StemCell Therapy

A diabetes education program, offered virtually by the Alabama Cooperative Extension System, will begin next in March, according to an announcement from the Lawrence County Extension Office.

The Diabetes Empowerment Education Program (DEEP) will be offered in six 30-minute to hour-long sessions online, beginning March 24.

"Let's have a DEEP conversation about managing your diabetes," Regional Agent Elaine Softly, who will lead the program, said.

About 610,458 Alabamians live with diabetes, notes Softley. Every year, an estimated 31,000 state residents are diagnosed with diabetes.

She added that diabetes and prediabetes cost an estimated $5.4 billion in Alabama each year, and serious complications from the conditions include heart disease, stroke, amputation, end-stage kidney disease, blindness and even death.

Softley's series will cover topics: Understanding the Human Body, Understanding Risk Factors for Diabetes, Monitoring Your Body, Being Physically Active, Planning Meals, Identifying and Preventing Complications, Learning about Medications & Medical Care, and Living with Diabetes: Mobilizing Your Family and Friends.

For those without access to reliable internet service, other program participation options may be available, according to Extension Coordinator Donna Shanklin.

"The program can be delivered face-to-face to established groups, such as a quilt group, church members, or book clubs, as long as they are following COVID-19 guidelines," Shanklin said. "Just give the office a call to see if Softley can fit you into her schedule. If you do not have access to the internet, we can offer the use of our facilities for a limited number of people following COVID-19 guidelines."

Online sessions will take place at noon on March 24, March 31, April 7, April 14, April 21 and April 28.

Questions may be directed to Elaine Softley by calling 256-324-2851, or by emailing es0021@aces.edu. The Lawrence County Extension Office, located on Alabama 157 in Moulton, may be reached by calling 256-974-2464.

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Extension system to offer diabetes education program this spring - Moulton Advertiser

Two weeks ago, I tore the meniscus of my right inner knee as I got off my stationary exercise bike. The pain of the injury didnt show up until a few mornings later -- getting out of bed, I set my foot onto the floor and immediately raised a yelp of misery.

At the orthopedist office, the doctor drained fluid from the knee and injected cortisone with the largest needle I had ever seen. Thankfully, the injection worked, and after a few days of ice and rest, I was cleared to return to my regular activities.

But I didnt. Instead of returning to my daily exercise routine, I stayed put as my bike and weights gathered dust. I didnt take walks outside; I didnt hit my yoga mat.

It wasnt only exercise I abandoned: I didnt take my blood sugars. I stood in the kitchen and -- ignoring years of "clean eating" -- downed six homemade chocolate chip cookie bars. I pushed the scale into the closet and avoided mirrors.

I had hit the wall when it came to my diabetes care. I was officially burned out.

What is diabetes burnout? Its when the emotional toll of taking care of your disease becomes overwhelming and, for whatever reason, you give up. In my case, my knee injury was the final straw that sent me over the edge; but the truth is, but there had been so much else leading up to it. The long pandemic months that kept us mostly inside, unable to visit family or friends. The death of my sisters mother-in-law earlier that week (a lovely, warm woman who dealt with her own late-in-life diabetes by permitting herself two -- exactly two -- Raisinets a night). The frustrating inability of my husband or myself to schedule a COVID-19 vaccine in our state despite our eligibility. The 21-degree weather with more snow and ice headed our way; the very notion that my beloved Bruce Springsteen had sold out and narrated an ad for the Super Bowl. The masks. The handwashing.

Everything.

There are many, many reasons for diabetes burnout. For some, it arrives when you get a complication even though youve done your best to take care of your disease. Or when despite every effort, the scale refuses to budge. Or high-sugar readings never drop. And it can take many forms: You might refuse to go to your doctor. Or stop monitoring your food. Or "forget" to renew your medications.

Most of us experience diabetes burnout at some point. No matter the cause, the signs and symptoms are the same: Youre sick of being sick, and you cant take it anymore.

For a week, that was me. So how did I deal? I made myself some rules:

1. No beating myself up. I gave myself the right to be sick of my disease.

2. I acknowledged that it couldnt last forever. As delicious as it was to pretend that I didnt have to care for my diabetes, I knew it couldnt last. I decided to call my time away from diabetes a vacation. Since I couldnt take a vacation during the pandemic, I reasoned, a short escape from diabetes might be the best Id get.

3. There were limits. I didnt down sleeves of Oreos or gallons of ice cream, but I did let loose: making spaghetti for dinner one night (white pasta!) and adding a glass of wine or two (or three). I exercised if I felt like it, but I didnt push myself to get a certain number of cardio minutes. If I felt like stopping, I did.

4. Medications were non-negotiable. I continued to take my medications (some habits survive burnout), but I ignored my sugar readings. (I really didnt want to know.)

5. I reached out for support. I talked to a friend about what I was going through and let her remind me of how careful I normally was, and how, maybe, I had needed to take a break to power through.

At the weeks end, I had put on a few pounds. When I got back to testing my sugars, my first reading wasnt great -- but it wasnt horrific either. I dumped the cookie bars and went food shopping for new items that were healthy, low carb, and a little off the beaten track: Japanese eggplant, portobello sliders, low-carb tortillas, a bottle of oyster sauce -- to regain my interest in healthy food.

Lets be clear: Burnout sucks, and it can hurt your health. Diabetes care is best when it's consistent and ongoing. If you find yourself experiencing diabetes burnout, contact your doctor or diabetes educator. They can help you get back on track by reminding you of your earlier progress or setting you up with a regular support group. In these difficult days, we need all the help we can get.

WebMD Blog

Ilene Raymond Rush is an award winning health and science freelance writer. Based on her own experiences with type 2 diabetes, she brings a personal take and a reporters eye to examine the best and newest methods of treating and controlling the disease.

Read the original post:
Diabetes Burnout: What It Is and How to Handle It - WebMD

A billboard in Johnston County suggests North Carolina Gov. Roy Cooper is shortchanging people with type 1 diabetes.

A WRAL viewer emailed a photo of the billboard on U.S. Highway 301 to PolitiFact. It says:

"Gov Roy Cooper does not consider Type 1 diabetes an under lying health issue! Think about that!"

The billboard does not show who paid for it. Warren Stancil, the president of the billboard company, InterState Outdoor Inc., said he doesnt know the buyers identity.

"This was an anonymous person who bought the ad space. All I know is whats in the message," Stancil said in an email. The ad went up around Jan. 22, he said.

Given the timing of the message in the midst of a vaccine rollout, were assuming for the purposes of this check that the messenger is likely referring to where diabetics fall in North Carolinas inoculation schedule.

The billboards message touches on a controversial subject. To date, the U.S. Centers for Disease Control and Prevention does not consider both types of diabetes to carry the same level of risk for COVID-19 complications. In North Carolina, meanwhile, the health department has grouped Type 1 and Type 2 diabetes together and people with either condition qualify for covid vaccines in Group 4, ahead of the general population.

Type 1 diabetes and COVID-19

The CDCs webpage about how the virus affects people with medical conditions says people with Type 2 diabetes are at increased risk, while people with Type 1 diabetes "might" be at increased risk.

Under current CDC recommendations, people with Type 1 diabetes would be vaccinated with the general population.

Advocacy groups such as the American Diabetes Association and JDRF (formerly known as the Juvenile Diabetes Research Foundation) are lobbying the CDC to place higher priority on people with Type 1 diabetes.

A study published in December found that Type 1 diabetes "independently increases the adverse impacts of COVID-19," while another recent study found that Black COVID-19 patients were more likely to develop a serious complication of Type 1 diabetes than white patients.

Still, JDRF spokeswoman Cynthia Rice said that, as a result of the CDCs recommendations, "many states" havent prioritized people with Type 1 diabetes. So the American Diabetes Association has been contacting governors and state agencies across the country, spokeswoman Daisy Diaz told PolitiFact.

Type 1 diabetes and North Carolina

In North Carolina, the health department currently considers both types of diabetes to be "chronic conditions." Where does that put diabetics in North Carolinas vaccine rollout?

Lets say someone has diabetes but isnt over age 65, doesnt work in an essential industry and doesnt meet any other criteria for moving up North Carolinas vaccine priority list.

That person would be in Group 4 of the states five groups:

Group 1: Healthcare workers, long-term care staff and residents

Group 2: Older adults

Group 3: Frontline essential workers

Group 4: Adults at increased risk of severe illness

Group 5: Everyone else

Asked about North Carolinas plan, Rice said: "That is the policy we are seeking around the country, with Type 1 included with other disease that increase risk of severe illness from COVID."

Possible confusion

While people with both types of diabetes are prioritized in North Carolina, old versions of the health departments website may have given people the wrong impression.

Take for example the departments FAQ page about COVID-19 vaccines. Under the "getting vaccinated" section, the department lists chronic conditions that make someone a higher priority for vaccination.

The page currently lists both types of diabetes as chronic conditions.

However, according to an internet archive, the page excluded Type 1 diabetes from its list of chronic conditions as recently as Feb. 12. The webpage quoted CDC guidance, mentioning only Type 2 diabetes as a chronic condition.

That exclusion may be why some media outlets have mentioned only Type 2 diabetes when reporting on North Carolinas rollout.

North Carolina has tried to follow most CDC recommendations, said SarahLewis Peel, a spokeswoman for the health department. However, Peel said, North Carolina has always intended to prioritize all diabetics for vaccines.

People with both types of diabetes have been prioritized together since the state released its guidance for Group 4 on Jan. 25, she said.

Our ruling

The billboard says "Cooper does not consider Type 1 diabetes an (underlying) health issue!"

North Carolinas vaccine rollout prioritizes people with type 1 diabetes ahead of the general population. So its clear that Cooper, to some degree, considers the disease to be an underlying health issue.

We rate this claim False.

See more here:
How are the CDC, North Carolina treating Type 1 diabetes in the vaccine rollout? - PolitiFact

This article was originally published here

Diabetologia. 2021 Feb 17. doi: 10.1007/s00125-020-05351-w. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19).

METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days.

RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors.

CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736.

PMID:33599800 | DOI:10.1007/s00125-020-05351-w

Link:
Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study - DocWire...

Patients' worries about supplies of insulin, as well as other diabetes medications and devices due to Brexit have not, so far, been born out in reality, but the long-term situation remains uncertain as cross-border movement of goods is set to rise, according to experts.

In particular, Northern Ireland puts a fine point on these concerns with difficulties already apparent at border crossings.

Experts also warn patients against stockpiling medicines and related goods, which would in itself create product shortages not directly related to Brexit border issues.

"In some areas the cure is worse than the disease," cautioned Mark Dayan, MSc, Brexit programme lead at the Nuffield Trust.

At only 7 weeks after the end of Brexit transitional arrangements, it is reasonable to assume that the first few weeks are a relatively artificial reflection of the longer-term status quo around the bidirectional trade between the UK and EU.

Concerns around the supply of devices and medicines including insulin are very real to those whose lives depend on it, but in reality, how valid are they?

Back in 2018 when Brexit negotiations were in full-flow, the scene was set when senior officials expressed concerns around insulin supply. Sir Michael Rawlins, who was chair of the Medicines and Healthcare products Regulatory Agency (MHRA) at the time, told the Pharmaceutical Journal that: "We make no insulin in the UK. We import every drop of it. You can't transport insulin around ordinarily because it must be temperature-controlled."

Then a study of tweets posted in 2019 by people with diabetes reflected that these concerns were rife among patients too. At this point the outcome of Brexit 'no deal' or 'deal' negotiations were unknown.

Recently published in JMIR Diabetes on 27 January, the study investigated patients' views around lots of disease-related issues, but of note, the tweets around diabetes product supplies were particularly poignant.

Insulin supply is a key concern for dependent patients because a lack of the replacement hormone can be fatal. The study found that 9% of tweets featured real worries among diabetes patients relating to insulin availability, whatever the outcome of Brexit negotiations.

Tweets emphasised the desperation and fear of some patients. One wrote: "INSULIN - for most of you it is just a medical term, but it is a lifesaver for me and other type 1 diabetics. Do I buy a big fridge to stockpile to make sure I can live while you #brexiters apply for your new blue passport?"

Another wrote: "Diabetics are not sure if their life-saving insulin will run out.So many medications CANNOT BE STOCKPILED!It's a DEATH THREAT from the government and violates our human right to life. #NotoDeathbyBrexit #DyingforBrexit."

Su Golder, PhD, from the University of York led the Twitter study. "UK-based patients with type 1 diabetes were all very worried and scared about supply," she told Medscape UK in an interview. "We don't know if these concerns were real, but the opinion expressed does show how vulnerable these people feel.

"Because insulin is a life-saving drug that needs storing in the fridge, it can't really be stockpiled," she adds.

