027, the healthcare IT market is expected to grow. According to Data Bridge Market Research, the market will be worth USD 150.97 billion by 2027, growing at a CAGR of 15.62 percent during the forecast period.

The European healthcare market is expected to grow from approximately $2080 billion in 2016 to approximately $2125 billion in 2020. The European healthcare market is expected to exceed US$ 224 billion by 2022.

The European home healthcare market was worth USD 70.28 billion in 2019 and is expected to grow at an 8.37 percent CAGR to reach USD 105.04 billion by 2024.

In 2019, Germany had the highest market share in Europe, followed by France. This is mostly due to rising in-home healthcare spending in the country and rising demand for the skilled nursing workers to provide in-home care.

Healthcare Market Overview in Australia

The health care and social assistance industry is Australia's largest employer. This industry employed over 1.7 million people in 2020, with a projected increase to more than 1.9 million by 2024.

Occupations related to the HLT Health Training Package account for roughly one-third of the workforce in Health Care and Social Assistance. The occupations with the highest proportion of the workforce are Aged and Disabled Carers and Nursing Support and Personal Care Workers. Both are expected to grow significantly until 2024, with Aged and Disabled Carers growing by more than 25%. Other occupations in this sector are expected to grow to varying degrees as well. Welfare Support Workers, for example, are expected to grow by nearly 23%, Health and Welfare Services Managers by about 19%, and Complementary Health Therapists by about 15%.

Medical device industry overview: The medical device sector in Australia is mature, with a well-developed regulatory system. However, in the next years, it will be one of the slowest-growing economies in the South Pacific area. In 2016, the market was worth $4 billion, down from $5 billion in 2014. Due to Australia's sinking currency, market recovery will be delayed in 2019. Despite its low growth, Australia's ageing population, Federal Budget measures, and openness to adopt new technology should help to stabilise the market.

Australian market opportunities: Australia's healthcare business is sophisticated and open to innovative products. A wide range of medical gadgets, particularly those designed to treat and manage age-related disorders, are in high demand. Because the Australian market is pushed to cut prices, imported devices are frequently inventive and cost-effective. In addition, there is a growing demand for gadgets that help people with disabilities and chronic pain, as well as those that help them recover faster. The Australian market is highly accessible from a regulatory aspect for items that already have CE Marking.

Healthcare Market Overview in Middle East

Healthcare prospects are expanding across the Middle East. According to a recent analysis by the US-UAE Business Council, healthcare spending in the UAE is forecast to rise from $17 billion in 2017 to $21.3 billion by 2021, with a CAGR of 8.5 percent predicted between 2018 and 2023 in the UAE Healthcare Sector Outlook 2023 report.

Aging populations, longer life expectancies, and sedentary lifestyles, all of which contribute to an increase in obesity, cancer, and diabetes, are driving demand growth. New modes of care and out-of-hospital services are emerging as a result of an emphasis on prevention and well-being rather than simply treating patients. Saudi Arabia, for example, is developing a new healthcare system that includes primary, community, and secondary care.

Simultaneously, labour challenges, such as a lack of competent clinical staff and a strong reliance on expatriates, are pushing demand for technology such as digital health, artificial intelligence, and robots to fill the gap. By 2025, the region's medical technology market is estimated to be worth $31.6 billion.

The size of the Middle East and Africa Home Healthcare Market was worth USD 21.62 billion in 2020 and estimated to be growing at a CAGR of 9.30%, to reach USD 33.32 billion by 2025 during the forecast period.

These countries are expected to have a market size of USD 102 billion in 2024 with a CAGR value of 9.2% during the forecast period. Healthcare is the fastest-growing sector in the UAE, accounting for 79% of the market.

Healthcare Market Overview in APAC

The size of the home Healthcare Market in the Asia Pacific was worth USD 43.25 billion in 2020 and estimated to be growing at a CAGR of 12.56% to each USD 78.14 billion by 2025.

Home Healthcare Market Report Scope

Report Attribute

Details

Market size value in 2020

USD 303.6 billion in 2020

Revenue forecast in 2027

USD 515.6 billion

Growth Rate

CAGR of 7.9% from 2020 to 2027

Max Seats15 seats

Speaker Time20 mins

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Healthcare Conferences and Preventive Medicine Conferences ...

Low-dose aspirin or baby aspirin (81 to 100 milligrams) has been used as a safe and cheap way to reduce the risk of cardiovascular diseases, heart attacks, strokes, and blood clots. Aspirin does this by thinning out the blood and preventing blood clots from forming, which may block arteries. Getty images

The United StatesPreventive Services Task Force (USPTF) released adraft guidelineon October 12 stating that a daily regimen of low-dose aspirin is no longer recommended as a preventative measure to reduce the risk of cardiovascular problems in older adults without heart disease, reports Lindsey Tanner for theAssociated Press.

Individuals over 60 should not take preventive aspirin because of the age-related risk for life-threatening bleeding. The guidelines are not yet final but may affect tens of millions of adults at high risk for cardiovascular disease, reports Roni Caryn Rabin for theNew York Times.

Ultimately, those currently on a low-dose aspirin regimen or who have cardiovascular risk factors should talk to their doctors about what is best for them.

We dont recommend anyone stop without talking to a clinician, and definitely not if they have already had a heart attack or stroke, says Chien-Wen Tseng, a USPTF memberand a University of Hawaii research director, to theNew York Times.

The report also states that those aged between 40 and 60 and worried about their heart health should decide to take aspirin on a case-by-case basis, reports Ed Cara forGizmodo.

The panel consists of 16 medicine and disease prevention experts who evaluate evidence-based preventative measures and screening tests. Panel members are appointed by theAgency for Healthcare Research and Quality.

Low-dose aspirin or baby aspirin (81 to 100 milligrams) has previously been recommended as a safe and cheap way to reduce the risk of cardiovascular diseases, heart attacks, strokes, and blood clots. Aspirin does this by thinning out the blood and preventing blood clots from forming, per theNew York Times. The drugseems to most help individuals who already have, or are at a high riskfor, cardiovascular disease.The panel found some evidence that baby aspirin may only benefit people between 40 and 60 years of age who have a 10 percent risk of having a heart attack or stroke, per the Associated Press.

However, aspirin can also cause life-threatening bleeding inthe digestive tractor brain, per the New York Times. One study published in 2018 in theNew England Journal of Medicinefound that the risk of bleeding from an aspirin regimen outweighs its potentialbenefits for those over 70 years of age,Gizmodoreports.

The USPTF made their assessments based on a literature review of data from recent trials and population studies.For older people who have no risks of heart disease, the potential for bleeding damageoutweighs any aspirin benefits.

When we looked at the literature, most of it suggested the net balance is not favorable for most people there was more bleeding than heart attacks prevented, says Amit Khera, an author of the guideline, to theNew York Times. And this isnt nose bleeds, this can be bleeding in the brain.

The draft recommendation statement is currently open for public comment until November 8, before a final version of the report Is published, theNew York Timesreports.

Theres no longer a blanket statement that everybody whos at increased risk for heart disease, even though they never had a heart attack, should be on aspirin, Tseng explains to theNew York Times. We need to be smarter at matching primary prevention to the people who will benefit the most and have the least risk of harm.

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Aspirin No Longer Recommended as a Preventative Measure Against Heart Attacks and Strokes in Older Individuals - Smithsonian

(Reuters) - Here's what you need to know about the coronavirus right now:

Merck seeks first U.S. FDA authorization for COVID-19 tablet

Merck & Co said on Monday it has applied for U.S. emergency use authorization for its tablet to treat mild-to-moderate patients of COVID-19, putting it on course to become the first oral antiviral medication for the disease.

Its authorization could help change clinical management of COVID-19 as the pill can be taken at home. The treatment, molnupiravir, could halve the chances of death or being hospitalized for those most at risk of contracting severe COVID-19, according to the drugmaker.

The interim efficacy data on the drug, which has been developed with Ridgeback Biotherapeutics, had heavily impacted the shares of COVID-19 vaccine makers when it was released last week.

AstraZeneca antibody cocktail succeeds in late-stage study

AstraZeneca's experimental COVID-19 drug has helped cut the risk of severe disease or death in a late-stage study, the British drugmaker said on Monday, a boost to its efforts to develop coronavirus medicines beyond vaccines.

The drug, a cocktail of two antibodies called AZD7442, reduced the risk of severe COVID-19 or death by 50% in non-hospitalised patients who have had symptoms for seven days or less, meeting the main goal of the study.

AstraZeneca's therapy, delivered via injection, is the first of its kind to show promise both as a preventative medicine and as a treatment for COVID-19 following multiple trials. It is designed to protect people who do not have a strong enough immune response to vaccines.

