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ED interrogates TMC leader Madan Mitra in Rose Valley scam

first_img Advertising Related News madan mitra, trinamool congress, madan mitra tmc, tmc madan mitra, tmc leader madan mitra, ponzi scam, saradha chitfund scam, cbi, ed, enforcement directorate, india news, Indian Express He was interrogated for more than four hours by the ED. (Representational Image)The Enforcement Directorate Monday interrogated senior Trinamool Congress leader Madan Mitra in connection with the Rose Valley scam, official sources said. Kolkata: CBI grills IPS officer for nearly seven hours Saradha case: CBI summons former Kolkata commissioner Rajeev Kumar today By PTI |Kolkata | Published: July 8, 2019 7:32:40 pm SIT member questioned in Saradha chit fund case This was the first time Mitra was interrogated in this connection and his statements were recorded, ED sources told PTI.He was interrogated for more than four hours.Mitra, who was the then transport minister, was arrested in 2014 by the Central Bureau of Investigation for his alleged connection with the multi-crore Saradha ponzi scam. He served a jail term of over 21 months before getting bail.According to the ED estimates, the Rose Valley scandal is at least five times the Saradha ponzi scam. The agency had arrested its chairman Gautam Kundu and attached his assets worth Rs 2,300 crore, including hotels and resorts.Multiple charge sheets had been filed by the ED in the courts of Kolkata and Bhubaneswar. Post Comment(s)last_img read more

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North Korea says US extension of sanctions a hostile act KCNA

first_img Best Of Express Advertising After Masood Azhar blacklisting, more isolation for Pakistan Karnataka trust vote today: Speaker’s call on resignations, says SC, but gives rebel MLAs a shield us sanctions on north korea, north korea nuclear and missile programmes, kcna, us- north korea summit, kim jong-un, donald trump, world news, indian express The White House extended last week six executive orders containing sanctions imposed over North Korea’s nuclear and missile programmes by one year.The recent US extension of sanctions against North Korea was an act of hostility and an outright challenge to an historic summit between the two countries in Singapore last year, a spokesman for Pyongyang’s foreign ministry said on Wednesday. How North Korea’s Kim Jong Un gets his luxury cars despite sanctions Virat Kohli won’t have a say in choosing new coach The White House last week extended six executive orders containing sanctions imposed over North Korea’s nuclear and missile programmes by one year.The unidentified North Korean foreign ministry spokesman denounced US Secretary of State Mike Pompeo’s remarks on Sunday that more than 80 per cent of the North Korean economy has been affected by sanctions.The spokesman also accused Washington of “viciously slandering” Pyongyang in its latest reports on human trafficking and religious freedom around the world. By Reuters |Seoul | Published: June 26, 2019 10:47:06 amcenter_img Australian student missing in North Korea is released North Korea is like the world’s Jurassic Park, where fossilised notions live and breathe Since then, North Korea has complained of US sanctions and demanded Pompeo be replaced by someone “more mature” while lauding the rapport Kim built with Trump.Pompeo, speaking to reporters on Sunday, raised hopes for a revival of nuclear talks after a recent exchange of letters between Trump and Kim.The North Korean spokesman warned it would be difficult to achieve denuclearisation as long as US politics are dominated by policymakers who have an “inveterate antagonism” towards North Korea.“We would not thirst for a lifting of sanctions,” the spokesman said.“Our state is not a country that will surrender to the US sanctions, nor are we a country which the US could attack whenever it desires to do so,” he added. “This is … a manifestation of the most extreme hostile acts by the United States,” the spokesman said in a statement carried by the North’s official KCNA news agency.“All these speak clearly to the fact that the wild dream of the United States to bring us to our knees by means of sanctions and pressure has not changed at all but grows even more undisguised,” he added.US President Donald Trump and North Korean leader Kim Jong Un held their first, groundbreaking summit in Singapore in June last year, agreeing to foster new relations and work towards the denuclearisation of the Korean peninsula.But a second summit in Vietnam in February collapsed as both sides failed to bridge differences between the US calls for denuclearisation and North Korean demands for sanctions relief. Related News Advertising Post Comment(s)last_img read more