Nikki Joule, policy manager at Diabetes UK, lends support but also contextualises these concerns. "The worry is understandable, particularly around insulin because people depend upon it for their lives," she said, but added that, "I think much of the concern expressed by people with diabetes is really anxiety and hasn't been borne out by reality, so far at least, and certainly not above and beyond normal short-term shortages that happen, Brexit or not."

Diabetes UK says it has supported Government calls to suppliers of insulin and other diabetes medicines too, asking them to keep 6 weeks of stockin the UK. "Contingency plans comprised alternative routes into the country, extra stock being held on UK soil, and the Department of Health and Social Care (DHSC) ensured those levels of stock with both medications and device companies," said Nikki Joule.

"In fact, we were aware that some companies had threetimes more stock than a 6-week supply, and so far, to our knowledge at Diabetes UK, supply routes seem to be operating well," she added.

The DHSC was always concerned about insulin given how essential it is for people with type 1 diabetes and others who are dependent on insulin, said Ms Joule, and this concern was not only due to the risk of 'no deal' but also for potential disruption due to restrictions or supply issues around COVID-19. "The same actions and contingency plans around supply would need to be taken whether issues were related to Brexit or COVID."

She also noted that stock problems are unlikely for many diabetes medicines such as metformin or gliclazide, because they are made by a large range of companies in the UK.

The default 'no deal' scenario never came to pass, and the EU-UK Trade and Cooperation Agreement was signed on December 24, 2020.

In an interview with Medscape UK, Mr Dayan explained some of the new processes and challenges underpinning the movement of medicines and devices, including those for diabetes, across borders between the European Union (EU) and UK.

Essentially, concerns prevail around customs and regulatory processes, including medicines' safety alert systems.

Since January 1, 2021, customs processes around the logging of import and exports declarations, as well as new permits and details have been required by hauliers to enable movement between countries.

In terms of diabetes-related products moving into the UK from the EU, the border checks and customs declarations required by UK authorities facilitate a smoother flow of goods into the UK than vice versa.

"Right now, things are relatively under control," said Mr Dayan, adding that companies have some concerns, but this does not seem to have led to more shortages than normal. He pointed out that this reflected several years of work by the DHSC and companies in trying to negotiate the best way forward.

To minimise any difficulties associated with Brexit, the UK has provided various grace periods for products entering the UK from the EU, explains Mr Dayan. "For example, deferral on customs forms for 6 months at the UK border, and a 2-year grace period for regulatory issues. Most relevant are the border-to border easement measures, so the UK is accepting batch testing certificates until 2023."

Some arrangements are more mutually beneficial than others and facilitate trade. "The trade and cooperation agreement that came out on Christmas Eve contains mutual recognition for Good Manufacturing Practice (GMP) for medicines, and EU inspection certificates are still accepted here in the UK," Mr Dayan highlights.

"Unfortunately, many of the easements applied by the UK are not reciprocated by the EU," he pointed out.The safety of medicines databases does raise some concerns, Mr Dayan says. When it left the single market, the UK also left behind its right to submit or receive safety alerts and data from the EU systems for pharmacovigilance (EudraVigilance) or devices (EudaMed). "The danger is that we are, as a result, less well informed about emerging or potential problems with drugs and devices on the market," says Mr Dayan.

Alone, the UK has a smaller population to report safety issues than the EU, and safety issues become more visible with higher patient numbers. However, he points out that reporting systems in the EU and US should mean any safety issues or anomalies are visible but the UK will not necessarily have direct access to these databases. "I'm not overly optimistic about this changing. I'd like to have seen more on this in the trade agreement."

The complex situation in Northern Ireland, which is subject to the Northern Ireland protocol (to overcome the need for a border between the Republic of Ireland, which is still part of the EU, and Northern Ireland, which is no longer part of the EU, there is an arrangement whereby there is effectively a border check down the Irish Sea) is challenging and promises to continue to be so.

"The situation around regulatory switch overs in Northern Ireland is making it far more difficult for companies to move medicines from the mainland,"Mr Dayanremarks.

This will remain a live issue, with Cabinet Office Minister, Michael Gove, recently requesting an extension to the existing grace period beyond April.Mr Dayanhighlights that this reflects genuine concerns around the situation there. "For medicines, Northern Ireland has effectively stayed in the EU, and the movement of medicines from the UK [mainland] faces similar hurdles as shipping them anywhere on the continent. This is certainly an area where there is more risk."

The UK is only 7 weeks into Brexit and many companies gave January a wide berth, avoiding the borders for fear of confusion and delays. As a result, cross-border controls have run relatively smoothly to date. The next few months might paint a different picture with volumes of trade at borders picking up.

With all of the UK's insulin imported from the EU, concerns are not without foundation. Supplies are all sourced from EU-based manufacturing and distribution centres, with the main providers being Sanofi (France), Novo Nordisk (Denmark), and Lilly (various EU locations).

But Mr Dayan explained that despite all the UK's insulin supply being imported, insulin supply from the large pharma companies is less risky than medicines made by smaller firms. "These companies might be less capable of dealing with Brexit-related changes around operating across different markets," he said.

On January 1, when the transition period ended, many companies responded to the anticipated pressures and extra administrative needs of Brexit by avoiding the border altogether. "However, at some point this will recover, and as trade volumes increase it might get more difficult. We need to start thinking about the longer-term, for example, around the introduction of new products and long-term cost implications," he cautions.

People building their own personal stockpiles of medicines is the greatest concern stressed by both Mr Dayan and Ms Joule, and more widely. "It isn't a good idea for patients to stockpile because that will create shortages. If people start stockpiling generally then it could apply to other types of medicines and be a greater problem than the effect of Brexit itself," Mr Dayan says.

Most devices, notably continuous glucose monitors (CGM) and goods such as testing strips and sensors, are largely made and supplied by the EU. Exceptionally, the Abbott FreeStyle Libre is made in the UK, and digital interventions likeLow Carb Programare also produced in the UK.

Supply of testing strips or sensors for CGMs might be more challenging than medications, especially ones that need frequent changes such as sensors that require replacement every 7 days.

In early January, people reported a problem obtaining sensors for a Medtronic pump, Ms Joule said, explaining that it actually turned out the delay was with the delivery firm and related to documentation rather than anything to do with the company directly. "This has been resolved now," she says.

Mr Dayan identifies that a key issue for devices is the validity of the manufacturer's CE mark. For UK firms wishing to export their devices to the EU, they would have needed to switch their CE (ConformitEuropenne) mark to an EU regulator prior to January 1, he said. "A UK regulator would not now be able to grant them a CE mark for export to the EU. These firms also have to work through many new customs and border checks for export to the EU that do not reflect the grace period that the UK is applying."

In theory, there is a UK equivalent of the CE mark known as theUKCA(UK Conformity Assessed) marking, which came into effect on January 1, 2021. It is a novel UK product marking that is used for goods being placed on the market in Great Britain (England, Wales, and Scotland). It is not yet widely used in practice. "It covers most goods which previously required theCE marking," says Mr Dayan. However, he adds, there is a grace period until mid-2023 when the UK will still accept EU-granted CE markings.

At the completion of the grace period, new devices made in the EU will need to obtain a UKCA marking as well as an EU CE mark. "This has the potential to increase costs at many steps," Mr Dayan points out.

Costs are predicted to increase once the grace period has passed and new checks, and a higher volume of checks, will need to be implemented.

Various studies have tried to work out the costs of having a free trade agreement versus being in the single market. One studyshowed a significant 5% increase in costs. "Given the NHS spends around 20 billion annually on medicines, that would require an extra one billion pounds," says Mr Dayan.

However, many medicine prices are resistant to price fluctuations due to a set drug price tariff, and a voluntary scheme that caps medicine costs, he explains."Companies are more likely to decide it is unprofitable to supply the UK anymore."

But insulin is unlikely to be affected, he stressed. "Lack of supply due to cost is unlikely to be an issue for insulin, which is a bulk product the UK is very willing to pay for."

However, for higher profit margin items, or at the other extreme, generic medicines where the profit margin is very low, firms might stop supply and this could lead to shortages, he adds. This happens quite regularly despite Brexit, he explained, and has happened more frequently since the EU referendum, probably due to the fall in the value of the Great British pound, which makes some products less profitable."For generic products, we would probably just pay more for them."

But the biggest concern will not be for medicines already on the market, but for new ones, said Mr Dayan. "The UK might be a lower priority market for new products. This tends to happen with smaller markets compared with the EU or US large markets."

Firms might not invest time and resource in a market that has lower returns. However, noted Mr Dayan, size might not be the only consideration. "I suspect the UK will try to use its regulatory system to remain an attractive place to introduce new medicines," he asserts.

"The MHRA granted approval to the COVID-19 vaccines quickly and the UK might be able to offer accelerated routes as an incentive."

More:
Diabetes Product Supply Is This the Calm Before Storm Brexit? - Medscape

Feb 15, 2021

Emily KaplanESPN

When the Chicago Blackhawks publicly admitted to a rebuild this past offseason, there was plenty of speculation about whether Chicago's veteran core would want to see it through.

Perhaps we weren't asking the right questions. One month into the 2021 season, the Blackhawks are far more competitive than expected; at 7-5-4, Chicago is in lockstep with the Columbus Blue Jackets for the fourth Central Division playoff spot. And while the youth movement has been a driving force, we should have been asking: Is the veteran core going to expedite this rebuild?

Captain Jonathan Toews remains away from the team with a medical absence, while Brent Seabrook has not played this season, still recovering from a back injury.

However, the two top performers on the Blackhawks -- besides rookie goaltender Kevin Lankinen -- are Stanley Cup stalwarts Patrick Kane, who is third in the league in points with 22 through 16 games, and Duncan Keith, who leads the team in minutes played by a decent margin while still playing elite-level defense. Neither appears to be slowing down anytime soon.

"I feel like my energy levels have never been better, really," Keith said Sunday evening.

2 Related

A quick reminder that Keith is 37 years old. But across sports, we're starting to recalibrate athletic longevity. Though there is still an obsession with youth, especially in hockey, we've been inundated with more and more examples of athletes defying Father Time.

When the Patriots parted with Tom Brady they might have figured he would decline in his 40s -- because quarterbacks typically have -- but that didn't happen. Brady credits his off-field work, the TB12 method, for a lot of his success. Meanwhile, in a season when many expected LeBron James to take it easy thanks to an unprecedented 71-day offseason, the 36-year-old is top 10 in the NBA in minutes played, building a legitimate MVP case. A few years ago, James' business partner, Maverick Carter, said the Lakers star spends about $1.5 million on his body per year.

A few years ago, Keith said he planned to play until he's 45. The defenseman admits he spoke a little capriciously. "I kind of just said that because I was sick of the media asking," he said. "It started a few years ago when I was 34 or 35. For me, I felt like I was young, I didn't know why I was being asked these questions. At 37 now, I look around and I'm the oldest guy on the team and there's not a whole lot of guys my age [in the league] anymore."

Asked if he could play to 50, Keith laughed. "I don't know if I'll go that far," he said. "But I feel really good right now."

Ask anyone who has played with Keith and they'll tell you he's obsessive about his off-ice regimen. Many young players try to absorb the lessons, while others are just in awe.

"My first year, I was really impressed to learn how much work [Keith] does off the ice, especially when it comes to recovery," Kirby Dach told me last year. "He puts so much work in you don't see behind closed doors."

In 2019, The New York Times wrote an article about Keith's routine in which he called himself a "biohacker and part-time hockey player." Keith said he lies on a mat with electric currents for eight minutes every morning, and routinely spends time in front of Joovv lights, which are designed to help with recovery.

"I've always been diligent about my training," Keith says, now. "But now I feel like I put it all together. I've learned a lot over the years of what my body specifically needs."

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Since Keith debuted in 2005-06, only Ryan Suter has played more minutes than his 28,839. Perhaps most impressive is Keith's consistency. As a rookie he led the Blackhawks in ice time with over 23 minutes per game. Sixteen years later, he's still leading the team, averaging over 24 minutes per contest.

Keith said the aspect of his routine that has changed the most as a pro is his nutrition. "I always thought my eating habits were pretty good," he said. "But now I'm at a point where I'm really dialed in, and I know how to get my energy levels up if they were down through healthy, nutritious foods I put in my body, knowing what my body responds well to."

And for Keith, the answer is not always complicated. "I eat a lot of steak, a lot of meat, and potatoes," he said.

Beyond nutrition, he's constantly thinking about his energy levels.

"I think in general, I've had more awareness to what takes energy away from myself," Keith said. "Whether that's staying up late, staring at my phone, looking at the screen on a TV or computer. I don't think it's necessarily one little gadget that helps me. They've got Normatec boots that help with lymphatic drainage, which is good. There's lots of those types of little things out there you can do and spend money on, but I feel it's always really important to master the basics, which nobody really can -- or anyone that I've met has. That's your sleep, your food, your hydration and your breathing. So I focus on those and it branches out after that."