Sydney reopens as Australia looks to live with COVID-19

Sydney's cafes, gyms and restaurants welcomed back fully vaccinated customers on Monday after nearly four months of lockdown, as Australia aims to begin living with the coronavirus and gradually reopen with high rates of inoculation.

Some pubs in Sydney, Australia's largest city, opened at 12:01 a.m. (1301 GMT Sunday) and friends and families huddled together for a midnight beer.

Story continues

"I see it as a day of freedom, it's a freedom day," New South Wales state Premier Dominic Perrottet told reporters in Sydney, the state capital. "We are leading the nation out of this pandemic but this will be a challenge."

New Zealand makes vaccinations mandatory for health workers

New Zealand will require teachers and workers in the health and disability sectors to be fully vaccinated against COVID-19, Prime Minister Jacinda Ardern said on Monday, as she extended restrictions in Auckland, its largest city, for another week.

New Zealand is fighting the highly infectious Delta outbreak that forced it to abandon its long-standing strategy of eliminating the new coronavirus amid persistent infections.

"New Zealand is at one of the trickiest and most challenging moments in the COVID-19 pandemic so far," Ardern told reporters in Wellington. Ardern, however, said "there is a clear path forward" in the next few months to live with fewer curbs and more freedoms once the country reaches a higher level of vaccinations.

Russia's daily death toll hovers near all-time high

Russia reported 957 coronavirus-related deaths on Monday, close to the all-time high of 968 reported two days earlier.

The government coronavirus task force also said it had recorded 29,409 new cases in the last 24 hours, an increase from 28,647 cases on Sunday.

(Compiled by Linda Noakes; Editing by Alex Richardson)

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What you need to know about the coronavirus right now - Yahoo News

The fate of the Biden administrations agenda on climate remains uncertain, captive to todays toxic atmosphere in Washington, DC. But the headlines of 2021 leave little in the way of ambiguity the era of dangerous climate change is already upon us, in the form of wildfires, hurricanes, droughts and flooding that have upended lives across America. A recent UN report on climate is clear these impacts will worsen in the coming two decades if we fail to halt the continued accumulation of greenhouse gases in the atmosphere.

To avert disaster, we must chart a different climate course, beginning this year, to achieve steep emissions reductions this decade. Meeting this moment demands an all hands-on-deck approach. And no stone should be left unturned in our quest for meaningful options for decarbonizing our economy.

But while it is tempting to pin our hopes on future technology that might reduce the scope of future climate damages, we must pursue such strategies based on sound science, with a keen eye for potential false leads and dead ends. And we must not allow ourselves to be distracted from the task at hand reducing fossil fuel emissions by technofixes that at best, may not pan out, and at worst, may open the door to potentially disastrous unintended consequences.

So-called geoengineering, the intentional manipulation of our planetary environment in a dubious effort to offset the warming from carbon pollution, is the poster child for such potentially dangerous gambits. As the threat of climate change becomes more apparent, an increasingly desperate public and the policymakers that represent them seem to be willing to entertain geoengineering schemes. And some prominent individuals, such as former Microsoft CEO Bill Gates, have been willing to use them to advocate for this risky path forward.

The New York Times recently injected momentum into the push for geoengineering strategies with a recent op-ed by Harvard scientist and geoengineering advocate David Keith. Keith argues that even in a world where emissions cuts are quick enough and large enough to limit warming to 1.5 degrees Celsius by 2050, we would face centuries of elevated atmospheric CO2 concentrations and global temperatures combined with rising sea levels.

The solution proposed by geoengineering proponents? A combination of slow but steady CO2 removal factories (including Keiths own for-profit company) and a quick-acting temperature fix likened to a band-aid delivered by a fleet of airplanes dumping vast quantities of chemicals into the upper atmosphere.

This latter scheme is sometimes called solar geoengineering or solar radiation management, but thats really a euphemism for efforts to inject potentially harmful chemicals into the stratosphere with potentially disastrous side effects, including more widespread drought, reduced agricultural productivity, and unpredictable shifts in regional climate patterns. Solar geoengineering does nothing to slow the pace of ocean acidification, which will increase with emissions.

On top of that is the risk of termination shock (a scenario in which we suffer the cumulative warming from decades of increasing emissions in a matter of several years, should we abruptly end solar geoengineering efforts). Herein lies the moral hazard of this scheme: It could well be used to justify delays in reducing carbon emissions, addicting human civilization writ large to these dangerous regular chemical injections into the atmosphere.

While this is the time to apply bold, creative thinking to accelerate progress toward climate stability, this is not the time to play fast and loose with the planet, in service of any agenda, be it political or scientific in nature. As the recent UN climate report makes clear, any emissions trajectory consistent with peak warming of 1.5 degrees Celsius by mid-century will pave the way for substantial drawdown of atmospheric CO2 thereafter. Such drawdown prevents further increases in surface temperatures once net emissions decline to zero, followed by global-scale cooling shortly after emissions go negative.

Natural carbon sinks over land as well as the ocean play a critical role in this scenario. They have sequestered half of our historic CO2 emissions, and are projected to continue to do so in coming decades. Their buffering capacity may be reduced with further warming, however, which is yet another reason to limit warming to 1.5 degrees Celsius this century. But if we are to achieve negative emissions this century manifest as steady reductions of atmospheric CO2 concentrations it will be because we reduce emissions below the level of uptake by natural carbon sinks. So, carbon removal technology trumpeted as a scalable solution to our emissions challenge is unlikely to make a meaningful dent in atmospheric CO2 concentrations.

As to the issue of climate reversibility, its nave to think that we could reverse nearly two centuries of cumulative emissions and associated warming in a matter of decades. Nonetheless, the latest science tells us that surface warming responds immediately to reductions in carbon emissions. Land responds the fastest, so we can expect a rapid halt to the worsening of heatwaves, droughts, wildfires and floods once we reach net-zero emissions. Climate impacts tied to the ocean, such as marine heat waves and hurricanes, would respond somewhat more slowly. And the polar ice sheets may continue to lose mass and contribute to sea-level rise for centuries, but coastal communities can more easily adapt to sea-level rise if warming is limited to 1.5 degrees Celsius.

While its appealing to think that a climate band-aid could protect us from the worst climate impacts, solar geoengineering is more like risky elective surgery than a preventative medicine. This supposed climate fix might very well be worse than the disease, drying the continents and reducing crop yields, and having potentially other unforeseen negative consequences. The notion that such an intervention might somehow aid the plight of the global poor seems misguided at best.

When considering how to advance climate justice in the world, it is critical to ask, Who wins and who loses? in a geoengineered future. If the winners are petrostates and large corporations who, if history is any guide, will likely be granted preferred access to the planetary thermostat, and the losers are the global poor who already suffer disproportionately from dirty fossil fuels and climate impacts then we might simply be adding insult to injury.

To be clear, the world should continue to invest in research and development of science and technology that might hasten societal decarbonization and climate stabilization, and eventually the return to a cooler climate. But those technologies must be measured, in both efficacy and safety, against the least risky and most surefire path to a net-zero world: the path from a fossil fuel-driven to a clean energy-driven society.

Kim Cobb is the director of the Global Change Program at the Georgia Institute of Technology and professor in the School of Earth and Atmospheric Sciences. She was a lead author on the recent UN Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report. Follow her on Twitter: @coralsncaves

Michael E. Mann is distinguished professor of atmospheric science and director of the Earth System Science Center at Penn State University. He is author of the recently released book,The New Climate War: The Fight to Take Back our Planet. Follow him on Twitter:@MichaelEMann

See the original post:
Geoengineering: We should not play dice with the planet | TheHill - The Hill

When it comes to our health, just about everyone is looking for an extra boostparticularly during the COVID-19 pandemic. That desire has helped vitamins and supplements grow into a $150 billion worldwide industry. If you're considering taking a daily vitaminor are taking one nowit's important to know there are clear things vitamins can and can't do, as indicated by decades of research. And if you take them the wrong way, they can be harmful. Read on to find out what taking a daily vitamin does to your bodyand to ensure your health and the health of others, don't miss these Sure Signs You May Have Already Had COVID.

Woman taking her medication in her bedroom at home.

"If you're like everybody else in the world, and you don't eat a perfect diet every day, a multivitamin is going to fill in the little deficits you have on a daily basis," Kathryn Boling, MD, a family medicine doctor with Mercy Medical Center in Baltimore, told ETNT Health. "And if you're OK paying money for something that you're mostly going to pee out, but it's going to fill in those tiny little deficits, then take a multivitamin. I do."