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Goa session starts with altered alignments

first_img Goa political crisis, Goa forward party, goa congress mla resignations, Goa bjp, goa forward party support, indian express Goa Chief Minister Pramod Sawant. (PTI)The traditional alignment of the Opposition on the left of the Assembly Speaker and treasury benches on the right saw adjustments on the first day of monsoon session in Goa Assembly, with Maharashtrawadi Gomantak Party (MGP) and Goa Forward, earlier part of the BJP-led government, now on the Opposition side, and Chandrakant Kavlekar, until Wednesday Leader of Opposition from the Congress, now occupying the Deputy Chief Minister’s chair. Karnataka trust vote today: Speaker’s call on resignations, says SC, but gives rebel MLAs a shield Silveira, who was with the Congress when he had drafted the question, asked whether the government “checks the quality of beef sold in St Andre constituency”. The minister replied in positive. On beef coming from other states, Godinho replied that beef from Karnataka is examined and certificate is given.Congress leaders took the matter of soil erosion as their first question in Question Hour, with Chief Minister Sawant promising that a scientific agency will be appointed to probe the declining beach beds across Goa. Cabinet asks finance panel to consider securing funds for defence After Masood Azhar blacklisting, more isolation for Pakistan Manohar Azgaonkar, formerly of MGP, is the other Deputy CM.The chair of Leader of Opposition remained vacant, while four ministers attended the proceedings without being allotted portfolios. Chief Minister Pramod Sawant told the House that he will answer questions on departments earlier held by the four ministers who have been dropped.Speaker Rajesh Patnekar confirmed to the media that questions were rearranged since some questions were from then Opposition members who are now in the government. A question from Francisco Silveira, thus, received a written reply from Minister for Animal Husbandry and Veterinary Services Mauvin Godinho – both MLAs now in the treasury benches. Post Comment(s) Advertising Written by Smita Nair | Panaji | Published: July 16, 2019 2:10:32 am Top News Advertisinglast_img read more

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Man smashes 19yearold girlfriends face arrested

first_img 4 Comment(s) Sheikh was later arrested, he said. According to the official, Sheikh has “confessed,” that he killed Parihar because he suspected her character and “closeness” with some youths.Prima facie, Sheikh travelled with Parihar in his car on July 12 and later allegedly killed her by crushing her head at Savli Fata near Pandhurna-Nagpur highway, the official said.A case of murder has been registered by Nagpur (Rural) police and further investigation is underway. By PTI |Nagpur | Updated: July 15, 2019 1:54:55 pm Advertising Maharashtra: 55-year-old woman killed by leopard in Chandrapur village Related News Man smashes 19-year-old girlfriend's face, arrested The victim is identified as Khushi Parihar, a resident of Nagpur, and the accused as Ashraf Sheikh. (Facebook/Khushi Parihar)A 19-year-old aspiring model was allegedly killed by her boyfriend on suspicion of her “character” in Maharashtra’s Nagpur district, police said Sunday, adding that the accused has been arrested. Advertising Nagpur drug exporter held in Prague for selling prohibited items Nagpur hospital’s prescription for mentally ill: work, wage, welfare The victim is identified as Khushi Parihar, a resident of Nagpur, and the accused as Ashraf Sheikh.A Nagpur police official said they received information on Saturday morning about the body of a woman with her face crushed lying along Pandhurna-Nagpur highway.Police identified the victim through social media, he said, adding that Parihar used to participate in local fashion shows and was aspiring to become a model.last_img read more

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Measure of ED threat perceptions could help identify patients at risk for