Of course, we've heard countless athletes talk about sleep, nutrition and hydration, but breathing is discussed far less often.

"It's very underrated," Keith said. "There should be more talk about that. Breathing, and the power of the brain, are two things in hockey or sports, that don't get enough attention. I don't know why that is. The muscles and aesthetics get mentioned -- everyone wants to look good -- and that's important, for sure. There's meditation breathing to bring your nervous system down to more of a parasympathetic state, where you're relaxing, and you're able to recover and rest. But for me, I work on my breathing and the mechanics of it a lot. I actually really started getting into proper breathing eight years ago, and have taken it to the next level in the last year especially. So that's something I'll continue working on."

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Entering the 2021 season, Keith wasn't quite as daunted by the team's approach as some Blackhawks fans might have been. "My mindset didn't really change, because it feels like this has been going on for a while now," Keith said. "As a player, going through the ups and downs of the season each day, wins and losses, the rebuild isn't just starting this season. I just think the organization is trying to be a little more transparent with people. Some of these young guys that come in are excited to play NHL hockey and be in the NHL, and it's invigorating to be part of that type of energy."

This gives Keith an opportunity to be transparent about his own situation. Because he's still contributing at an elite level, and playing on a bargain of a contract for his services -- he's on the tail end of a 13-year contract, which pays him $5,538,462 annually through 2022-23 -- many have assumed Keith might waive his no-trade clause to play for a contender. But Keith emphatically says he has no intention of doing that.

"Why would I go anywhere?" Keith said. "Where is it better than Chicago? It's a great city, I've been fortunate to play here my whole career, great ownership, and I just love it. My goal is to win another Stanley Cup in Chicago. That's what I want."

Jump ahead:Three stars of the weekWhat we liked this weekWhat we didn't likeBest games on tapSocial post of the week

1. A group of 27 student-athletes, coaches and administrators announced the formation of a group called College Hockey for Diversity, Equity & Inclusion this week.

"It's a group of people that wanted to get together and actually make a change in hockey," says University of Alabama Huntsville freshman Ayodele Adeniye, who is part of the coalition. "Our saying is, 'One shift at a time.' Because it might not be the biggest change at a time, but we're just trying to enact change in some way at all times."

Adeniye himself has an interesting story. He was born in 1999 in Ohio, one year before the Blue Jackets debuted, so he grew up amid the area's participation spike, fostered by the Blue Jackets. Adeniye began playing through the NHL's local Hockey Is For Everyone program, the Columbus Ice Hockey Club. "Up until I was around 6 or 7, I was playing with a majority of Black kids," he said. "But as I started going from lower-level hockey and working my way up to higher levels, I started to be the only one."

Who will be the top pick this summer? Early top-32 prospect rankings How COVID-19 will impact evaluations

College hockey, Adeniye explains, is not extremely diverse. "I have one teammate [Peyton Francis] who is African-Jamaican-Canadian," Adeniye says. "But other than him, I have not seen another Black kid in our league. I saw one other player of color this year, when we played [Robert Morris University]. I'm actually in a group on Instagram of all the Black kids playing in NCAA hockey, and I think there are 15 or 16 of us total."

Adeniye chose UAH in part because his parents moved to Alabama when he was 16. UAH is the only Division I program in a southern state. "My mom hasn't really been able to see me play a lot since I was 16," he said. "So I knew I would be closer to her, and the fam."

When he heard about the formation of the College Hockey for Diversity, Equity & Inclusion group, it piqued his interest. Adeniye reached out to a reporter he knew who had a phone number for Jennifer Flowers, the WCHA women's league commissioner who was organizing the group. "I reached out to her, then told my coach I wanted to be a part of it, and they accepted me," he said.

The group meets on Sundays, via Zoom, and so far is focusing on its "first shift." Members have been sending each other resources they find online focusing on systemic racism. Their first goal is to put together an instructional video that can be played in every college hockey locker room ahead of next season. Adeniye has his own ideas, too.

"There isn't a whole lot of grassroots hockey in Alabama," Adeniye says. "There's not a lot of hockey programs down there, and we definitely don't have any diversity programs or anything like that down here. So once COVID is over, I'm hoping to get into the inner city, and places where there hasn't traditionally been hockey here, and spread the game. I already have a couple teammates that want to support me. I'm going to call it African Floor Hockey Fanatics, and we'll go to Boys & Girls Clubs around here and teach them how to play ball hockey, give them tickets to games, and spread hockey all over Huntsville and the South, which will make it a more inclusive game."

2. It's been a while since the best women's players in the world -- Marie-Philip Poulin, Shannon Szabados, Hilary Knight, Kendall Coyne-Schofield, Brianna Decker -- have had a stage to perform. We'll start to see them showcased in PWHPA games, beginning Feb. 27 at Madison Square Garden, but the event everyone is circling is April's IIHF Women's World Championship in Nova Scotia (which gets a second chance at hosting after the 2020 tournament was canceled).

Players I've talked to are cautiously optimistic the world championships will go on this year -- especially since the IIHF and Hockey Canada were able to stage a world junior championships in December, in a bubble in Edmonton. However, we haven't heard much about the women's senior tournament, at all. I heard that Hockey Canada asked the IIHF to move the tournament back until May, and the sides might push it back as far as August. I asked Hockey Canada for an update last week. In a statement, the organization said it is in constant communication with IIHF as well as the province of Nova Scotia.

"At present time, hosting the 2021 IIHF Women's World Championship in Halifax and Truro, N.S., on behalf of the International Ice Hockey Federation (IIHF) remains a priority for Hockey Canada," the statement said. "All our hockey, venue and event partners remain committed to finding a solution to host a successful world championship."

So, stay tuned ...

1. Cam Atkinson, RW, Columbus Blue Jackets

After a down 2019-20, Atkinson looks to have rediscovered his scoring touch. The Blue Jackets veteran had three goals and four assists in three games this week. Atkinson now has three short-handed goals on the season, and 15 shorties for his career, which is now the most in Columbus franchise history (passing Rick Nash's 14).

2. Mike Smith, G, Edmonton Oilers

He missed the first month of the season on long-term injured reserve, and some fans weren't pleased that the Oilers decided to bring back the 38-year-old (instead of finding an upgrade this offseason). But Smith was a stabilizing force for Edmonton this week, stopping 65 of 66 shots over two appearances (.985 save percentage), including a shutout against Montreal.

3. Marc-Andre Fleury, G, Vegas Golden Knights

The Golden Knights are 8-1-1 at home this season, and Fleury has been a big part of that success. A 30-save shutout on Sunday (the 63rd of his career) meant he stopped 100 of 106 shots over four games this week (.943 save percentage), three of which were wins.

1. Boston Bruins goalie Tuukka Rask is one of the best personalities in the game. He doesn't take himself too seriously. He has human moments, and is happy to talk about them. And that's exactly what happened Wednesday night when Rask left the Bruins' net with one minute remaining in a tied game.

"I honestly thought we were down 2-1," Rask admitted afterward. "That's it. I thought we were down 2-1. I was waiting for [coach Bruce Cassidy] to wave me over there. I'm like why the heck is he not? ... Then I think Chucky [Charlie McAvoy] told me, 'Buddy it's 2-2.' So ..."

Luckily the Bruins made it out of the jam unscathed, and won thanks to Brad Marchand's overtime winner.

"It's an entertainment industry I guess," Rask said. "That's what we're trying to provide, entertainment for the fans. I'm sure people were shocked at first, but hopefully they got a good laugh out of that. I sure did."

2. Speaking of Fleury, here's the best save I've seen this year:

3. The Los Angeles Kings recognized Black History Month on Tuesday with all players wearing warm-up jerseys featuring either Willie O'Ree's or Blake Bolden's name. This is exactly what allyship looks like, and it was cool to see how moving the gesture was for the 29-year-old Bolden, who works for the Kings and is the NHL's first Black female scout.

1. While I know new Pittsburgh president of hockey ops Brian Burke and GM Ron Hextall are well-known hockey men with experience running NHL teams -- something the Pittsburgh Penguins coveted, given their urgency to maximize the end of the Sidney Crosby era -- you have to ask yourself: Are there really only 40 people qualified for these types of jobs, and at what point do we stop cycling through them? Again, not a total slight to the Penguins here, what they did is just emblematic of hockey's hiring practices.

Last year, NHL coaching agent Neil Glasberg -- a champion for diversifying front offices, including the consideration of more European candidates -- called this the NHL's groupthink problem. We've talked about it in relation to coaches, but it's just as bad with management positions.

"The easiest way to frame it is an unwillingness to consider -- let alone listen -- to anybody who isn't widely known by the hiring manager, whether it's the GM, the [assistant] GM, owner, or whoever is running the search," Glasberg said. "Which I think is selling themselves short. Why wouldn't you want to talk to as many qualified people as possible? Instead, most NHL teams have this 'hire-a-friend' mentality. I hear this from my guys all the time: 'It's not the best candidate that gets hired. It's the candidate with the best network or who is the best known.' That's not how you build success. No company would ever be successful if they were just hiring people they knew."

2. Greg Wyshynski and I will have much more on the NHL's plans to finish the season later this week, but it's of note that we're only a month in, and the NHL has already had to adjust its safety protocols twice -- clamping down on player movements each time. In the latest edict, sent to teams this week, it is "strongly recommended" that members of players' households limit their activities as much as possible. Players, meanwhile, will be required to remain at home unless they are attending practices and games, exercising outdoors, performing essential activities (such as going to the doctor), or dealing with family or other emergencies.

There's still optimism that the season can be completed in its current format, and sources on both the NHL and NHLPA sides stressed that they're willing to tweak protocols as many times as needed to adapt. There haven't been any meaningful conversations about returning to a bubble -- and we know how players feel about the bubble, so it would be a hard sell -- but it's alarming that we're in a situation where some teams (like the Vancouver Canucks, who have competed in 18 games) have played double the amount as other teams (the New Jersey Devils have completed just nine games).

That's why everyone you talk to around the NHL stresses one thing: Pay attention to points percentage. All teams might not get to 56 games, but it will be essential for every division to hit approximately the same number of games.

Note: All times Eastern.

Monday, Feb. 15: St. Louis Blues vs Arizona Coyotes, 4 p.m.

It all comes down to this: In an unprecedented seven straight games featuring the same opponents, Monday marks the pivotal Game 7. The Yotes came out strong, but the banged-up Blues won the past two. Aggregate goals are 20-19, St. Louis. Both teams are looking forward to a break from each other after this.

Friday, Feb. 19: Edmonton Oilers at Calgary Flames, 9 p.m. (ESPN+)

Despite this being an entire season built around rivalry games, every contest in the Battle of Alberta feels like appointment viewing. Both teams are still trying to find their stride, with Edmonton putting veteran James Neal on waivers over the weekend (to be put on the taxi squad for cap flexibility).

Saturday, Feb. 20: Vegas Golden Knights at Colorado Avalanche, 3 p.m.

The NHL's first of a two-game set in Lake Tahoe will feature these two Western powers. Get excited for a stunning backdrop -- the rink was built on a golf course next to the lake -- plenty of panoramic views and some playoff-level intensity (it will be the third time these teams play this week). Luckily for Colorado, star Nathan MacKinnon is back after being sidelined three weeks with a lower-body injury.

Chirping doesn't stop once you hang up the skates. Classic troll job from Kevin Bieksa here:

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The NHL's best and worst this week - The secrets to Chicago Blackhawks defenseman Duncan Keith's longevity - ESPN

Beans play a big part in sustaining a healthier and lengthier life. Dubbed the worlds easiest beans by Blue Zones founder Dan Buettner, youll only need a handful of ingredients for his latest recipe to promote longevity. Its delightfully simple, especially at a time when so many of us are over it when it comes to cooking.

According to Buettner, incorporating beans into your everyday diet is very much a good idea. The longevity all-star food is beans, he says. If youre eating about a cup of beans a day, its probably worth an extra four years of life expectancy.

Chickpeas, in particular, are high in fiber and help regulate your blood sugar. Theyre also high in protein, delivering 39 grams per cup. The worlds easiest chickpea recipe below packs 78 grams of protein and 22 grams of fiber for the day.

Chickpeas are a fun and versatile legume, says Tracey Lockwood Beckerman, RD. The combo of fiber and protein helps slow carb absorption and maintain healthy blood sugar levels. The high fiber content also supports a healthy heart.

One of the best things about Buettners chickpea recipe is that its so easy to modify. Try adding some fresh pressed garlic, a pinch of red pepper flakes, or a minced shallotwhatever your heart desires.

Ingredients2 cups chickpeas2 Tbsp olive oilLemonSaltPepper

1. Place chickpeas, olive oil, salt and pepper, with a squeeze of lemon in a bowl.2. Mix all ingredients together.3. You can serve it at room temperature or warm it up on the stovetop.