RELATED: Health Habits You Should Avoid if Over 50

vitamin d

If your daily multivitamin contains vitamins C and D (and most do), those nutrients may support your immune system. "If you're deficient in vitamin D, that does have an impact on your susceptibility to infection," said Dr. Anthony Fauci, the nation's top infectious-disease specialist, in an interview last fall. "I would not mind recommendingand I do it myselftaking vitamin D supplements."

He added: "The other vitamin that people take is vitamin C because it's a good antioxidant, so if people want to take a gram or so of vitamin C, that would be fine."

RELATED: Everyday Habits That Add Years to Your Life, Say Experts

Story continues

Man sitting at the table and taking vitamin D

You might erase potential benefits from vitamins if you chase them with soda and sugary snacks, or use them as justification for too many cheat meals. "Supplements are never a substitute for a balanced, healthful diet," said Dr. JoAnn Manson, a preventative medicine specialist, in an interview with Harvard Health. "And they can be a distraction from healthy lifestyle practices that confer much greater benefits."

RELATED: Forgetting This One Thing Can Mean You Have Alzheimer's

young woman with stomach pain

If your vitamin contains high doses of certain nutrients, that can cause problems. Most vitamins are water-soluble, meaning they can't build up in the body because any excess is cleared by urine. But fat-soluble vitamins including A, D, E and K can build up in the body and may be dangerous at high levels, particularly A and E.

RELATED: Common Habits That Age You Faster, According to Science

Shot of woman nutritionist doctor writes the medical prescription for a correct diet on a desk with fruits, pills and supplements.

If you're taking multivitamins for protection against serious disease, you should know that the science isn't quite there yet. In 2018, researchers from Johns Hopkins analyzed studies involving almost half a million people; they determined that taking multivitamins doesn't lower your risk of heart disease, cancer, cognitive decline, or early death. Their advice: Don't waste your money on multivitaminsget the vitamins and minerals you need from food. And to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.

Go here to read the rest:
What Taking a Vitamin Every Day Does to Your Body - Yahoo Lifestyle

If we have learned anything about controlling epidemics in the past year, its that its very difficult to halt the spread of disease with vaccines aloneespecially when they first appear. As the vaccines are endorsed, financed, and rolled out, other prevention strategies are key for controlling the illness.

Insecticide-treated bed netsthats what has made the biggest difference in most parts of Africa over the last couple of decades, Clarke said. And they will remain really important, because the insecticide on the bed net kills mosquitoes, and by reducing the number of mosquitoes, even people who dont sleep under the bed net will be protected, whereas a vaccine can only protect the person whos vaccinated.

Anotherstudy published last month found that combining vaccines with preventative drugs roughly doubled protection for kids. This combination can be used in places with clearly defined malaria seasons, particularly tied to the rainy season, where children are at very high risk of dying from the illness. Families were eager to get both the shots and the medications, Clarke said, because they take malaria extremely seriously.

Its imperative to move quickly, particularly when children are dying. Its all the question of investmentif the investment is made into these types of vaccines, it can be done in five years, Kappe said. When you look at, for example, the investments that have been made over a period of a year, a year and a half, in coronavirus vaccinesif the same resources would be thrown at malaria vaccines, I think we would be there already.

Read this article:
Welcome to the New Era of Vaccine Acceleration - The New Republic

[Left to Right] Clark Cahill, Manager of Events and Conferences at SCMP, Dr Ngai-tseung Cheung, Head of Information Technology & Health Informatics for the Hospital Authority, Megan Lam, Co-founder & CEO of Neurum Health, and Dr Matthew Man, Chief Executive Officer of Megasoft Limited took a deep dive into the current state of healthcare including the implementation of AI and the Internet of Things (IoT) into the industry in this series.

Dr Ngai-tseung Cheung, Head of Information Technology & Health Informatics for the Hospital Authority, mentioned how Covid-19 has made the close collaboration between the fields of healthcare, computer science, and machine learning even stronger.

Dr Matthew Man, Chief Executive Officer of Megasoft Limited, proposed the industry should start at the bottom [with] frontline staff [as they] have a lot of pain points.

Co-founder & CEO of Neurum Health, Megan Lam, said health and wellness is one size fits one as opposed to one size fits all.

(Left to Right) Joey Liu, Chief of Staff to the CEO at SCMP, and Dr Kee Yuan Ngiam, Group Chief Technology Officer at National University Health System, discussed how the end goal of medicine is to be more proactive and preventative rather than reactive.

Link:
Telehealth acts as a preview of the imminent digital revolution in healthcare as AI gains popularity - South China Morning Post

Dr. John McGonigle| Guest columnist

Dr. John McGonigle is an assistant clinical professor of family medicine at the Warren Alpert School of Medicine at Brown University.

I am a board-certified primary care doctor and an assistant clinical professor in family medicine at Brown University. I have been practicing primary care in Rhode Island since starting residency at Memorial Hospital in Pawtucket in 2006. I am educated, trained and schooled in the most powerful system of medicine the world has ever known.

Indeed, I have not infrequently described this system as analogous to the United States military. When Europe was overrun with Nazis, send the U.S. Army in, and tell them to flatten anything that resists. Its great for killing Nazis. As our recently concluded experience in Afghanistan tells us, send the military into a country and ask them to build schools and they will fail miserably. Wrong tool. Unbeatable in war, quiescent in peace.

The United States, Rhode Island, and the rest of the planet have been engaged in an undertaking unparalleled since the Second World War. While the politicians stay at home and dither over strategy, the people go offand fight. We have been asked to operate on a war footing, and whatever our political or social or economic means have enabled us to do we have done. We have cussed, and spit, and sometimes ridiculed higher officers but have done what they have asked, when they have asked, and in whatever spirits we can muster.

Last year was more straightforward in primary care, since it was all triage, all the time. We didnt know much about Sars-Co-V2, and knew less about treatment. Little of its spread, little of its contagion patterns. Our patients knew even less. They brought us unanswerable questions of life and death, and we worked tirelessly keeping the emergency rooms from being tragically overrun. The usual go to the ER for a full assessment when one was uncertain, or too tired to shake the uncertainty, was off limits.

To carry the battlefield the confusion had to be minimized. ER and ICU doctors and nurses fought heroically, in shifts. Primary Care is not adrenaline soaked and filled with mayhem, but it is unrelenting and remorseless. Primary Care makes it possible for ERs and ICUs to function at ALL times, and when Primary Care is overwhelmed like dishes piling up in the restaurant sink the establishment no longer functions anywhere near optimal efficiency.

We are tired from all the fear and we are tired of filling out forms. We are tired of having kept the supply and chow and ambulance lines going to the front for over 21 months now. Like a returning army our people have come home, and many are gravely scarred. For some the wounds are obvious, and the thank you for your services and sorry for your losses are heartfelt. For far too many the wounds are unseeable and barely reachable and require patience, not stitches.

The tidal wave of wounded families that I am seeing is unparalleled in my 15 years of practice. I am seeing the harms within: between parents, parents and children, children, children and schools; between parents and peers; between my patients' blood pressures and their suffocating, sedentary fears; between health-giving practices and the despairs of a war zone.

We have all been hearing about this war we are in and I am tired of hearing about how much preventative care has been deferred and ignored, and how much the mental health and well-being of the nation needs attention. The country is devastated, and to continue to keep it on a war-footing is prolonging the devastation. It is time for COVID to put down its weapons. The eagle has landed. It is time to start building schools.

See the original post:
Opinion/McGonigle: It is time to stop fighting - The Providence Journal

FRANKLIN, Tenn. - Today, Mitsubishi Motors North America (MMNA) unveiled the 2022 Outlander SUV that will carry Team 207 throughout the Rebelle Rally on October 7-16.

* 2022 Outlander livery celebrates 2001 Dakar rally victory of Jutta Kleinschmidt, first woman to ever win the famed event

* U.S. military veterans and a PTSD service-dog named Sammy talk about the invisible scars of war, overseas deployments, returning home, and family

The lightly modified vehicle sports a special livery that pays tribute to the brand's history-making Dakar Rally win twenty years ago, when Jutta Kleinschmidt drove a Mitsubishi Pajero to victory, becoming the only woman ever to win the world-famous Dakar. Before the event even starts, the crew of Team 207 are already winners.

Sisters-in-law Selena 'Mason' Converse and Erin Mason are not afraid of a challenge. As an emergency medical services technician in the U.S. Air Force, Mason provided emergency medical care in both non-combat and combat situations. As an aviation structural mechanic, you could find Erin weaving in and out of incoming plane traffic on U.S. Navy aircraft carriers. They joined the military, right out of high school, to establish their independence, seek adventure, and serve their country.