first_img Source:http://www.saem.org/ Reviewed by James Ives, M.Psych. (Editor)Oct 3 2018A brief tool assessing emergency department (ED) threat perceptions has clinical utility for providers to identify patients at risk for developing cardiac-induced PTSD and is critical to inform research on whether threat may be modified in-ED to reduce post-traumatic stress disorder (PTSD) incidence. That is the finding of a study to be published in the October 2018 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM).The lead author of the study is Talea Cornelius, PhD, a postdoctoral research scientist at Columbia University Medical Center in the Center for Behavioral Cardiovascular Health, New York.Related StoriesTransobturator sling surgery shows promise for stress urinary incontinenceNew research links “broken heart syndrome” to cancerUTHealth researchers investigate how to reduce stress-driven alcohol useThe study, by Cornelius, et al., reports the development and validation of a brief, self-report, seven-item measure of ED threat perceptions (e.g., patients’ subjective feelings of helplessness or lack of control) in English- and Spanish-speaking patients evaluated for acute coronary syndrome (ACS).In addition to providing a foundation for standardized research programs across protocols and disease contexts, the study suggested that the brief assessment could inform clinical interventions and has practical implications: the ability to identify at-risk patients at an early point of contact in the ED and provide appropriate and targeted support to improve patient outcomes. Further, the study showed the feasibility of administering this instrument in the acute care setting.Rosemarie Ramos, PhD, MPH, assistant professor and assistant research program director in the Department of Emergency Medicine, University of Texas Health-San Antonio, commented:”Perceived stress and powerlessness are well-established risk factors for poor functional and psychological resilience among those who have witnessed trauma (e.g., community violence, military combat.) When one experiences the trauma of emergency treatment for a life-altering condition in a seemingly-chaotic setting, the psychological impact of such is rarely addressed at point-of-care. This study offers an invaluable instrument that aligns with the goals of Social Emergency Medicine; specifically, the need to assess and address plausible determinants of resilience before discharge from the ED.”The findings of the study are discussed in the most recent AEM podcast,last_img read more

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Google May Have Pixel Chromebook Showcase Tiny Home in the Works

first_imgGoogle’s introduction of a “little brother” for its Home smart speaker is a much-expected move, said Brad Russell, a research analyst at Parks Associates.”They need a low-cost entry point for consumers that aren’t already in the space,” he told TechNewsWorld.One of the goals of these product lines is ubiquity in the home, Russell pointed out.”The reason Amazon’s Dot has been so successful is not just because it’s cheap — it’s because you can afford to put one in every room if you choose to,” he said.Offering a range of devices enhances a vendor’s prospects for appealing to a wider audience, noted Jonathan Collins, a research director at ABI Research.While the idea is to expand the number of devices in the home, vendors’ ambitions reach beyond the devices.”In the long term, each vendor wants to get their voice assistant platform in the smart home,” Collins told TechNewsWorld.”These speakers have become a Trojan horse for the digital assistants,” said Technalysis’ O’Donnell.”People are using these speakers to get access to personal assistants more than they’re even using them on their phones,” he said, “so if Google wants to have more people use Google Assistant, they have to sell more smart speakers.” Bison Spinoff? Google appears to be planning a Pixel-branded Chromebook and a downsized version of its Home smart speaker, following in the steps of Microsoft and Amazon respectively.Along with two expected new Pixel phones, Google this fall will unveil a Pixel-branded Chromebook and smaller, lower-priced version of its Home smart speaker, Android Police reported Monday, citing a source familiar with the company’s plans.Chromebooks typically have been popular with budget-conscious schools and penny-pinching consumers, but the Pixel laptop may be setting it sights on a segment of the market that’s willing to spend more, the Android Police report suggests.If so, it won’t be Google’s first effort to sell a premium Chromebook. It first introduced a Pixel Chromebook in 2013, and it offered an upgrade with a base model price of US$999 in 2015. Neither captured much market share.If Google should decide to continue its Chromebook line, price could be a big factor in its success.”Chromebooks have never sold as high-end notebooks,” said Bob O’Donnell, chief analyst at Technalysis Research.”For them to try to do something in the premium area would be challenging,” he told TechNewsWorld. “That has never been a product category where Chromebooks have sold well.” Sales may be a secondary consideration for Google in the Chromebook market, though. Like Microsoft with its Surface tablet and laptop products, Google likely wants to show other Chromebook makers the platform’s potential.”What they’re trying to do is establish a benchmark product that shows the market what the technology can do, and hope the other guys follow suit,” noted Jack E. Gold, principal analyst at J.Gold Associates.”I don’t think Google is going to play the low-end price game,” he told TechNewsWorld. “They’re going to try and show more capabilities and encourage OEMs to get more creative with their Chromebooks.”The impetus behind a new Pixel Chromebook is the same as always, noted Charles King, principal analyst at Pund-IT.”It allows Google to demonstrate just how robust and great a Chromebook can be,” he told TechNewsWorld.A high-end Chromebook also could prove the value of the ChromeOS to Google’s partners by opening a premium market to them.”Its partners have been reluctant to push the price opportunity for Chromebooks above $400,” said Stephen Baker, an analyst with the NPD Group.”To be a viable alternative to Windows, Google has to offer its device partners a path to better revenue and profits with Chromebook,” he told TechNewsWorld.”The Pixel Chromebook will be designed to help create a viable more premium market, which the partners want,” Baker said, but they “can’t take the financial risk that Google can in building it.” John P. Mello Jr. has been an ECT News Network reportersince 2003. His areas of focus include cybersecurity, IT issues, privacy, e-commerce, social media, artificial intelligence, big data and consumer electronics. He has written and edited for numerous publications, including the Boston Business Journal, theBoston Phoenix, Megapixel.Net and GovernmentSecurity News. Email John.center_img Benchmark for Others Because the Pixel Chromebook likely will be a premium product, it won’t be stepping on the sales of existing Chromebook makers, said Rhoda Alexander, director of tablet and notebook research at IHS Markit.”I don’t see this offering serious competition to their hardware partners,” she told TechNewsWorld. “It’s Google taking a leadership role, showing how things can be done, rather than a volume-hardware play.”Although details were sparse, it seems likely the new Pixel Chromebook will spring from Project Bison, a Google project veiled in secrecy and originally scheduled for release in this year’s third quarter, the Android Police report suggested.Bison was intended as a serious competitor to Apple’s MacBook and Microsoft’s Surface Pro, according to the report. It was to have a 12.3-inch screen, 32 or 128 gigabytes of storage, 8 or 16 gigabytes of RAM, and an optional Wacom stylus that would be sold separately.”The biggest rumor about the Pixel Chromebook concerns Google integrating support for Android apps, which would be a large, significant step forward,” Pund-IT’s King said.”It also seems possible that the company could add support for features tied to it’s Home devices or emerging technologies like Cardboard,” he added. Home’s ‘Little Brother’last_img read more