The health benefits of chickpeas, according to a registered dietitian:

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This Worlds Easiest Beans Recipe for Longevity Only Requires a Handful of Simple Ingredients - Well+Good

HONG KONG, Feb. 16, 2021 /PRNewswire/ -- Regent Pacific Group Limited ("Regent Pacific" or the "Company" and together with its subsidiaries, the "Group"; SEHK: 0575.HK)'s Deep Longevity, Inc, a company acquired on 14 December 2020 which develops artificial intelligence to track human aging and extend productive longevity, today announced the publication of an article in Lancet Healthy Aging titled "The potential of rapalogs to enhance resilience against SARS-CoV-2 infection and reduce the severity of COVID-19".

While the pandemic continues to unfold, targeted therapeutic solutions for COVID-19 are still not established. The extremely rapid development of various vaccines as a preventative approach provides reassurance, but at the same time faces a number of majour challenges: insufficient protection against mutated variants, production line limitations, anti-vaccination sceptics etc. At the same time, COVID-19 still disproportionately affects older and comorbid individuals, who mostly suffer from more severe courses of illness, complications and lethal outcomes. Most frequently, advanced age goes hand in hand with comorbidities, which potentiates the adverse effect of the virus drastically.

Vaccines are still far from arriving at a complete protection. Unfortunately, the population least likely to benefit from such solutions are also those at the highest risk: the elderly and individuals with pre-existing age-related conditions. "It is a double-edged sword: the immune system of elderly and multimorbid (any age) patients is compromised. Those individuals are thus more prone to get infected and to develop a more severe disease. On the other hand, their response to a vaccine -- which acts on and with the immune system - might be insufficient. We also see reinfections occurring in elderly patients, which then take an even more aggressive course, leading to fatalities," said associate prof. Evelyne Bischof, Harvard, Columbia and Basel trained MD, practicing physician, one of the authors of the paper in Lancet Healthy Longevity today -- a joined work of the world-renowned biogerontologists and longevity specialists prof. Alex Zhavoronkov, prof.Matt Kaeberlein, and prof. Richard Siow. 'It is a major problem not only because of the predominantly aged demographics, increased danger in care homes for elderly, but especially because most elderly patients are also comorbid -- due to the aging processes causing age-related, mostly chronic diseases," prof. Evelyne Bischof continues. Such patients are at a significantly enhanced high risk of infection and death if they need to be hospitalized for non-COVID-19 reasons.

Story continues

While most trials exclusively target the infectious component of the disease, the authors outline the rationale behind a double approach: targeting COVID in the biologically aged for better prevention, vaccination efficacy and improved outcomes. The reasoning is complex and interrelated: old age is related with immunosenescence (immune system aging and thus worse function), with age-related diseases that are related with more severe COVID-19 course, e.g. diabetes, hypertension, cancer etc., with frailty and vulnerability (more exposure, e.g. due to homecare or institutionalization). Therefore, in order to efficiently intervene, geroprotective and senoremediative interventions towards mounting the immune response to vaccines are of uttermost importance, both from the medical, as well as the global economic aspect.

AI-based strategies were harnessed for repurposing known geroprotectors such as rapamycin, for the prevention of SARS-CoV-2 infection. Pre-clinical simulation analysis and previous evidence showing paradoxical immunopotentiation effects of rapamycin urge to propose additional clinical trials for these molecules in the broad elderly population.

In addition, in contrast to current studies, the authors propose to use an objective measurement of the biological rather than the chronological age. In the absence of reliable predictive and prognostic COVID19-biomarkers, minimally-invasive deep aging clocks are suggested as surrogate markers of biological age to track the efficacy of these preventative geroprotective interventions and to stratify the patients by predicted severity of the disease. Moreover, it will allow validation of markers of biological age in the context of viral infections and identification mechanisms by which geroprotectors enhance resilience against infections and reduce the severity of symptoms. This AI based approach in precision medicine was just recently illustrated in Nature Aging.

The Lancet Healthy Aging paper outlined the available evidence and a clinical translation of the geroprotector rapamycin for further research in a clinical trial setting, paving a new perspective: longevity medicine in pandemics. Longevity medicine as AI-based precision medicine aims to assure a healthy lifespan, mitigating and eliminating the risks and development of age-related diseases. Different from the reactive medicine, it uses the latest anticipatory technologies and muti-omics technologies to delay, attenuate or reverse senescence on all levels (cellular, tissue, system, organism, society). The benefits of such an approach in this and future pandemics is obvious, while the publication pioneers the scientific base for a longevity medicine RCT using geroprotective interventions.

About Deep Longevity

Originally incubated by Insilico Medicine, Deep Longevity was acquired on 14 December 2020 by Regent Pacific Group Limited (SEHK:0575.HK), a specialist healthcare, wellness and life sciences investment group whose shares are listed on the HK Stock Exchange. Deep Longevity is developing explainable artificial intelligence systems to track the rate of aging at the molecular, cellular, tissue, organ, system, physiological, and psychological levels. It is also developing systems for the emerging field of longevity medicine enabling physicians to make better decisions on the interventions that may slow down or reverse the aging processes. Deep Longevity developed Longevity as a Service (LaaS) solution to integrate multiple deep biomarkers of aging dubbed "deep aging clocks" to provide a universal multifactorial measure of human biological age. Deep Longevity started its independent journey in 2020 after securing a round of funding from the most credible venture capitalists specializing in biotechnology, longevity, and artificial intelligence. ETP Ventures, Human Longevity and Performance Impact Venture Fund, BOLD Capital Partners, Longevity Vision Fund, LongeVC, co-founder of Oculus, Michael Antonov, and other experts AI and biotechnology investors supported the company. Deep Longevity established a research partnership with one of the most prominent longevity organizations, Human Longevity, Inc. to provide a range of aging clocks to the network of advanced physicians and researchers.

longevity.ai/

About Regent Pacific (SEHK: 0575.HK)

Regent Pacific is a diversified investment group based in Hong Kong currently holding various corporate and strategic investments focusing on the healthcare, wellness and life sciences sectors whose shares are listed on the HK Stock Exchange. The Group has a strong track record of investments and has returned approximately US$298 million to shareholders in the 21 years of financial reporting since its initial public offering.

regentpac.com

SOURCE Regent Pacific Group Limited

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Deep Longevity Publishes Article About Preventing COVID-19 and Aging - Yahoo Finance

NORTH PALM BEACH, Fla., Feb. 15, 2021 /PRNewswire/ --West Palm Beach-based R3 Health, a provider of individualized services that address the health, medical, beauty, lifestyle, and aging concerns of patients, is set to introduce its innovative whole-body approach to wellness to North Palm Beach with the opening of a brand new location in March. This is the second location that the company has established, and it will be based at 772 US-1 Suite 101, North Palm Beach, FL 33408.

"At R3 Health, we believe that personalized healthcare is the key to optimal and balanced wellness. In turn, it helps prevent chronic disease and manages the aging process. We've seen how well a more individualized form of healthcare can enhance the overall wellness of our patients in West Palm Beach, so we're delighted to now have the chance to help the people of North Palm Beach experience the same improvements in their quality of life," said Joseph Radich, Founder and Clinical Director of R3 Health. "We're thrilled to be opening our second location in North Palm Beach this March and look forward to helping those in the community achieve and maintain optimal health."

R3 Health offers three areas of service in their all-encompassing approach: medical, beauty, and regenerative. For its medical services, rather than using a synthetic drug to mask the developed result of an imbalance, R3 Health's approach to patient care focuses on utilizing naturally occurring substances to help better balance the natural homeostasis of our bodies. The company's beauty solutions utilize cutting-edge techniques, like OxyGeneo and stem cell facials, customized and formulated to give skin the highest level of treatment and care. Finally, for its regenerative service, R3 Health provides advanced, minimally invasive, and regenerative therapies individualized for patients who simply want to improve their longevity and quality of life. R3 health not only provides world renowned individualized regenerative treatment plans for its patients, but also has a full physician training program, so not only are you getting the best services but you're also receiving them from a group that has trained over 500 physicians from all over the world.

During this year, R3 Health will also be refreshing its flagship West Palm Beach location to include a brand new, never-before-seen, and state-of-the-art regenerative medicine membership facility. Additionally, the company plans to launch a telemedicine and video medicine service with a dedicated app later this year, allowing them to serve patients all over the world, including countries like United Kingdom, Israel, Turkey, Greece, Italy, and Canada.

Widely known for offering a safe and trusted VIP healthcare experience, R3 Health treats household name celebrities, athletes, and CEOs of major brands.

As well as performing the most cutting-edge wellness, anti-aging, beauty, and regenerative services, R3 Health has an online supplement store at R3HealthEssentials.com that offers top notch physician grade only nutraceuticals. The company also offers a full practitioner training program and has trained over 500 doctors in more than 30 states.

About R3 Health

Headquartered in West Palm Beach, Florida, R3 Health provides a safe and trusted VIP experience designed for patients to address all their health, medical, beauty, regenerative, and lifestyle concerns. By applying the latest technology, individualized wellness programs, and cutting-edge treatments, R3 Health treats every patient with a whole-body approach. For more information, please visit R3Health.co.

Media Contact

Alejandro Narvaez[emailprotected](561) 331-2983

SOURCE R3 Health

http://R3Health.co

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R3 Health to Bring Whole-Body, Individualized Healthcare Longevity Services to North Palm Beach with New Location Opening - PRNewswire

The roaring 90s were a heyday for the music biz especially for bands in the college and alt-rock sectors. Record deals were given out like candy to any group falling under that newly burgeoning musical umbrella. A worthy beneficiary of the craze for quirk and cool was Local H. They first got together in 1987 while in high school officially forming Local H in the first year of the 90s, setting themselves apart by usually performing as a duo.

Led by singer/guitarist Scott Lucas (the only regular member), the Illinois-based band ended up with an unlikely hit on alt-rock and modern rock radio with 1996s Bound for the Floor, which propelled Local H from the underground to the mainstream adjacent. The angst-driven song was perfect for the time (and would never get on mainstream radio today) and ended up charting at No. 5 on the Billboard Modern Rock Tracks chart and No. 10 on the Mainstream Rock Tracks chart. Theyd also have another pair of hits with Eddie Vedder (which includes the classic line, If I was Eddie Vedder/would you like me any better?) and Fritzs Corner landing on the Billboard Mainstream and Alternative Charts. They also had a stint opening up for Stone Temple Pilots on their 1996 fall tour.

Record biz politics ultimately derailed Local Hs chance at further widespread fame, but Lucas carried on. Over 30 years into the bands career, Local H endures. They continue to release music, like last years strong LIFERS album that featured fellow alt-rock luminary Juliana Hatfield and was produced by Steve Albini and Andy Gerber.

We caught up with Lucas, who reflected on the bands biggest hit, LIFERS and who would replace Eddie Vedder today as the title name in that eponymous song.

SPIN: LIFERS is a concept album, but also seems like an apropos title for an album about a duo of guys who, somehow, continue to soldier on in the music biz. Was that the double intent?Scott Lucas: That kind of IS the concept. We wanted this record to feel like a concept record without actually being a concept record at least in any technical sense. Kind of like The White Album. Thats not really a concept album, but in the way it feels plugged into the general mood of its time it certainly comes off like a concept record. But it isnt, even though in my mind, it feels more like a concept record than Sgt. Peppers. So I was very sure to make lyrical references to things that were going on in this country, but without mentioning any names so to speak. You want your record to be just as timeless as it is timely, so making something where youre screaming Fuck Trump for 11 tracks might not have the staying power or resonance that youd hope for. But once we had Juliana singing on the record, that made us think about the people we were surrounding ourselves with not just with this record, but in everything we try to do with our, um, career. These people that we look up to. That inspires us. Suddenly this idea of lifers became very interesting to us. And knowing that even that word itself has a double edge is it somebody who refuses to give up? or is it somebody whos just a loser? That became the concept.

What was it like working with Juliana Hatfield, John McCauley of Deer Tick and Steve Albini?Great! The thing with Juliana and John is, theyre friends. So it was just a matter of asking them to do something on the record while hoping that they wouldnt say no. It was the same thing with John Haggerty. But with Albini, I didnt know him at all. And I was kind of afraid of him. I mean, Id read his interviews. I knew he didnt suffer any bullshit. But Haggerty, who knows him very well, just laughed at me when I told him I was intimidated by Steve. He was like, Fuck that. You should work together. And he was right, of course.

Was this done prior to the pandemic?Yup. This was all in 2019. The idea was to take a year off from touring, make the record, and then tour the shit out of the record in 2020. Our timing. Impeccable as always.

What was the inspiration for Winter Western?I dont remember. Ha! I remember theres a line about raids before the dawn, and I know that had something to do with one of Trumps cronies. But I just love the imagery of Western movies that take place in winter. Like McCabe And Mrs. Miller. I do know that the song was just okay until we had the idea to ask Juliana to sing on it. After that, the song just clicked. I seriously got chills the first time I listened to her vocal. She sounds so cool on darker, heavier songs. Especially tunes that are in F#minor. Not to get too far in the weeds, but it is the saddest of all keys.