This October, Mason and Erin, along with Mason's two-and-a-half-year-old, PTSD-trained service dog, Sammy, are embarking on a new adventure, further testing themselves and their 2022 Mitsubishi Outlander. They will represent MMNA and veterans nonprofit Record the Journey (RTJ) on the nine-day, 2000-km, all-women, off-road Rebelle Rally.

Described by veterans who competed with Mitsubishi Motors and RTJ in past years as a 'mini-deployment,' Mason, Erin and Sammy will face a grueling schedule of long days and short nights, challenging and diverse off-road terrain, and the memories of their service - the good and the bad - head on.

We sat down with the team, before they head out on the Rebelle, to learn more of their stories.

FIVE QUESTIONS WITH U.S. AIR FORCE VETERAN SELENA 'MASON' CONVERSE

Team Record the Journey Driver, Owner of Mason Converse Media

1. On paper, you are a wife, mother, combat veteran and small-business owner. How do you define yourself? I am all of those things with all of my heart. Those titles are a huge part of me and have helped form who I have become. I have not seen any of those titles as a job, rather, an opportunity that I have been gifted. I've grown to know that I am a caretaker. I consider myself as caring and creative and I am the happiest when I am caring for others and/or utilizing my creative talents.

2. You were an emergency medical services technician in the U.S. Air Force - stationed all over the U.S. and once deployed to Afghanistan. Help us understand, as much as a civilian could, what that was like. My job as an EMT for the U.S. Air Force was incredible, and for the most part, very rewarding. I saved lives, cared for countless families and was able to train future medics for the U.S. Air Force and Navy. I was initially trained at the EMT - basic level, and I was able to work in the emergency room, on an ambulance and in multiple specialties around the hospital.

Realizing my love for teaching, I became a certified Nationally Registered EMT (NREMT) Instructor. Eventually, I deployed to Afghanistan and worked in the intensive care unit and the emergency room. I cared for injured U.S. soldiers, our allies, as well as confirmed enemy combatants.

My job at home, when not deployed, was primarily focused on preventative medicine - keeping soldiers (and their families) healthy. My job while I was deployed was rather different. There was no preventative medicine, only reactive medicine to the most traumatic injuries with limited supplies. After returning from Afghanistan, I was hand-selected to become a military training instructor at the Military Education and Training Center in Texas.

3. You left the military after almost 13 years to put down roots and raise your family, and you started your company, Mason Converse Media. Everything was going well. When did you begin realizing you might have PTSD? PTSD came in waves. I didn't just leave the military and feel this intense overwhelming PTSD sensation - it is not quite like that. I experienced traumatic things during my deployment, and they forever changed who I am. But while in the military, we were trained to deal with stress and trauma extremely well.

After leaving the military, I had the mindset that I 'had PTSD,' but I did not 'suffer from PTSD'. I assumed the things I felt were just transition stress and that they would go away on their own. What I did start to notice was that I perceived and dealt with certain things differently than my non-military friends. Things that I worried about, or that caused me anxiety, did not cause others to have the same emotional triggers.

I lost my parents as a child. Since then, I've used the avoidance tactic to manage extreme stress: if I didn't face it, discuss it, or even think about it, then it couldn't affect me. I applied this same tactic to my post-military life, and it 'worked' for quite some time. The pandemic was a huge PTSD trigger for me and a turning point for me to openly evaluate and discuss my PTSD symptoms.

4. You are the proud mother of three human children, and Sammy, a two-and-a-half-year-old, all-black German Shepherd. Tell us how Sammy entered your life. Sammy entered my life as an unexpected blessing. She was born at a time that I was navigating my PTSD symptoms and not openly discussing any of them. At that same time, my husband's canine best friend of 13 (Joe) years was getting to the end-stage of life. A neighbor of ours offered my husband a German Shepherd puppy, Sammy, to help with the transition and eventual loss of his dog. Sammy came to us much sooner than expected, at just four weeks old (another story for another day), and I spent the next four weeks being mom to the tiniest bear-cub looking puppy.

Joe passed shortly thereafter, and Chuck did not yet feel connected with Sammy. We thought it would just take time for the bond to form, so we kept her and spent the next year training her. Sammy was smart and was ready for a meaningful role. At that time, I had begun therapy for PTSD. The idea of having Sammy trained as a service dog came up, and it really became obvious that she was truly meant for me and not my husband.

5. Together, you, Sammy and your sister-in-law Erin make up Team 207, Mitsubishi Motors' entry into the 2021 Rebelle Rally. As you head into the dunes, why is it important for you to tell your story? The biggest key to managing my PTSD was being able to admit the issues and symptoms I was experiencing. When you separate out the individual symptoms or triggers, then you can treat the PTSD more effectively. Many people assume the treatment for PTSD is taking a prescription medicine. It can be, but that's not the treatment for everyone.

Part of my PTSD treatment is the use of a service dog. Service dogs provide treatment of PTSD symptoms, much like a medication could, but other times better than medication can. Service dogs are specifically trained to perform tasks to aid in a person's disability.

As a team of female veterans, I believe it is so important to share our story and help others understand that PTSD does not have to control your whole life - it is possible to live the life you want while managing PTSD. Sammy's participation in the Rebelle Rally will go a long way to doing that.

FIVE QUESTIONS WITH U.S. NAVY VETERAN ERIN MASON

Team Record the Journey Navigator, Owner & Farmer, Mason Wholesale Greenhouses

1. Congratulations (and awe) are in order! You just welcomed a new baby girl, Selena, to your family, and she will be just six weeks old when you head out for the Rebelle. What is motivating you to take this on so soon? By competing in an all-woman rally, I believe I am sending my two young girls a message that anything is possible and that some things are meant to be. A year ago, Rachael Ridenour, founder of veterans non-profit Record the Journey, picked us to go on this adventure to represent her charity and Mitsubishi. Before Mason and I knew it, we were driving across the country to learn technical driving and navigation skills from Rachael, and in between trips to the desert, were on Zoom calls, trying to absorb as much as we could. Around Christmas, I learned I was expecting, and was relieved to learn the due date - I'd be cutting it close, but I could still compete in the Rally. It was a good pregnancy, and even better delivery, so it really feels meant to be. I know my daughter Selena will be cheering me on from home. As if the rally wasn't challenging enough, I will also be pumping so I can return to breast feeding when I get home.

2. You joined the military, in your words, as soon as you could. You were young, wide-eyed and from a small town. What were those first years like for you? Sitting across from the recruiter, signing my papers to join the military, I knew I was leaving my small town for something bigger, and I was right. If you've never seen an aircraft carrier, it's beautiful, the way the planes come in and out. It's like controlled chaos, like synchronized swimming - it's an adrenaline rush. My first years were defined by adventure. My first assignment was Virginia Beach, and I was crossing the seas in an aircraft carrier in no time. I would volunteer for every detachment and work to achieve every qualification, chasing fighter jets across the world, knowing it would mean more adventure, and that's exactly what I wanted.

3. What deployment stands out to you as having the biggest personal impact. My deployment on the USS George H. W. Bush was by far the most impactful time I spent serving my country. It was the ship's maiden deployment - we sailed for eight months, from Virginia, to the Rock of Gibraltar, to the Suez Canal, around the Horn of Africa and into the Arabian Gulf. Along the way, we made stops in England, Italy, France, Spain, Bahrain and Dubai. It was equally thrilling and grueling. I learned what my body was capable of, by operating on minimal sleep and maximum exhaustion. When we arrived back in the States, I quickly came to grips with the mental toll as well, as a good friend from the deployment took his own life. Losing him is one reason I am so passionate about mental health awareness and PTSD advocacy for my military brothers and sisters.

4. You would have stayed in the service longer, if that was an option. Describe your transition out of the military and into civilian life. The year I left, the government was downsizing the military, and was not renewing thousands of service member contracts. I thought I was going to spend my whole life in the Navy, but life had other plans. Navigating the transition was lonely and confusing - all of a sudden, I felt like I didn't have a purpose. In the service, we are a family. We grow together. We experience life and death, births and divorces together. I was a shoulder to cry on when a friend was on a deployment, watching a YouTube video of their baby taking their first steps. I went from traveling the world, to being stuck in one place. Re-entering the civilian world, returning to people who never left... they can't understand what we are going through. It took me a couple years to adjust back to civilian life and to find my identity outside of the military. I became a civilian mechanic... I met my husband, also a veteran, who served in the Air Force. I eventually finished school and started a family. There will always a part of me that can only be filled up by my military family, so I try to be around them as much as I can.