If you were to rerecord Eddie Vedder now, who would be the person highlighted in the song title?Shit. Taylor Swift?

Ha! Whats it like to hear Bound for the Floor on rock radio or satellite radio all these years later?Awesome. I remember a few years ago hearing Bound played on the Loop, here in Chicago. A great classic rock station that is now, sadly, no longer with us. We were sandwiched between Boston and Tom Petty. I thought that was pretty fucking cool.

Looking back, does it seem like more of a miracle that you were able to make a second album with a major label?There was some stuff going on behind the scenes that I wasnt really aware of at the time. But we were really rushed into making our second record by our A&R guy. I now know that was because we were a C-hair away from being dropped. I remember being told that we needed to sell 100,000 copies of our second record or else wed be dropped. That was the only time in my life that I counted sales. Once we got past 100,000 I said Fuck it. Lets make record number three.

Over 30 years in, are you surprised that not only youre still making music, but continue to do so in front of enthusiastic fans?Sometimes I feel like George Bailey in Its A Wonderful Life. I get the sense that people are constantly trying to frame our career as some kind of tragedy. But it just isnt so. We were never really cut out for the big leagues. Its just not us. There may not be a whole lot of people that dig us, but the ones that do holy shit! Ill never make a record good enough to deserve those people.

What are your thoughts on the current civil rights movement?Well. I certainly dont get why Black Lives Matter is supposed to be a controversial statement. I dont even understand why were discussing it. I was watching Blazing Saddles the other day and it struck me how beautiful that movie is. There was this moment in the 70s where it seemed like we could have some open and honest and even hilarious conversations about race in this country. But in America we cant have nice things, so the 80s came up and strangled the fuck out of that idea. I guess we have a lot of unfinished business in this country when it comes to race. Its fucked up.

Did you march or protest?I did not. I was driving across the country when that happened here in Chicago. But I had this idea for a noise rock jam called 8:46. And I remember thinking Whats the point? Surely, someone else will come up with the same idea and do it better. But that didnt happen. So I sat on it for a second. And that was a mistake, but I was like, who needs to hear this shit from us? Then I watched that Dave Chappelle special while I was driving through Kentucky and it devastated me. I realized that it didnt matter if somebody else had the same idea. In fact, it would be pretty cool if everybody on the planet released someTHING called 8:46. We went in and recorded our version the next week.

Local H's Scott Lucas performs in Los Angeles, 2018 CREDIT: Scott Dudelson/Getty Images

Are you optimistic about the state of the country?No. Are you? I dont know what to tell you.

Not really, no. On a lighter note, whats been your favorite pandemic discovery?My dog.

Is there a future for guitar rock anymore?Is Annie Clark (St. Vincent) not guitar rock? Is Phoebe Bridgers not guitar rock? The future of guitar rock is happening right now, guys like me are just too stupid to see it.

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Local Hs Scott Lucas on the Bands Longevity and Copacetic Career - SPIN

It's common knowledge that fruits and vegetables are extremely healthy for you. Certain fruits are in fact known as superfoods due to their numerous health benefits including helping to boost your longevity.

In one study, fruit flies were shown to live 10 percent longer when fed a regular diet containing blueberry extract.

Not only did the fruit flies live longer but they also showed improved levels of physical activity.

These enhancements arise both from increased tolerance of oxidant stress and from beneficial changes in the way certain important genes are expressed.

It was also shown that after supplementation with blueberry extract, these organisms lived an average of 28 percent longer, and the maximum life span increased by 14 percent.

The supplemented animals showed a 20 percent reduction in an age-related protein that impairs function, and vastly improved tolerance of stress in their environment.

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In addition to extending the life span of whole organisms, blueberries and their extracts slow ageing in individual tissues, providing wide physiological benefits, said Lifespan.

The health site added: Along with increasing all around longevity, blueberries can specifically decrease the risk of various degenerative diseases that reduce the human life spans.

Blueberry extracts have many positive effects that may help you lose weight and keep it off.

Studies show that animals fed blueberry extracts while on a high-fat diet had lower overall weight gain, and smaller accumulations of body fat, than control animals.

Importantly, the loss of body fat is especially prominent in the abdominal areas and the liver; fat in those areas poses the greatest risk of cardiovascular disease and other life-shortening complications of obesity.

Blueberry extracts promote sugar uptake into muscle cells, where it can be used as energy, rather than being stored as fat.

Berries are not only superstars for brain longevity, they also help with keeping the memory sharp.

Studies have found that a group of healthy elderly people performed better on cognitive tests when ingesting a daily dose of wild blueberry juice.

Blueberries are packed with polyphenols, a group of compounds which includes anthocyanins, the nutrient that gives blueberries their colour.

Anthocyanins are powerful medicine for the brain as they reduce inflammation, help neurons communicate, and regulate how the brain utilizes glucose for energy.

Along with other antioxidant-rich fruits and vegetables, eating blueberries can increase your total antioxidant intake to help reduce premature ageing.

Blueberries are high in antioxidants which help protect the skin from damage and promotes skin healing.

Meaning blueberries help with keeping both your inside and outside glowing with good health.

From improving brain health, helping with weight loss, improve the ageing process and boosting longevity; its a no brainer that blueberries should be included in your daily diet.

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How to live longer: Blueberries may reduce age-related diseases to boost longevity - Express

Why does it seem like every "wellness influencer" on Earth wants me to eat nothing but kale and drink nothing but water when it seems like everyone who lives a long and happy life does so while sipping on booze and eating sausages and French fries? I, for one, will be taking my cues from Sister Andr, Europe's oldest living person who turned 117 last week.

Sister Andr, a nun, currently resides in a nursing home in Toulon in France and recently became the oldest known person to survive a COVID-19 infection, according to The New York Times. The outbreak in her nursing home sickened 81 people and killed 11. Though she was infected, she is thought to have been largely asymptomatic during that time. Sister Andr and most of the other nursing home residents were allowed out of isolation last week, just in time for her birthday.

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Sister Andr didnt feel the disease, so she wondered a lot why we were talking about the coronavirus every day, why she couldnt receive visits from us at the nursing home, or from relatives or fellow residents, David Tavella, the spokesman at the Ste. Catherine Labour nursing home told the Times.

During her birthday lunch on Thursday she was expected to celebrate with port wine, foie gras with hot figs, as well "roasted capon with mushrooms and sweet potatoes as a main course, followed by a two-cheese platterRoquefort, and goat cheeseand maybe a few glasses of red wine," the latter of which Tavella told the Associated Press was "one of her secrets of longevity."

As for a birthday cake, Tavella joked that putting candles on top for Sister Andr, believed to be the second-oldest living person in the world, hasn't always worked out so well: We stopped trying a long time ago. Even if we made big cakes, Im not sure that she would have enough breath to blow them all out. You would need a fire extinguisher.

The lunch was expected to be topped off with raspberry and peach flavored Baked Alaska and a glass of Champagne, of course. All of this made her "very, very, very, very happy," as she told the AP.

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The World's Second-Oldest Person Turned 117 And Said Red Wine Is One Of Her Longevity Secrets - Delish

A new NUS research at Bia-Echo Asia Centre for Reproductive Longevity and Equality will study ways to advance female fertility, lifespan and health-span

The Centre, to be established at the Yong Loo Lin School of Medicine at Singapore's National University of Singapore (NUS), was made possible by an $8 million gift from the Bia-Echo Foundation, based in the USA, whose founder is attorney and entrepreneur Nicole Shanahan.

Research initiatives at the Centre will be led by scientists and clinicians from NUS Medicine and other institutions here as well as the Asia-Pacific, US and Europe, and specializing in womens reproductive health, aging, and digital medicine. The effort will seek to find ways to improve and lengthen female reproductive health and longevity, helping women to preserve and improve their reproductive systems for conception and general health, potentially enabling women to conceive safely in their later years.

Declining fertility and associated health risks

The issue of female fertility has come into sharp focus in recent years, with more women getting married later and having children later in life. In Singapore, the number of women giving birth in their 40s has almost doubled in the last three to four decades, according to data from Singapores Department of Statistics.

The number of births per 1000 women aged between 40-45 was 9.9 in 2019, nearly double the number recorded between 1980 to 1989. However, conception is an uphill task for women above 40 as fertility declines with age. The chances of natural conception fall to less than 5% and this also often comes with serious health risks and complications, such as miscarriages and premature live births, and higher chances of having a child with Downs Syndrome.

Furthermore, as women in their 40s approach menopause, they also face increasing health issues such as metabolic diseases, neurocognitive decline, osteoporosis, and poor urogenital health, which result in poorer general health. Current medical approaches to assist conception include the use of fertility drugs, as well as reproductive assistance technologies. Their efficacy, however, remains limited as the woman ages.

Bia-Echo Asia Centre for Reproductive Longevity and Equality:

The centerspecificallyaims to;

The vision of the US-based Bia-Echo Foundation, a private enterprise founded to accelerate social change to establish a fair and equitable society for generations to thrive, aligns with that of the NUS medical school, said its Dean, Professor Chong Yap Seng.

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Bia-Echo Foundation invest $8M in Singapore to study women's reproductive longevity - BSA bureau

Growing old is hard. The aging process is not kind on us. The worst bit is, age creeps up on you so quietly that you dont even realize it until one day you look in the mirror and barely recognize yourself. However, all is not lost. Practicing healthier habits can positively affect the aging process and help you slow down if you want to turn back the clocknow.

Losing weight is number one on our list for obvious reasons. A trim body not only gives the illusion of youth, it can add years to your life. According to some research published in the American Journal of Clinical Nutrition, there is a direct link between obesity and increased risk of life-threatening diseases like heart problems, diabetes, embolisms, and even some forms of cancer.

Extra weight also makes you sluggish and lazy. Luckily, the research also suggests that by losing just 10 percent of your total body weight, there will be a remarkable increase in life expectancy and your overall health. How long does it take to lose 10 pounds? Not very long at all if you consider the benefits.

If you eat green vegetables with all your meals, it will help you stay healthier for longer. Research on Alzheimers & dementia has proven that eating more leafy greens has been explicitly linked to lower rates of Alzheimers disease and other instances of brain aging (1).

The antioxidants that green leafy vegetables contain also does wonders for how your skin looks. This means that eating your greens regularly will not only help you retain your mental prowess, it will also ensure you look fresh, radiant, and youthful.

Ditch carb-rich breakfast options and fill up on eggs instead. Eggs are a great combatant against aging. Researchers at the University of Wisconsin discovered that lutein and zeaxanthin, both components of egg yolks, can keep macular degeneration at bay. This means that your eyes will remain clear and healthy as you age. Eggs are also a great food for weight loss and maintenance. Make sure yours are organic free-range eggs, which are the healthier choice!

While exposure to sunlight is important in order to get the requisite amounts of vitamin D, too much sun is not a good thing. Vitamin D is responsible for maintaining metabolism, mood and other important health aspects, but you should be careful about unnecessary exposure and invest in a good sunscreen.

Too much sun increases the risk of skin cancer, causes dark spots and wrinkles due to sun damage, all affecting your longevity and making you look years older than you are. Practice safe sun exposure by using sunscreen regularly and stop the aging process.

Ditch unhealthy packaged snacks and eat these super fruits instead. Bananas are an excellent source of potassium, which keeps your heart healthy and reduces muscle cramps. The resistant starch found in bananas leads to healthier gut bacteria, which decreases the risk of Alzheimers.

Resveratrol, a compound found in red grapes, helps keep off belly fatand is linked to improved circulation in the eyes which helps maintain your eyesight as you get older.Oranges, strawberries and kiwis are high in vitamin C which increases collagen production in your body. Collagen keeps cellulite and sagging at bay by increasing the firmness of your skin, making you look younger than ever.

Apricots contain beta-carotene, which lowers the risk of Alzheimers and other forms of cognitive decline.Blueberries help maintain youthful glow and the anthocyanin they contain significantly reduces the risk of dementia as you age.

Positive thinking can go a long way in your quest for anti-aging. Research published in the Journal of Personality and Social Psychology shows that people who reflected positively on their lives decreased their risk of death significantly. Additionally, focusing on the positives makes you happier and seem more youthful. Smiling makes you look younger.

Sitting all day speeds up the aging process, increases the risk of obesity and the risk of premature death. To keep your body healthy and youthful, make it a point to stay active. Go for a walk, swim, play with your kids or grandkids, do any activity as long as you get up and move about at least once every hour. Finally, a good nights sleep is the best way to stop the aging process.