5. Now, you run Mason Wholesale Greenhouses with your husband - also former military. Tell us about the business and how you got started. We started when my husband was transitioning out of the military. He worked at a nursey in high school and has a real way with plants. I found a place called Archi's Acres in Southern California that has a six-week course, designed to introduce veterans to sustainable agriculture, and I signed us both up. While we were there, my husband received a call that his former boss, the nursery owner, passed away, and his wife wanted to sell the property to us! Now in East Texas, we grow organic produce and crops in greenhouses. We aim to keep a small carbon footprint and really enjoy sharing our passion for sustainable agriculture with our community. The soil therapy has been so good for me! In the future, we hope to invite other veterans to our property for off-grid retreats, to help others find the same peace.

FIVE QUESTIONS SAMMY THE SERVICE DOG

PTSD-Trained, 2.5-Year-Old, All-Black German Shepherd

1. Describe your perfect day. I love to go on adventures with my family - my mom, dad, my human sisters and my brother. My mom owns a 4x4 off-road adventure photo and video company, so it is kind of part of the territory. We go to lakes, where I am learning to fetch rocks and sticks off of the lake bottom, and we go to the desert, where I am learning to help mom dig big trucks out of the sand. (Should come in handy for Rebelle, right?) By nature, I am curious, confident and loyal, making me the pawfect adventure partner. Oh, and I absolutely love frisbee. I could play frisbee for hours. At the end of a long day of adventures, or a long day on PTSD-service duty, I love my quiet time. Did I mention I love frisbee?

2. What does it mean to be a PTSD-trained service animal? My mom is my hero. She served in the U.S. Air Force for 13 years. (Planes are like frisbees, but much bigger.) As an emergency medical services technician, she skillfully and bravely attended to men and women on both sides of armed conflict. But when she came home, it was hard for her to really feel at home. She had flashbacks and nightmares; sometimes she felt sad, isolated, angry and scared. Not to brag, but I am pretty intelligent and observant, and I take direction really well, so I am kind of the perfect service animal. I went through intense training, learning about all of the things that could trigger my mom's anxiety, and how to make her, and my whole family, feel safe. Now, everywhere they go - on adventures, to the grocery store, to bed at night - I have their back.

3. And we understand your vest isn't just a fashion accessory... It is a very cool vest, yes, but it is much more. It is like a super-hero cape. When I put on my vest, it makes me feel powerful, and it reminds me of my training. It means that I am on duty, and no one can mess with me or my family. When I take off my vest, I am just your average 2.5-year-old puppy. I like to play frisbee... run, jump, roll, scratch and snuggle with my siblings. I take my job seriously; I take my play time seriously, and I take my down time seriously. You have to, in this business. Sometimes, it is important for me to find a quiet space, sit, and reflect on the day.

4. All-black German Shepherds are extremely rare. How do you keep that beautiful coat so clean? Why, thank you. It's true, my line of work can be ruff on hair, skin, nails and teeth. To keep me looking and feeling good on the Rebelle, pet wellness company Skout's Honor has loaded down our 2022 Mitsubishi Outlander with array of probiotic grooming and wellness essentials, including Probiotic Shampoo + Conditioner, Prebiotic Pet Balm, Probiotic Deodorizer and Paw Spray. Also, Mitsubishi has outfitted us with some pretty cool, Team 207 swag, including a custom bandana from http://www.mymitsubishistore.com. Shout out to my sponsors!

5. What are you most looking forward to about Rebelle Rally? Well, I have done my research, and there are a lot of car commercials with dogs in them, but none can do what I can. I don't see any other pups protecting their mom from danger, or digging their team out of sand dunes. I will be the first animal to ever compete in the Rally, just saying... In all seriousness, I really identify with the spirit of Rebelle - the adventure, the strategy, the girl power! My mom can do anything, with me at her side. I hope her story inspires others to be authentic, brave and embrace adventure - just like us.

For more information on the 2022 Mitsubishi Outlander, visit https://www.mitsubishicars.com/outlander/2022.

About Mitsubishi Motors North America, Inc.

Through a network of approximately 330 dealer partners across the United States, Mitsubishi Motors North America, Inc., (MMNA) is responsible for the sales, marketing and customer service of Mitsubishi Motors vehicles in the U.S. MMNA was the top-ranked Japanese brand in the J.D. Power 2021 Initial Quality study, ranking third overall and tied with Lexus. In its Environmental Targets 2030, MMNA's parent company Mitsubishi Motors Corporation has set a goal of a 40 percent reduction in the CO2 emissions of its new cars by 2030 through leveraging EVs - with PHEVs as the centerpiece - to help create a sustainable society.

With headquarters in Franklin, Tennessee, and corporate operations in California, Georgia, Michigan, New Jersey, Texas, Florida and Virginia, MMNA directly and indirectly employs more than 8,000 people across the United States.

For more information on Mitsubishi vehicles, please contact the Mitsubishi Motors News Bureau at 615-257-2698 or visit media.mitsubishicars.com.

Contacts

Jeremy Barnes

Senior Director, Communications and Events

jeremy.barnes@na.mitsubishi-motors.com

Mobile: 714-296-1402

Lauren Ryan

Manager, Communications and Events

lauren.ryan@na.mitsubishi-motors.com

Mobile: 404-862-8286

Read this article:
Mitsubishi Motors : Unveils 2022 Outlander for 2021 Rebelle Rally; Introduces the Military Veterans Who Will Contest the Event - marketscreener.com

Dr. Michael DiGiorno

By Dan Murphy

With most Westchester residents vaccinated, and with COVID-19 positivity rates at less than 1%, Dr. Michael DiGiorno, Medical Director of St. Johns Medical Group, is encouraging patients and our readers to return to their pre-COVID routine of getting tested, including getting their annual physicals, screening colonoscopies, bone density testing and mammograms.

Its important not to let your health lapse because of the pandemic any longer. At least come in and have an annual physical and ensure that your health screening tests are up to date. It is an extraordinarily safe time for patients to come in and catch up with their health care needs, and we are here to help them through the testing process.

Part of our challenge during the COVID-19 pandemic was to make sure that we stayed open, and that we continued to deliver care to Yonkers and the surrounding communities. We thought it was crucial to maintain a presence in the community during a very difficult time, and if you had an underlying medical condition, or had a medical question or needed a prescription refill, we were open for in person and telemedicine appointments. We concentrated on the safety of our physicians and staff and made sure we were all protected, and we did so quite successfully, said Dr. DiGiorno.

Now we are moving towards a return to normalcy. People are vaccinated and we can accommodate more patients in person. We are maintaining processes in place, including using masks and enhanced cleaning to ensure optimal safety. We provide a very safe, clean environment, so now is the time to pivot and focus on health care maintenance.

Our physicians and staff are available and understand that not everyone has the same level of comfort. If you have any specific concerns, let us know and we will work to ensure your return is a positive experience. In addition to primary care, our specialty physicians are on-site and available to address your gastroenterology, nephrology, physical medicine, vascular, podiatric and pain management needs.

Dr. DiGiorno stressed that, unfortunately, underlying health conditions dont wait for the pandemic to pass. We do see some patients, with diabetes who have strayed and have weight gain because of a lack of activity. As a result, their diabetes has become poorly controlled. Similarly, we are seeing patients with chronic hypertension, which was once well-controlled, now require additional therapy. We understand whygyms were closed, our diets and routines were interrupted, and we were told to stay home, and it all took a toll on our health.

Now is the time to get people back on track, with basic testing, and diabetes and blood pressure treatments and screenings. While we have seen some slippage with chronic conditions in some patients, we want that to be the exception and not the rule.

So go back for your basic labs, physicals, and colonoscopies. The environment is safe and clean and accessible. They will expedite your appointment and connect you to your primary care physician. If you do not have a physician, St. Johns has lots of options and it all starts with a phone call.

We understand what our community, and the world has been through. There is no judgement here. Our goal is to achieve wellness, so dont be afraid to see a physician. We just want everyone to get well again, and move forward as a community said Dr. DiGiorno.

Michael DiGiorno, DO, MHSA, FASN, is the Vice-President, Medical Operations, and the Chief of Nephrology at St. Johns Riverside Hospital, and the Medical Director of the St. Johns Medical Group practice.

To make an appointment or contact a member of St. Johns Riverside Hospital, or St. Johns Medical Group call 914.964.4DOC.

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Dr. Michael DiGiorno, Director of St. John's Medical Group: Now is the Time to Catch up with Preventative Health Care, Testing - Yonkers Times

Just like other devices we rely on, medical devices can improve our quality of life so long as they are maintained to work properly. When they are not or not maintained or serviced in line with FDA approval there can be huge health care and cybersecurity risks.