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Anti-Aging Tips To Set The Clock Back 10 Years - Longevity LIVE - Longevity LIVE

There are lots of common misconceptions when it comes to the paleo diet. Often, people tend to view it as simply a high protein diet. However, the paleo diet is actually mostly plant-based. Its not a high protein diet either. Heres what you need to know

The paleo diet is a dietary plan that is heavily based on what humans might have consumed during the Palaeolithic era. Hence the name. Thistypically includes lean meats, fish, fruits, vegetables, nuts and seeds foods that in the past could be obtained by hunting and gathering.Importantly a paleo diet limits foods that became common when farming emerged about 10,000 years ago. These foods include dairy products, legumes and grains.

Thus, the majority of this diet is plant-based with most foods coming from what the gatherers would have been able to find. These foods include nuts, seeds, vegetables and fruits. Protein would have been eaten only when it was available and mostly in the form of lean meats or fish.

Its likely that some palaeolithic era humans followed what we would call a low-carb high-protein diet. But its just as likely that others will have eaten a high-carb low-protein diet. This diet, therefore, is a guideline and does not have to be the same for everyone. There are now several different versions of it. Some of these may include butter and even gluten-free grains such as rice.

Generally, however, according to Kris Gunnars of Healthline, these are the foods form the basic building blocks of a paleo diet:

Essentially, you want a diet full of whole, unprocessed foods. Try to choose the least processed option you can. Ideally, grass-fed, pasture-raised and organic. Other foods allowed in moderation include good qualityred wine as it is high in antioxidants or dark chocolate that has 70% or higher cocoa content.

Its all well and good to know what you can eat but what should you avoid if you want to move towards a paleo diet. According to Healthline, these are the foods you should be avoiding.

It may come across as a rather extreme way of eating, and it is. Youre essentially cutting out entire food groups from your diet. But the paleo diet does have quite a few benefits. One of the major benefits is of course weight loss. Its the extreme opposite to the current western diet which is packed full of processed foods. Instead, the paleo diet replaces processed foods with whole foods which are still packed full of nutrients.

Cutting out sugary foods and empty calories is definitely healthier and will ultimately lead to weight loss. According to a review in the American Journal of Clinical Nutrition, the paleo diet also has other major benefits. This includes lowering blood pressure, which ultimately reduces the risk of stroke, heart disease, heart attack and death.

And its not just the female celebs who have taken to paleo, Channing Tatum has tried it too. Voted the sexist man alive in 2012, its no surprise that Tatum has some tips and tricks up his sleeve to prepare for the big screen. Tatum went paleo to prepare for his role as an Olympic wrestler in Foxcatcher. Tatum explained that he ate mostly meat and vegetables during his preparation time but did allow himself to cheat on the weekends. Professional golfer Phil Mickelson, actress and comedian Aisha Tyler and even Matthew McConaughey are also reportedly followers of the paleo diet.

https://pubmed.ncbi.nlm.nih.gov/26269362/

https://www.everydayhealth.com/diet-nutrition/paleo-diet/what-are-risks-benefits-paleo-diet/

https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/paleo-diet/art-20111182

https://www.healthline.com/nutrition/paleo-diet-meal-plan-and-menu#TOC_TITLE_HDR_6

https://my.clevelandclinic.org/health/articles/17583-triglyceridesheart-health

https://www.everydayhealth.com/paleo-diet/diet/celebrities-who-have-tried-paleo-diet/

https://extratv.com/2016/06/23/blake-lively-on-her-body-transformation-for-the-shallows-and-her-obsession-with-harry-potter/

https://www.latimes.com/health/la-he-jessica-biel-5q-20170124-story.html

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The Paleo Diet: What is it really? - Longevity LIVE - Longevity LIVE

The University of Pittsburgh School of Medicine today announced the launch of the Alba Tull Center for Neuro Imaging and Therapeutics. The center will be dedicated to designing and expanding imaging technologies for patient care to produce a new, sophisticated understanding of the brain at the molecular level with the goal of developing anti-aging therapeutics.

The Alba Tull Center for Neuro Imaging and Therapeutics is the result of a $1 million grant from the Tull Family Foundation, longtime supporters of the University of Pittsburgh Medical Center. Among the centers other priorities will be training physician-scientists in the imaging technologies uses and finding innovative methods to apply augmented reality (AR) to help guide surgeons hands.

About the foundationThe Tull Family Foundation (TFF) was founded by Thomas and Alba Tull to support organizations that are devoted to transforming the lives of the people in underserved and underfunded communities. A private foundation, TFF funds the advancement of innovative ideas in education, medical and scientific research, and conservation. In 2019, the foundation made a $1.5 million grant to the Children's Hospital of Pittsburgh Foundation to support pediatric research and art therapy programs.

This gift enables a first-of-its-kind center for multidisciplinary collaboration to advance the fields of neuroscience, therapeutics and imaging, said Dr. Anantha Shekhar, senior vice chancellor for the health sciences and John and Gertrude Petersen Dean of the School of Medicine at the University of Pittsburgh. This support from the Tull Family Foundation will expand and enhance the Universitys already robust research in this field.

I am excited about the opportunity to advance our work in neuro AR, chemistry and personalized medicine, keeping us at the forefront of patient care and research breakthroughs, said Robert Friedlander, MD, Walter E. Dandy Professor and chairman of the University of Pittsburgh Department of Neurological Surgery and co-director of the UPMC Neurological Institute. Dr. Friedlander also highlighted the key role Joseph Maroon, MD, clinical professor of neurological surgery at the University of Pittsburgh Medical Center, played in securing this important gift.The Alba Tull Center will encourage researchers to collaborate on leading cross-disciplinary projects exploring new frontiers in imaging technology and its applications. Work will include the development of a single, non-invasive scan, known as radiomics, that integrates multiple patient records to predict responses to therapies in order to help determine the best course of treatment. It will also enhance high-definition imaging of fiber connections in the brain to better fight tumors without damaging other tissue.

Alba Tull added, The past year, more than ever, has underscored the power medicine has to change the world and the future. Supporting leading medical care and research is one of our priorities and this new center will enable scientific innovations from allowing physicians to examine a patients brain without making an incision to guiding surgeons hands in real-time when invasive treatment is the only option. We are proud to be able to support the University of Pittsburgh School of Medicine and look forward to continuing to work together.

The University of Pittsburgh Department of Neurosurgery is the largest neurosurgical academic provider in the United States, with UPMC clinicians performing more than 12,000 procedures annually, and ranked among the top five neurosurgical residency programs in the country in terms of academic publishing output of faculty. The department is guided by three core goals: to provide outstanding care to patients with neurological disease; to equip neurosurgeons of the future with state-of-the-art techniques and analytical skills to lead the field of neurosurgery; and to foster research designed to enhance the treatment of diverse diseases affecting the nervous system.

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University of Pittsburgh School of Medicine Launches Neurological Imaging and Therapeutics Center - UPJ Athletics

Some of the biggest names in healthcare including Tenet Health, Providence and CommonSpirit Health have launched a new startup to pool and analyze patient data for research and drug development.

Capitalizing on health systems' troves of patient data, 14 health systems are backing the new company, called Truveta. Among the backers are AdventHealth, Advocate Aurora Health, Baptist Health of Northeast Florida, Bon Secours Mercy Health, Hawaii Pacific Health,Henry Ford Health System,Memorial Hermann Health System,Northwell Health, Novant Health, Sentara Healthcare and Trinity Health.

The Seattle-based startup will pull together and sell normalized andde-identifieddata from the group of providers with a keeneye onprotecting patient privacy and security, the companies said in a press release.

Disruption, Acceleration & Innovation: Pharmacists on the Frontline

This year, pharmacists will play a critical role in the United States COVID-19 immunization efforts. Although this is welcomed news, this new duty and other coronavirus responsibilities are exacerbating pharmacist burnout. In this panel, experts will explore how pharmacists can leverage technology to automate administrative tasks and satisfy patient needs.

The new data platform, using the power of artificial intelligenceand machine learning, will helpdeliver "personalized medicine, advance health equity, and empower the health community with insights on how to best treat patients," the press release said.

The 14 health systems representtens of millions of patients and operate thousands of care facilities across 40 states.

RELATED:Mayo Clinic taps Google Cloud as strategic partner to accelerate innovation in AI, analytics and digital tools

Truveta will be jointly ownedby the hospital operators and willbe board-advised with a strong focus on ethics and health equity, data integrity and clinical outcomes.

Former Microsoft executive Terry Myerson will lead the new startup.

Myerson told The Wall Street Journal that the company is still developing its pricing plans. Potentially, fees will vary depending on the type of entity seeking access, the WSJ reported.

The COVID-19 pandemic has shown us how much the world needs to learn faster, so we can better serve our communities, Myerson said in a statement.Our vision is to save lives with data. We want to help researchers find cures faster, empower every clinician to be an expert, and help families make the most informed decisions on their care. We believe the Truveta platform can help improve health equity and advance personalized medicine. We are honored to be partnering with innovative and world-class health providers in this pursuit.

For years we have seen the opportunity for diverse health providers to come together with a shared sense of purpose and use our collective data for the common good of humanity. With Truveta, we created a unique model that is led by the health providers yet supported by one of the most talented technical teams to focus on health, said Rod Hochman, M.D, president and CEO of Providence, in a statement.

Hochman said the hospital systems will focus on research questions around health equity as well as improving medical treatment, the WSJ reported.

The COVID-19 pandemic illustrates how quickly healthcare must move to effectively serve patients, according to the companies. The healthcare community has made remarkable progress, from diagnosis to vaccine distribution in less than a year.

Truvetas innovative health provider partners agree COVID-19 must be a catalyst for even more rapid progress,the companies said in the press release.

Truveta aims todrive innovation in patient care and the development of new therapies through the creation of adata platform researchers can use to analyzebillions of clinical data points with a single search.

RELATED:Google, Ascension defend their health 'data transformation' partnership

The Truveta platform will structure and normalize a wide range of data across structured and unstructured data types to unlock the power of de-identified data across all diagnoses, geographies and demographics. Using advanced AI and machine learning, Truveta will deliver continuous learning to physicians, researchers, biopharma and more with aggregate analysis of conditions, therapies and prognoses, according to the press release.

Health system leaders involved in the effort said protecting patient data privacy would be a key priority forTruveta.

We know health data is unlike other data. It is the very definition of personal, Myerson said. While we embark on our pursuit to generate knowledge and insights to improve patientcare around the world, we must do so with the utmost caution to protect the privacy of patients.

The initiativeis an important step in unlocking the hidden insights from data sitting in silos in large health systems, saidPaddy Padmanabhan, founder and CEO of Damo Consulting, a growth strategy and digital transformation advisory firm.Healthcare has been hobbled by the inability to harness available data to improve healthcare outcomes, enhance patient experiences and reduce health inequities," he said.Truveta's success will depend on execution, he added.

Where will the data be hosted? How will Truveta build the advanced analytics and AI capabilities required to turn the vision to reality?" he said. Truveta is a welcome new approach to industry-level collaboration for turning data into insights. However, the fact is that it is a collaborative effort among health systems and the data sets therefore provide only a partial view of patient histories for driving innovations in care management and developing new therapies."

Over the longer term, the industry will need to achieve active collaboration across health plans and life sciences companies as well tounleash innovation in new therapies, drive research and improve healthcare outcomes,Padmanabhan said.

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Tenet, Providence, other health giants band together to form new health data startup - FierceHealthcare

Already containing health records, surveys, and measurements from more than 200,000 people from all walks of life, the All of Us Research Programs Researcher Workbench is a treasure trove waiting to be mined.

An immigrant from Peru, Dr. Ral Montaez-Valverde was surprised to encounter perplexing research showing that Latinos in the United States are at lower risk of heart disease than their white counterpartsdespite a generally lower socioeconomic status and access to health care.

It prompted me to think about why Hispanics could have better outcomes, given all the challenges, said Montaez-Valverde. I was very curious about this question.

So curious that, despite his intense schedule as a second-year internal medicine resident at Jackson Memorial Hospital, Montaez-Valverde jumped at the chance to use the All of Us Research Programs Researcher Workbench to investigate the long-debated validity of whats known as the Latino Epidemiological Paradox. Now open to investigators from all disciplines and career stages across the University of Miami, the Researcher Workbench contains the de-identified electronic health records of more than 200,000 people across the United Statesincluding 10,000 from Greater Miamiwho have enrolled in the most inclusive study ever undertaken by the National Institutes of Health.

Launched in 2018, the 10-year, $2 billion-plus All of Us Research Program (AoURP) is building one of the worlds largest and most diverse health datasets by collecting lifestyle, health, and genetic information from 1 million people of all races, ethnicities, backgrounds, and gender identities living in the U.S. The ultimate goal is to advance personalized medicine by helping researchers and physicians like Montaez-Valverde understand why different people are more vulnerable to different diseases and conditions and tailor prevention, treatment, and care approaches specifically for them.