In the brief on a just-released FDA discussion paper, William Maisel, notes,Many medical devices are reusable and need preventative maintenance and repair during their useful life; therefore, proper servicing is critical to their continued safe and effective use.Maisel, M.D., is the director of the Office of Product Evaluation and Quality in FDAs Center for Devices and Radiological Health.Who could possibly disagree with such a statement? Lawyers.

Thats right, the tort bar is prioritizing profit over patient safety. For shame. (No, Im not surprised either.)

Quality is the glue that holds together our health care technology ecosystem. Whether its a medicine for high blood pressure, a COVID-19 vaccine or a medical device such as an implantable stent or a room-size MRI machine, the FDAs mission rests upon a triad of trust safety, effectiveness and quality. And the bedrock upon which quality rests isGood Manufacturing Practices. Who could be against that? Lawyers.

Considerthe recent spate of suggested state and federal legislationon what is called Right-to-Repair. At first glance, it seems like a good idea. Why not make it easier for consumers to fix their broken electronics, without having to pay a costly sum to the original manufacturer? But, as HL Mencken reminds us, for every complex problem there is an answer that is clear, simple, and wrong. The reality is that Right-to-Repair presents many dangerous unintended consequences. The No.1 problem is that it compromises patient safety.

The core of Right-to-Repair laws is to require innovative technology companies to make product repair information, replacement parts and tools readily available to consumers and third-party repair shops. Should that be the case for devices such as Automated External Defibrillators and hospital ventilators? What about electrocardiograph (ECG) machines? Can physicians and patients be confident in non-FDA compliant vendors without the advanced training and technical ability to properly repair and recalibrate life-saving machines? Who could argue that anyone can do it? Lawyers.

Why? Because when things go wrong, when medical devices fail, when patients and their families suffer the consequences, when associated health care costs skyrocket it seems lawyers see opportunity. And they aim their lightening lances of litigation at the deepest pockets the original manufacturers.

It seems the tort bar is creating a problem they can exploit for profit.

But wait, it gets worse. By allowing third parties without any FDA competence to repair regulated, complicated medical devices, Right-to-Repair also opens the door to breaches in cybersecurity.

According to the FDA, cybersecurity is a widespread issue affecting medical devices connected to the Internet, networks, and other devices. Cybersecurity is the process of preventing unauthorized access, modification, misuse or denial of use, or the unauthorized use of information that is stored, accessed, or transferred from a medical device to an external recipient.

In the just-released FDA discussion paper that I referenced above, Strengthening Cybersecurity Practices Associated with Servicing Medical Devices: Challenges and Opportunities, the agency asks, How can entities that service medical devices contribute to strengthening the cybersecurity of medical devices?

According to the discussion paper, FDA defines service to be the repair and/or preventive or routine maintenance of one or more parts in a finished device, after distribution, for purposes of returning it to the safety and performance specifications established by the original equipment manufacturer (OEM) and to meet its original intended use.

In other words, the first step in advancing medical device cybersecurity is to limit and ensure that those who control repairs and maintenance of these highly sophisticated pieces of health care technology are regulated FDA manufacturers.

On July 27, the FDA is holding a public meeting on this topic. It couldnt be timelier. The proper servicing and security of medical devices and other health care technologies mustnt be subsumed for profit.

Peter J.Pitts, a former FDA Associate Commissioner, is president of the Center for Medicine in the Public Interest and a visiting professor at the University of Paris School of Medicine.

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The major health care and cybersecurity risk of 'Right-to-Repair' laws | TheHill - The Hill

Researchers from the University of Leeds and the University of Sheffield have discovered a key mechanism in preventing the escalation of blockages caused by blood clots.

A blood clot forms a pulmonary embolism or blockage, cutting off blood flow to major blood vessels in the lungs. In many cases, the blockage is caused by fragments that have broken away from a blood clot elsewhere in the body, such as a deep vein thrombosis in one of the legs. The fragments are transported to the lungs via the blood stream. Now, researchers have discovered that the protein fibrin plays a key role in stabilising the original clot to prevent bits of clot from breaking loose.

The findings from the research, which was funded by the British Heart Foundation, have been published in the scientific journal PNAS.

The research team used animal studies involving mice to investigate a key chemical building block of the clotting protein fibrin, known as -chain cross links. The scientists found that the -chain cross links give the fibrin its stability through enhanced resistance to rupture and clot fragmentation.

The study examined clot behaviour in mice that were genetically modified so they could not produce the stabilising -chain cross links in the fibrin, and compared them with mice that could.

The results revealed that the clots without the -chain cross links were more unstable and more likely to fragment and produced more associated embolisms.

Dr Cdric Duval, the studys lead author and lecturer in the School of Medicine at Leeds, said: What we believe is happening is that, without the -chain cross links, the fibrin is not strong enough to hold the clot in place against the forces generated in the body from muscle movement and from blood flow.

Professor Robert Arins, also from the School of Medicine at Leeds, who supervised the research, said: The findings reveal the importance of the -chain cross links. These are the structural supports in the fibrin that keep the clot in place.

By identifying the structural dynamics of this mechanism, we have identified new targets for drugs that could be developed to stop fragments of a thrombosis breaking away to cause an embolism in the lungs.

This is a disease that is a major cause of disability and death around the world.

The research findings confirm the long-held suspicion by Professor Arins that the structure of fibrin plays a role in the fragmentation of clots but, until now, there was no scientific evidence.

He said: I have always thought that the remarkable elasticity of fibrin, which has been described as like rubber or spider silk, would be important to prevent clot fragmentation and thus thromboembolic disease.

I was astounded to see the level of differences in pulmonary embolism that resulted from a genetic mutation that resulted in reduced elastic recovery of the fibres. So, when I saw the results, it definitely was a wow moment and I also had the I told you so feeling.

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Discovery could inform new preventive treatment for blood clots - Health Europa

Pancreatic cancer accounts for 3% of all new cancer diagnoses, but is the fourth leading cause of cancer death in the United States.5 Therefore, it is imperative that we, as a community, focus our efforts on learning more about precancerous conditions within the pancreas and the early identification of cancers; pancreatic cysts are an ideal target. There are 2 key components to remember with regard to pancreatic cysts: accurate identification and evidence-based longitudinal surveillance. Unfortunately, an ongoing issue for this patient population is that many are never appropriately identified or followed. However, even when identified, many patients are not referred to a pancreatic center of excellence, a gastroenterologist who focuses on the pancreas, or a surgeon with experience in pancreatic cysts. As a result, these patients can re-present years later with a pancreatic cancer.

Our institution, Saint Barnabas Medical Center, an RWJBarnabas Health Facility, in conjunction with the Rutgers Cancer Institute of New Jersey, has made efforts to focus on preventative care. Specifically, we have recently focused our attention on pancreatic cysts and partnered

with Eon to develop and implement a platform called Essential Patient Management (EPM) Pancreas to identify patients with a pancreatic abnormality, and then, longitudinally follow them using an innovative and modern cloud-based platform that includes automatic patient and physician reminders.

Through the adoption of Eon EPM Pancreas, patients who now undergo either ultrasound, computed tomography, or magnetic resonance imaging in our Emergency Department, inpatient setting, or outpatient imaging facility, will be automatically identified if they are found to have an abnormality within their pancreas. The patient will then be contacted by one of our preventative medicine nurse navigators with a phone call and a letter; they will also be offered consultation with our pancreatic care team. Additionally, the patients ordering physician will also be contacted with a letter and a call. This algorithm links all parties together and lets them know about the pancreatic abnormality that may harbor precancerous potential. This automatic identification and population of cyst factors into the cloud-based platform accomplishes the first key component to remember with these cysts.

The second component is accomplished through individual risk stratification. The pancreatic cyst size, tempo of growth, pancreatic duct caliber, mural nodularity, evidence of pancreatitis, tumor markers, pancreatic cyst fluid aspirate for carcinoembryonic and amylase levels, and, at times, genetic mutations are added to the Eon EPM dashboard. Putting these factors together, along with national and international guidelines, we determine how to best manage and follow a particular patient. Previously, this has been done by using an Excel spreadsheet. However, now, with the EPM platform, we can advance healthcare and manage patients electronically; the cloud-based system embeds into our institutions electronic medical record (EMR) system, and with that, all the aforementioned factors can be seen immediately at the time of consultation. Moreover, we have extrapolated the method of a tumor board into our pancreatic cyst clinic and we now have a weekly pancreatic multidisciplinary conference where we discuss our patients with pancreatic cysts, thus providing them with a multidisciplinary/team approach.