But neither the AoURP nor the Universitys Miller School of Medicine, which is leading the AoURPs effort to recruit some 80,000 of the 1 million participants from Florida and Georgia, are waiting for the enrollment process to conclude before making the data available to researchers. The University has signed a data-use agreement with the NIH allowing any faculty members, research assistants, students, residents, or other trainees with an NIH eRA Commons account to begin mining the treasure trove, which will grow in both value and volume as more people discover its riches.

The Researcher Workbench is a major milestone in fulfilling the promise of the All of Us program, but for now it may be one of the best kept secrets in biomedical research, said Stephan Zchner, professor and chair of the Dr. John T. Macdonald Foundation Department of Human Genetics and the lead principal investigator for the AoURPs Southeast Enrollment Center (SEEC), which also includes the University of Florida, Emory University, and Morehouse School of Medicine.

At the end of the day, continued Zchner, who also co-directs the John P. Hussman Institute for Human Genomics, we want to work with data to create new knowledge and insights into medicine, and the workbench is a major tool for that. Whats exciting is that it opens biomedical data access to many qualified investigators, including people in the social sciences, basic sciences, sports, even the arts. The possibilities are endless, and there will be a lot more of them as the data get richer and larger over time.

For the time being, the cloud-based research platform, which requires proficiency with the R or Python programming languages, does not include the genetic information that most interests researchers like Zchner. But as he noted, the AoURP is currently sequencing the genomes of the first 100,000 participants and plans to do the same for all 1 million participantsall of which eventually will make its way into the database and the hands of those who shared their DNA.

Yet even in its infancy, the workbench already contains four types of data. In addition to the electronic health records of roughly 203,000 people, the database includes survey data from more than 315,000 people who answered questions about their medical history, lifestyle, access to care and, more recently, experiences with COVID-19, including the pandemics impact on their mental and financial health. It also contains physical measurementsincluding blood pressure, heart rate, and body mass indexfrom more than 260,000 people, and data collected by the Fitbit wearable devices of more than 8,000 people.

But for Dr. Olveen Carrasquillo, an expert in health disparities who serves as the SEECs participant engagement lead, the most exciting aspect of the AoURP is its success in recruiting minorities who have long been overlooked by medical research. According to the AoURP, about half of the participants whose data is in the Researcher Workbench are people of color.

One of my biggest concerns was that this project would be like everything else, and minorities would be left out, but weve seen really robust and good efforts at assuring they are included, said Carrasquillo, professor of public health sciences, chief of the Division of General Internal Medicine, and a co-principal investigator for the AoURP. And by minorities, I mean that in the full sense, not just race and ethnicity, but by income, education, gender identity. So, with lots of data on minorities, this humongous data source will be a very powerful tool for people who want to reduce health disparities and improve health equity.

To get an idea of its power, Carrasquillo enlisted Montaez-Valverde, the resident he happened to meet on the Metrorail after leaving Jackson Memorial one night, to become one of the Universitys first workbench users. At the time, Montaez-Valverde, who plans to specialize in cardiology, wasnt familiar with the AoURP, or the Latino paradox. But he shared Carrasquillos skepticism that, given their higher rates of diabetes and uncontrolled blood pressure, Latinos would have better cardiovascular health than their white counterparts, as other studies have shown.

Montaez-Valverde was amazed to learn he would have the electronic records of more than 200,000 people to analyze, a powerful tool that helped him conclude that Latinos in the AoURP dataset actually have a higher, not lower, or similar prevalence of cardiovascular disease, than whites. He was just invited to present those findings at theAmerican College of Cardiologys 70th annual scientific session in May.

What we saw clearly does not support the Latino paradox, Carrasquillo said. But thats only in this database, so for now were just throwing more fire on a debate thats been raging for 25 years.

But not subject to much debate will be the growing value of using the AoURP Research Workbench for research and discovery. As the data grow, the research is going to be a lot more powerful, meaningful, and useful, he said.

To learn more about the workbench, visit the All of Us Research Hub or listen to an overview by Drs. Zchner and Carrasquillo presented by the Clinical and Translational Science Institute. For more information about or to enroll in the study, visit the All of Us Research Program.

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National health database opens to University researchers - University of Miami

Method utilizes electronic sensor that instantly and accurately detects concentrations of the antipsychotic drug, clozapine, in the blood via a finger prick, allowing maximal therapeutic benefit while minimizing side effects

BEER-SHEVA, Israel, Feb. 16, 2021 /PRNewswire/ -- Researchers at Ben-Gurion University of the Negev (BGU) have developed a novel method for instantly and accurately monitoring blood levels of the antipsychotic drug, clozapine, using a blood drop from a finger prick. The method, developed by Dr. Hadar Ben-Yoav, Department of Biomedical Engineering and Ilse Katz Institute for Nanoscale Science and Technology, BGU, is based on an electrochemical microsensor which enables, for the first time, clozapine detection in one drop of finger-pricked whole blood samples of schizophrenia patients without using any pretreatment steps.

Clozapine is considered the most effective antipsychotic medication for schizophrenia and the only antipsychotic currently approved for treatment-resistant schizophrenia but is also associated with harsh side effect. Both its efficacy and its side effects are strongly correlated with blood concentration levels, which can differ up to 20-fold between individuals prescribed identical doses, and can be greatly affected by age, gender, drug interactions and other parameters.

Despite the importance of monitoring clozapine blood levels, its current monitoring scheme is burdensome and involves frequent invasive blood draws, leading to sub-optimal treatment efficacy due to the poor ability to titrate its dose for maximal therapeutic benefit while minimizing side effects. As a result, clozapine is still one of the most underutilized evidence-based treatments in the field of mental health.

Dr. Ben-Yoav's team has invented a miniaturized microelectrode sensor that is able to accurately and immediately detect clozapine levels in a microliter-sample of whole blood such as obtained by a simple finger prick. A recent study carried out in collaboration with Prof. Deanna L. Kelly, Maryland Psychiatric Research Center (MPRC), University of Maryland, School of Medicine, showed good correlation between clozapine blood concentrations measured by the device compared to standard laboratory blood tests in schizophrenia patients[i].

Dr. Ben-Yoav, said, "We were excited to see the promising initial results of our novel device, that can supply people with schizophrenia and their caretakers with instantaneous, accurate results of their blood clozapine levels. Clozapine plasma levels are helpful in improving response rates and minimizing unnecessary side effects. Our device can be the basis of rapid, accurate point-of-care monitoring of patients that will enable personalized medicine through close monitoring and adjustment of the dose of this important drug."

"We hope that this innovative invention will help increase patient compliance and facilitate the use of clozapine for people living with schizophrenia," said Josh Peleg, CEO of BGN Technologies. "The medical research field is investing considerable efforts in simplifying and miniaturizing various blood tests, enabling patients to receive medical results immediately and at home, and the device being developed by the team of Dr. Ben-Yoav is an important contribution to this trend. Importantly, the technology underlying this novel clozapine sensor can be used as a platform for the detection of additional substances. After filing for patent protection, BGN Technologies is currently seeking a strategic partner for further developing and commercializing this device."

The novel sensor can be used as a platform for detecting other redox (reducing-oxidizing) chemicals in small quantities of untreated, whole blood samples. Redox molecules are involved in multiple significant chemical reactions, such as synthesis of various substances, biochemical processes in living organisms, diagnostics and medical procedures. Redox agents can be monitored by specific electrodes, but currently available methods of detection require pretreatment of the blood sample in order to separate the desired molecules from other, interfering substances. The sensor developed by Dr. Ben-Yoav's team can detect minute quantities of various redox molecules in untreated blood samples, thus paving the way for developing miniaturized, point-of-care devices that will be able to monitor various targets.

In August 2020, Dr. Ben-Yoav was one of the recipients of the Brain & Behavior Research Foundation's 2020 Klerman and Freedman Prizes, recognizing exceptional clinical and basic research in mental illness. The prizes are awarded annually to honor outstanding scientists working to advance the prevention, diagnosis and treatment of psychiatric illness. Dr. Ben-Yoav received the prize for his development of "novel biosensors to detect unique diagnostic electrical fingerprints from blood samples of schizophrenia patients that can provide crucial information about their treatment management."

References:

[i] Shukla et al. (2020) An integrated electrochemical microsystem for real-time treatment monitoring of clozapine in microliter volume samples from schizophrenia patients. Electrochemistry Communications 120 (2020) 106850; https://doi.org/10.1016/j.elecom.2020.106850

About BGN Technologies

BGN Technologies is the technology transfer company of Ben-Gurion University, the third largest university in Israel. BGN Technologies brings technological innovations from the lab to the market and fosters research collaborations and entrepreneurship among researchers and students. To date, BGN Technologies has established over 100 startup companies in the fields of biotech, hi-tech, and cleantech, and has initiated leading technology hubs, incubators, and accelerators. Over the past decade, BGN Technologies has focused on creating long-term partnerships with multinational corporations such as Deutsche Telekom, Dell-EMC, PayPal, and Lockheed Martin, securing value and growth for Ben-Gurion University as well as the Negev region. For more information, visit the BGN Technologies website.

Media Contact: Tsipi HaitovskyGlobal Media LiaisonBGN TechnologiesTel: +972-52-598-9892E-mail: tsipihai5@gmail.com

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Ben-Gurion University Researchers Develop Novel Method for Personalizing Dose of Schizophrenia Drug Clozapine - BioSpace

Introduction

Low-density lipoprotein (LDL) cholesterol has been identified as the causative factor for atherosclerotic cardiovascular disease (ASCVD) based on a variety of evidence obtained from epidemiology,1 human pathology,2 human genetics,3 and clinical trials.47 Familial hypercholesterolemia (FH), an inherited hyper-LDL cholesterolemia, has often been associated with tendon and cutaneous xanthomas and premature ASCVD.8 This disorder has been regarded as a Mendelian autosomal dominant disease caused by rare genetic mutation(s) in the LDL receptor or its associated genes. Theoretically, this disease can be diagnosed at the early stages of life, even as early as pregnancy. Currently, two major methods have been proposed for the screening of FH worldwide.9 The first approach involves cascade screening where a diagnosis of FH in new cases, typically younger relatives, is triggered by the diagnosis of the index cases. The second approach involves universal screening where LDL cholesterol measurements are conducted universally at a certain age, after which detailed assessments, including genetic analyses, are subsequently performed to confirm their diagnoses. However, diagnosing FH in children and adolescents is often quite difficult given that physical xanthomas and family histories are usually obscure and/or difficult to obtain among such young patients.

Apart from the difficulties in diagnosing FH among children and adolescents, debates regarding when, how, and who to treat at this early stage of life have remained ongoing. In this regard, recent advancements in human genetics have revealed that personalized medicine can also be applicable to FH, where patients with deleterious genetic mutations and/or signs of premature atherosclerosis development should be treated earlier and more aggressively.10 On the other hand, children and adolescents with FH who had started early treatment exhibited excellent prognosis even under mild treatment,11 suggesting the importance of earlier treatment in the management of FH.

The current review outlines the current status of clinical and genetic diagnosis of FH in children and adolescents while also providing useful management strategies for FH in children and adolescents based on currently available clinical evidence.

FH is characterized by the clinical triad of primary hyper-LDL cholesterolemia, tendon xanthomas, and premature ASCVD.12 The first documentation of FH dates back as far as 1873,13 during which it had been described as xanthomatous disease. By the 1930s, FH had started to be considered as an inherited disease,14 with Prof. Brown and Goldstein later discovering genetic abnormalities in the LDL receptor as the principal cause of this condition by the 1970s.15 Subsequently, other genes, including apolipoprotein B (APOB)16 and proprotein convertase subtilisin/kexin type 9 (PCSK9)17 genes, have also been identified to cause this disease. Since its initial documentation, FH has long been described to have a prevalence of 1 in 500 individuals among the general population. In 2011, our group found that FH had a prevalence of 1 in 208 based on genetic epidemiology of homozygous FH in the Hokuriku district of Japan.18 Following our report, similar estimates have been obtained in the United States and Europe.19,20 Currently, FH is considered to have a prevalence of 1 in ~300 individuals among the general population.21 By such estimates, only one monogenic mutation causes the critical phenotype. Monogenic FH is considered the standard form of FH, wherein the mutation status of affected genes is associated with increased likelihood of developing ASCVD, independent of LDL cholesterol values.22 This disease appears to account for at least a portion of patients with ASCVD (estimated to be ~1 in 31 individuals), especially those with premature ASCVD (estimated to be ~1 in 15 individuals). No other single disorder can be responsible for such proportions of ASCVD, which has been identified as the leading cause of mortality worldwide.23 Moreover, timely diagnosis and treatment of children and adolescents with FH have been shown to promote a favorable prognosis.11 Accordingly, children and adolescents with require better awareness and more attempts at diagnosing FH compared to adults.