Eon EPM offers the most powerful Pancreas solution that uses best-in-class technology to identify incidental pancreatic abnormalities, and longitudinally track patients who require serial surveillance. Eon EPM uses sophisticated proprietary models, referred to as Computational Linguistics data science models, to positively identify incidentally found pancreatic abnormalities with 93.9% accuracy; this high accuracy rate means fewer missed patients and less coordinator effort. Moreover, EPM can integrate with any facilitys EMR and IT system, and through Robotic Process Automation, it automates many mundane and repetitive tasks.

Eon EPM Pancreas detects incidental pancreatic abnormalities noted in radiology reports, extracts pertinent information from these reports such as pancreatic cyst characteristics, enters all information into one dashboard for serial surveillance, ensures patients are tracked and followed according to evidence-based guidelines, segments and prioritizes patients based on risk stratification, and triggers follow-up.

In summary, there are 2 overarching goals of this program. The first is to improve the quality in identifying patients with pancreatic cysts and longitudinally following them to ensure that they do not fall through the cracks within the community in which they are being served. The second goal is to offer patients surgery only when it is indicated because the great majority of pancreatic cysts only require lifetime surveillancenot an operation. If we can identify high-risk pancreatic cysts and surgically remove them prior to the development of pancreas cancer and prevent other patients from having an unnecessary operation, we believe that to be a massive improvement in how patients are being cared for. I have no doubt that Eon EPM Pancreas Solution will change the landscape for patients with pancreatic cysts and tumors, and have a true impact on survival from pancreatic-related diseases.

Russell Langan, M.D., is chief of Surgical Oncology and Hepatopancreatobiliary Surgery at Saint Barnabas Medical Center (SBMC), an RWJBarnabas Health facility, and surgical oncologist at Rutgers Cancer Institute of New Jersey.

Link:
RWJBarnabas Health Pioneers Innovative Pancreatic Cyst Surveillance Program - OncLive

(Okoboji)-Pet Owners are urged to take precautions during the holiday weekend, KUOO's Becky Thoreson has details:

Pet Owners encouraged to take Precautions during 4th of July Weekend

Pet Experts are urging owners to take extra care with pets during the 4th of July holiday weekend.

Kristi Henning, Director of the Emmet County Animal Shelter says it's best to take preventative measures. "You can prevent some fear anxiety in pets from something as turning up the radio or the TV really, really loud to try to drown out the sound of the fireworks. You can do a thunder shirt, if you have one. A lot of times that snug feeling of that thunder shirt gives them comfort. If you don't have one , you can pop on Pinterest, and they'll actually show you how to make one out of an old tee shirt or a wide ace bandage. It's pretty simple, it's basically just making something snug on them so they feel safe. Another alternative is to contact your vet, and ask them what sort of medicine you could give them as a preventative to an anxiety reaction."

She notes that it's important to secure your pet, and have identification. "Definitely make sure they're secured, that's important. Also, some kind of ID. If you don't have a tag on your pet and you don't have time to get one, even just taking a piece of duct tape and write your name and phone number on it, and then wrap that around their collar so taht they have something on them. Long term though, getting appropriate tags helps all the times of the year and microchips can never get lost."

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Pet Owners encouraged to take Precautions during 4th of July Weekend - exploreokoboji.com

Seven states will lift their eviction bans next month, and the cases to follow will offer a glimpse of the onslaught to come. (iStock)

In Connecticut, real estate attorney Ori Spiegel hadnt heard much from landlords as the end of his states eviction ban approached. He expects that to change, starting today.

There are many who Ive asked to call me back on June 30, Spiegel said. The governor has often waited until the last minute to extend the moratorium, so I dont really have information for them until that point.

Barring any 11th-hour interventions, Connecticut, Kentucky, North Carolina and Oregon are set to drop their state eviction protections at midnight. Four more states plus the District of Columbia are slated to do the same in July.

The expiring bans will leave the overwhelming majority of U.S. tenants whove fallen behind on rent with only the federal moratorium imposed by the Centers for Disease Control, which offers less protection and gives landlords more ways to circumnavigate.

In states without protections, eviction cases filed this month will offer a glimpse of whats to come when the federal moratorium sunsets July 31. Tenant advocates and landlord attorneys expect an onslaught of cases for arrears each in the tens of thousands of dollars that could carry astronomical costs for communities left with the job of housing the newly homeless.

Landlords in the 15 states that maintained their own bans before June 30 have largely had their hands tied when it comes to filing eviction cases. In Connecticut, the state moratorium affords a few exceptions, such as for tenants who owe back rent from before the pandemic. But Spiegel has advised landlords not to take anything to court until the state ban lifts.

Thats because the CDC moratorium offers a workaround for landlords.

The federal ban only protects tenants if they fill out a hardship declaration. In Connecticut, a judge may determine a tenants form isnt credible, paving the way for eviction.

The CDCs moratorium also includes five exemptions, the last of which has allowed eviction cases to proceed. If a tenant violated a lease for a reason other than non-payment, the landlord can bring them to court. Attorneys in states with expiring bans expect more of these cases in the next month.

States with weaker protections like North Carolina, or those without a state ban, like Florida, have already seen tenants evicted for reasons other than non-payment.

James Surane, a North Carolina attorney, said hes taken on a steady stream of cases in which the tenant had owed money, and had an expired lease, allowing the landlord to move forward with a case. And Florida attorney David Winker said the recent mass eviction of 200 tenants from a Miami building owned by apartment giant Aimco and spinoff Air was also a non-monetary action.

And for cases that are brought over arrears, the CDCs ban doesnt stop a filing in its tracks or a court from issuing a judgment. It just prevents tenants from being kicked out of their homes.

Portland, Oregon, tenant attorney Troy Pickard expects that in situations where a judge has ruled against a tenant in an eviction case, the parties wont need to go to court once the federal ban expires. The judge will be able to issue a notice that makes the eviction effective.

The sheriff will be able to go to that home and rip the people out of the house, Pickard said.

In most states, even those like New York and California that have extended eviction proceedings through the summer and beyond, the end of the federal ban will also bring an influx of filings.

About 11 million renters about 1 in every 33 Americans are estimated to be behind on their payments, according to estimates by the Center on Budget and Policy Priorities. In cases that have already been brought, the arrears owed are record-breaking.

Ive been doing this for about 30 years; probably did a half a million evictions and Ive never seen ledgers like these, Surane said. They are now topping $20,000 in arrears

Theres no comprehensive data on U.S. eviction filings. The Eviction Lab at Princeton University, which tracks five states and 29 cities, has found nearly 385,000 evictions filed since the start of the pandemic. Still, anecdotes from attorneys point to a much bigger backlog of cases.

For the landlords doing the filing, an eviction is often an act of desperation a last resort to regain financial control after as many as 15 months of non-payment.

Of the 10 million to 11 million small landlords HUD estimates are in the U.S., one-third are at risk of bankruptcy or foreclosure because of unpaid rents, the Washington Post reported.

In California, where the governor just extended rental protections until Sept. 30 one of the longest state bans nationally landlord advocates fear that smaller landlords owning four to eight units could be facing foreclosure.

Its hard enough for landlords to miss a couple of months of rent payments, but to have this go on for over a year, it has put property owners in financial peril, said Daniel Yukelson, executive director of the Apartment Association of Greater Los Angeles, which represents landlords.

Bidens decision last week to extend the federal moratorium until July 31 probably wont raise the risks for landlords by much. But the extension will add to the growing ire of property owners, particularly landlords who kept up with mortgage and bill payments by going into debt or tapping into retirement accounts because their tenants couldnt or wouldnt pay the rent.

Winker said one of his clients, a model and single mother who emigrated from Russia, was incredulous at the extended ban.

She didnt know it was coming, he said. And when she heard about it, she said this is like socialism, but its not the government that pays for it, its the landowner.

Older people just over one-third of landlords owning two- to four-unit buildings are also suffering. Many are retired and unlikely to have another source of income apart from rent, according to The Urban Institute.

A subset of owners is itching to sell. Some are scarred from the stress of the last year and want to get out entirely. Others are hoping to take advantage of the hot market, but cant unload property while their tenant is in possession. Connecticut attorney Mark Sank said he gets calls daily from owners looking to sell and tells each to wait until the state moratorium lifts.

In states where tenant occupancy isnt an issue, landlords have sold to institutional investors who will then have to take tenants who owe back rent to court.

To describe what may happen when the federal ban finally lifts, tenant advocates have relied on a grab bag of flood metaphors a wave, a deluge, a tsunami to predict the number of evictions that will ensue.