As stated previously, timely diagnosis and treatment has been shown to prevent ASCVD events in patients with FH. As such, identifying patients with FH at a younger age is of particular importance given that this leads to prompt treatment initiation and prevention of premature ASCVD. However, diagnosing FH in younger individuals is somewhat difficult considering that they typically do not exhibit increased Achilles tendon thickness, which has been used as one of the major diagnostic criteria for adult FH worldwide. One proposed screening method for FH is universal screening at an age when FH can be effectively identified.24,25 On the other hand, opportunistic screening, utilizing every opportunity to screen patients for FH, is also effective to find FH.2628 For example, measurement of LDL cholesterol is common practice, and we can find patients with FH when LDL cholesterol level is over a threshold irrespective of the primary aim of its measurements. Another effective screening method for FH is cascade screening, which has been recommended by many organizations around the world. Indeed, countries where dedicated cascade screening programs have been implemented have identified a notably higher number of patients with FHs. For instance, the Netherlands and Norway have diagnosed 71% and 43% of FH cases, respectively.29 In addition, we had demonstrated that cascade screening is significantly associated with better prognoses among patients with FH30 One of the major factors contributing to our results is the notion that an earlier diagnosis promotes better outcomes, which is especially true for patients with FH. As such, although numerous studies have shown the efficacy of LDL-lowering therapies among patients with FH, the magnitude of the benefits obtained from such therapies appear to vary according to the timing of therapy commencement, with far greater benefits having been observed among children than among adults in secondary prevention settings.11,30,31 Accordingly, we firmly believe that earlier diagnosis either via cascade or universal screening and timely LDL-lowering therapies could be beneficial for patients with FH. Alternative way of screening for FH is reverse cascade screening where the index case is a child, and then parents are diagnosed as FH.32,33 It is usually associated with universal screening. However, studying the parents first has a high diagnostic yield.34

Several different types of clinical diagnostic criteria have been established for FH globally, including the Dutch Lipid Clinical Network (DLCN),35 Make Early Diagnosis to Prevent Early Deaths (MEDPED) diagnostic criteria,36 Japan Atherosclerosis Society (JAS) FH diagnostic criteria,37 and Simon Broome diagnostic criteria for FH.35 Each of the aforementioned diagnostic criteria for pediatric FH has specific cutoffs for LDL cholesterol (Boxes 1 and 2; Tables 1 and 2) given the considerable variability in its levels within this group, especially among adolescents.38 Moreover, children and adolescents with FH barely exhibit physical xanthomas, which is one of the major clinical diagnostic criteria for adults. Nonetheless, care should be exercised when using lower LDL cholesterol thresholds for screening young patients with FH, with family history being much more important in pediatric than in adult cases. In this regard, clinical diagnostic criteria for pediatric FH by JAS appears to be quite useful. Because it is quite simple to use (there are only 2 elements), and it really put weight on their family history (of parents). In order to diagnose them as FH, (reverse) cascade screening for FH will be conducted, and then at least 2, or perhaps even more patients with FH can be identified.

Box 1 Diagnosis of Familial Hypercholesterolemia in Children and Adolescents (EAS)

Box 2 Pediatric Familial Hypercholesterolemia Diagnostic Criteria (JAS)

Table 1 Diagnosis of Familial Hypercholesterolemia (MEDPED)

Table 2 Simon Broome Diagnostic Criteria for FH

To establish a diagnosis of FH in children and adolescents, genetic testing may be quite useful, although ethical aspects should be carefully considered.39 However, we also need to be careful for what is FH. A few years ago, an useful classification has been proposed regarding the classification of FH. According to this, FH can be classified into heterozygous FH (caused by a deleterious mutation in FH-gene), homozygous FH (caused by double deleterious mutations in FH-gene), polygenic FH (caused by LDL-associated common genetic variations), and polygenic FH plus hypertriglyceridemia (caused by LDL-, and TG-associated common genetic variations).40 In terms of genetic diagnosis, it is still quite difficult to diagnose polygenic state of FH. Accordingly, genetic diagnosis of FH is usually referring to genetic testing for rare genetic variations of FH-genes. In addition, it is also important to think differently between heterozygous FH and homozygous FH irrespective of ages. As stated above, the prevalence of heterozygous FH is 1 in ~300 among general population, which is a common disorder, and difficult to diagnose them as FH in children adolescents because of reasons stated previously. On the other hand, homozygous FH is a rare condition, the prevalence of which is estimated to 1 in 160,000 among general population. However, it is of note that state of homozygous FH is an emergent condition, where cardiovascular complications are observed in their adolescence.8 There are several special treatments for homozygous FH, including microsomal triglyceride transfer protein (MTTP) inhibitor, LDL apheresis, and liver transplantation.4145 Genetic diagnosis for homozygous FH is very important not just because of their diagnosis, but can be useful for their phenotyping. It has been shown that PCSK9 inhibitor, which is quite useful for heterozygous FH, has minimal effect to reduce LDL cholesterol level among the patients with homozygous FH caused by null-type of mutations of LDLR.46 Other useful points for this matter include assessment of responsiveness to dietary intervention, although dietary interventions typically have minimal influence on LDL cholesterol levels among pediatric patients with FH.47 Moreover, an important differential diagnosis worth considering in pediatric FH includes sitosterolemia,48,49 a disease found to be a phenocopy of homozygous FH. Although patients with sitosterolemia usually exhibit physical xanthomas associated with elevated LDL cholesterol, sitosterolemia is a recessive disorder, with dietary interventions being quite useful for reducing LDL cholesterol levels.50 Sitosterolemia can be distinguished from FH based on the mentioned important clinical manifestations.

FH has been considered one of the major causes of premature ASCVD, with carotid ultrasound being one of the most popular and non-invasive methods for assessing atherosclerosis among pediatric patients with FH. Carotid intima-media thickness (IMT) is often used as a surrogate marker for systemic atherosclerosis among not only the general population but also pediatric patients with FH.51,52 Moreover, coronary and/or aortic calcium scores have been used to assess early subclinical atherosclerosis,53 apart from actual plaque accumulation in the coronary artery.54 Furthermore, arterial stiffness assessed through brachial-ankle pulse wave velocity had been found to be significantly associated with the presence of ASCVD in patients with FH.55 According to accumulated evidence obtained thus far, the development of ASCVD among patients with FH appears to start during adolescence. These findings have motivated us to consider initiating LDL cholesterol-lowering treatments at an earlier stage of life.

Lifestyle interventions should be the fundamental strategy for managing FH in children and adolescents at any age. Statins can be introduced according to guidelines or recommendations. For instance, pitavastatin can be used for Japanese pediatric patients with FH (age 10 years) whose LDL cholesterol levels remain 180 mg/dL under lifestyle interventions, with the optimal target being set at <140 mg/dL, especially among those with diabetes or a family history of premature ASCVD (Figure 1).37 There are many studies showing the efficacy and safety regarding the use of statins for children and adolescents, and a meta-analysis and a systemic review are suggesting that it is true.56,57 Adherence should be closely monitored among those with poor response to statins before increasing the dose. Adolescent girls should be counseled to suspend statin therapy when contemplating pregnancy. Other medications, such as ezetimibe and resin, can be considered when needed. Notably, the European Atherosclerosis Society had proposed a similar strategy in Europe where high-risk pediatric patients with FH aged 810 years are recommended to start statins to reduce LDL cholesterol (Figure 2).10 Moreover, the National Lipid Association expert panel on FH had recommended similar management approaches (Box 3).58 In addition, resin, and ezetimibe are also shown to effectively reduce LDL cholesterol among the pediatric FH patients.59,60 More recently, it has been shown that evolocumab reduced the LDL cholesterol level and other lipid variables among them.61 Notably, all of the mentioned recommendations have acknowledged the need for actively attempting to diagnose/identify FH in children and adolescents and considering lowering LDL cholesterol levels through lifestyle intervention and statins.62

Figure 1 Strategies for the management of pediatric familial hypercholesterolemia (FH) (JAS). Green arrows indicate Yes; blue arrows indicate No. The essential message is that the pediatric patients with FH aged 10 or greater who have low-density lipoprotein cholesterol levels 180 mg/dL under appropriate lifestyle intervention may be treated using statins. Reproduced from Harada-Shiba M, Ohta T, Ohtake A, et al. Joint Working Group by Japan Pediatric Society and Japan Atherosclerosis Society for Making Guidance of Pediatric Familial Hypercholesterolemia.Guidance for Pediatric Familial Hypercholesterolemia 2017.J Atheroscler Thromb. 2018;25(6):539553.37

Figure 2 Strategies for the diagnosis and management of familial hypercholesterolemia (FH) in children and adolescents (EAS). Premature coronary heart disease is defined as a coronary event before age 55 and 60 years in men and women, respectively. Definite FH is defined as genetic confirmation of at least one FH-causing genetic mutation. Close relative is defined as 1st or 2nd degree relatives. Highly probable FH is based on clinical presentation (ie, phenotypic FH): either an elevated low-density lipoprotein cholesterol (LDL-C) level 5 mmol/L in a child after dietary intervention or a LDL-C level 4 mmol/L in a child with a family history of premature coronary heart disease in close relatives and/or high baseline cholesterol in one parent. Cascade screening from an index case with a FH-causing mutation may identify a child with elevated LDL-C levels 3.5 mmol/L. Reproduced with permission from Wiegman A, Gidding SS, Watts GF, et al. European atherosclerosis society consensus panel. Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment. Eur Heart J. 2015;36(36):24252437.10

On the other hand, there are other strategies, including MTTP inhibitor (lomitapide), APOB inhibitor (mipomersen), LDL apheresis, and liver transplantation for the cases with homozygous FH. Another potential medical therapy is Angiopoietin-like 3 (ANGPTL3) inhibitor, whose efficacy and safety for adult patients with homozygous FH has been shown.63

Box 3 Summary Recommendations from the National Lipid Association Expert Panel on Treatments for Pediatric Familial Hypercholesterolemia

Regardless of its definition, genetic analyses for patients with FH should have clear indications beyond clinical diagnosis. As such, we herein highlight the several advantages of genetic background analysis in FH. First, quite a few patients with hypercholesterolemia have obscure or marginal clinical diagnoses of FH. Moreover, their family history is sometimes quite challenging to obtain. Genetic analyses can definitively identify patients with FH, especially those with traditional monogenic FH. Second, genetic analysis allows us to determine whether patients are heterozygous or homozygous. Several special medical therapies, such as MTTP inhibitors and LDL apheresis, have typically only been used for homozygous FH in many parts of the world. Moreover, homozygous FH is one of the designated intractable diseases where all medical costs can be covered by the Japanese government, thereby increasing the importance of diagnosis. Third, a portion of patients with FH may have been misdiagnosed as such and actually have another diagnosis, such as sitosterolemia. In such cases, ezetimibe instead of statins is recommended. Fourth, the genetic status of patients with FH has been found to be associated with increased risk for ASCVD. Accordingly, determining the genetic status can lead to better risk stratification. Fifth, genetic status determination can lead to better cascade screening and consequently better prognoses. Panel sequencing covering FH genes appears to be the current gold standard for determining the genetic status.64 However, determining the pathogenicity of the identified genetic variations has remained challenging for us.

We currently face an important dilemma regarding the definition of FH. If we adhere to clinical manifestations, such as tendon xanthomas, we believe that it is too late considering that earlier interventions based on earlier diagnosis have already been proposed. We believe that at least two different types of diagnostic criteria can be established. The first criteria, which would aim to diagnose definite FH, can be rather strict and have high diagnostic specificity, whereas the second one, which would aim to diagnose potential FH, can have high diagnostic sensitivity. Nonetheless, a diagnosis of FH needs to be ultimately established and adequately treated as early as possible before pediatric patients grow into adults.

Data science and personalized medicine are two major keywords describing medical innovations in the coming 10 years. In the management of FH, genetic analyses involving genes associated with not only LDL cholesterol itself but also ASCVD will become standard. Moreover, target, timing, and LDL cholesterol-lowering therapies will become quite individualized based on genotype, lifestyle, environmental factors, and belief systems. For the earlier identification of patients with FH, nation-wide mass screening, similar to that currently conducted for several other inherited metabolic diseases, such as newborn screening, phenylketonuria, and homocystinuria, will become standard. Furthermore, family history will be automatically assessed to accumulate a huge dataset over the years, which will help us minimize the risk of overlooking children and adolescents with FH (and other inherited diseases).

Given that FH is an inherited disease, early diagnosis and intervention can lead to excellent prognosis. Cascade and universal screening appear to be practical strategies for the early identification of patients with FH; however, we need to consider that certain clinical approaches can promote better identification of children and adolescents with FH. Clinical practices and genetic analyses will certainly help improve not only diagnostic accuracy but also risk stratification for personalized medicine.

The authors report no conflicts of interest in this work.

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[Full text] Familial Hypercholesterolemia: A Narrative Review on Diagnosis and Man | VHRM - Dove Medical Press