For landlord attorneys, the rental housing market itself is sick, an economic manifestation of Covid-19, and evictions are just triage. And waiting only makes it worse.

Winker compared it to preventative medicine. Take your 10-cent-per day blood pressure medication because if you dont, youll face much worse consequences.

I will end up in the hospital in the emergency room in full cardiac arrest and that is the least efficient way for me to receive my health care, Winker said. I often talk about courts being that way.

With states struggling to dole out assistance payments, many arrears cases wont be remedied until they hit housing court the last and most expensive course.

The Cost of Eviction Calculator developed by the University of Arizona estimates that the 11 million renters at risk for eviction could cost the U.S. as much as $101 billion to care for through shelter, health care and foster care.

Eventually there has to be a reckoning of some kind. The question is how does this thing ultimately end? Pickard said. Hopefully it wont end in a mass of evictions, because if it does thats just going to be one more huge cost to society that might have been avoided through some kind of intervention.

Contact Suzannah Cavanaugh

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Landlords in peril, tenants in distress: Expiring eviction bans foreshadow national reckoning - The Real Deal

Australias medicines regulator has fined Melbourne biotech Starpharma $93,000 for advertising breaches related to its COVID-fighting nasal spray, just weeks after the UK regulator raised questions about promotions of the product.

The Therapeutic Goods Administration confirmed on Friday evening it had issued the company with seven infringement notices worth $93,200 for promoting its nasal spray Viraleze via its website and YouTube channel even though the product is not yet authorised for use in Australia.

Starpharma has been clear with investors that its product is not yet available for sale in Australia. However, its online retail site with explanations of Viraleze was available to view from Australia until recently.

The regulator said the companys advertising included a restricted representation claiming that Viraleze is an antiviral nasal spray that stops SARS-CoV-2, the virus that causes COVID-19. Any claims or references to preventing or treating a serious form of a disease, condition, ailment or defect are restricted representations.

In a statement to the ASX on Monday morning, Starpharma said upon receiving the infringement notices it acted quickly to block Australians from being able to view the materials that the regulator had concerns about, including preventing them from accessing the products marketing website and its YouTube channel.

The company will work closely with the TGA to resolve the current matter and how to balance the need to provide information to its shareholders about key company milestones...with requirements of the [Therapeutic Goods] Act in relation to advertising in Australia, Starpharma said.

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Starpharma is an ASX-listed pharmaceuticals developer which currently sells a range of sexual health products including antiviral condoms.

The company pivoted its research towards coronavirus in the middle of 2020 and developed Viraleze, an antiviral nasal spray, using the same active ingredient that is in its other products.

Viraleze, which has undergone laboratory testing, is designed as a preventative measure against the virus to be used as an additional layer of protection on top of mask wearing, social distancing and vaccines.

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Starpharma whacked with $93,000 TGA fine over COVID spray ads - Sydney Morning Herald

Baby seizures happen when an abnormal extra burst of electrical activity occurs between neurons, or brain cells, in a babys brain. These can happen for many reasons.

Causes may include brain injury, infection, and underlying health conditions, such as cerebral palsy. A babys risk of fever-related seizure is highest when they are younger than 18 months.

Sometimes, it is difficult for parents or caregivers to notice seizures in babies and young children, as they can be subtle. However, common signs include loss of consciousness and jerking of the arms and legs.

Read on to learn more about the signs and symptoms of a baby seizure and treatment.

The symptoms a baby experiences depend on the type of seizure they have.

These types of seizures are most common in the newborn period. However, these signs may resemble usual, everyday movements and may be difficult to spot. Symptoms of subtle seizures can include:

Tonic means muscle stiffness. When a baby experiences a tonic seizure, they may:

Clonic means twitching or jerking, so when a baby has a clonic seizure, they may display repeated, uncontrolled jerking muscle movements.

During this seizure, a parent or caregiver may notice the baby is clenching or twitching parts of its body, including:

This refers to a type of seizure that starts with stiffening (tonic phase) followed by jerking (clonic phase). Therefore, a person may observe symptoms of a tonic seizure followed by signs of a clonic seizure.

Learn more about seizures here.

According to The National Institute of Neurological Disorders and Stroke, when a baby is having a seizure, it is crucial to keep them away from any hard objects to reduce the risk of injury. When the area is safe, roll them onto their side to prevent choking.

Do not put anything in the babys mouth or try to stop any mouth movements, such as tongue biting, as this can injure the baby.

Call 911, or take the baby to an emergency room if they are:

Learn what a seizure looks like here.

Seizures are the most common neurological emergency in the first 4 weeks of a babys life. As many as 15 babies per 1,000 experience a seizure. Some seizures only last a few minutes and occur once, leaving no lasting damage.

When a baby experiences frequent seizures, they must receive treatment to prevent brain damage. Brain damage occurs due to the frequent disruption of brain oxygen levels and excessive brain cell activity.

Learn more about seizures in babies here.

Sometimes, when babies show signs of a seizure, they are demonstrating healthy reflexes.

The Moro reflex, or startle, reflex is a healthy part of a babys development. If a baby hears a loud sound or senses a sudden movement, they may throw their head back and suddenly stiffen and extend their arms. Parents or caregivers should not worry when they notice this behavior. Babies tend to outgrow this reflex at 36 months.

The tonic neck reflex is a movement where a baby looks to the side with one arm extended and the other bent; it may look like they are imitating holding a sword or firing an arrow. This primitive reflex first develops in the womb and helps the baby coordinate their eyes and control fine movement. Babies may demonstrate this reflex up to 9 months old.

However, while this reflex presents with signs such as eye-rolling, lip-smacking, and leg pedaling movements, these are normal movements, particularly in newborns. It is worth noting that this reflex does not present with characteristic features of a seizure, such as jerking or stiffening.

There are many causes of seizures in babies. Some may occur due to an event such as a head injury, while others could be symptoms of an infection or an underlying health condition.

Some causes of baby seizures include:

Viral encephalitis causes brain inflammation and seizures. Common viruses, such as the flu, can cause a babys temperature to rise, increasing their risk of a febrile seizure. Bacterial infections, in particular, Group B strep bacteria can cause meningitis in babies, which can present with seizures.

Learn about the differences between viral and bacterial infections here.

Sometimes babies that have a fever or high body temperature may develop a febrile seizure. They typically only last a few minutes and occur most often in young children, roughly between 6 months and 5 years.

Signs of a febrile seizure include:

Learn more about febrile seizures here.

When a baby has hydrocephalus, cerebrospinal fluid (CSF) applies pressure on the brain. It is a common condition and can also occur on its own in the womb. If a doctor uses forceps or vacuum extractors to help deliver the baby, this may injure the head and cause CSF to accumulate on the brain.

Learn more about CSF here.

Seizures are a common symptom of cerebral palsy. If a baby has cerebral palsy, they will find it difficult to control muscle. Researchers are unsure of the exact cause of cerebral palsy. However, they do know it occurs in some babies that do not receive enough oxygen.

Learn more about cerebral palsy here.

Other causes of baby seizures include:

Learn more about epilepsy in children here.

To find out what is causing the seizure, a doctor may run an electroencephalogram (EEG). This is a test that measures electrical activity in the brain. They may do this in the emergency room or as a separate appointment.

To prepare for the EEG, a doctor places metal discs on the babys head that detect and record their brains electrical impulses.

A baby may need several EEGs, so a doctor can see what their brain activity is like between seizures.

Some conditions that induce seizures may produce healthy EEG readings, so imaging tests, such as an MRI and CT scan, may be necessary to see if any structural changes or obstructions are causing seizures.

Learn about head and brain MRIs here.

If necessary, doctors may control seizures in babies with anticonvulsant medication, including:

If the seizures are due to a lack of oxygen, doctors may administer hypothermic treatment. This procedure cools the babys brain and body to prevent brain damage. They may do this if a baby experiences difficulties during birth and is not able to breathe.

Some babies may need long-term treatment to prevent seizures from recurring. A doctor needs to know the exact cause of the seizures before prescribing an effective treatment plan. For example, treatment will differ if a baby has epilepsy or is recovering from meningitis.

Learn more about meningitis in babies here.

Several types of seizures affect babies, including subtle, tonic, clonic, and febrile seizures. Some seizures are not serious and do not leave any lasting brain damage. Infection and injury are common causes of brain seizures.

Sometimes, underlying health conditions, such as cerebral palsy, can cause seizures that require long-term treatment. If a baby has a seizure and struggles to breathe or their symptoms last longer than 5 minutes, call 911 or take them to an emergency room.

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Baby seizures: Signs, what to do, causes, and treatment - Medical News Today