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Cancer stem cells depend on amino acid metabolism and its proving to

first_img Source:https://coloradocancerblogs.org/cancer-stem-cells-get-energy-from-protein-and-its-proving-to-be-their-achilles-heel/ Reviewed by James Ives, M.Psych. (Editor)Nov 13 2018Think of energy metabolism like a party popper: Ripping something apart releases a bang. Most of your cells rip apart sugar to release the “bang” of energy. Sometimes they rip apart fats, and in a pinch, cells can even metabolize protein.Cancer cells do things a little differently. First, most cancer cells continue to depend on glucose, but switch over from “cellular respiration” (which requires oxygen), to “glycolysis” (which can happen with or without oxygen). A University of Colorado Cancer Center study published today in the journal Cancer Cell shows that cancer stem cells take a third approach: They stick with cellular respiration, but switch from metabolizing sugar to metabolizing protein, or more precisely amino acids, which are the building blocks of protein.Healthy cells don’t need to metabolize protein. The current study shows that cancer stem cells do need to metabolize protein. And this difference is proving to be an Achilles’ heel that allows researchers to target cancer stem cells without harming healthy cells – the approach has already proven effective in clinical trials against acute myeloid leukemia and holds promise for other cancers including breast, pancreatic, and liver.”In acute myeloid leukemia, we’ve gotten pretty good at killing the bulk of cancer cells, but a small population of cancer stem cells are uniquely equipped to resist these therapies, and these stem cells often survive to restart the condition later. We’ve needed a way to specifically target cancer stem cells, and it looks like this might be it,” says Craig Jordan, PhD, investigator at University of Colorado Cancer Center, division chief of the Division of Hematology and the Nancy Carroll Allen Professor of Hematology at the University of Colorado School of Medicine.In fact, Jordan has spent more than 20 years laying the scientific groundwork for this attack against cancer stem cells, and now just in the past six months, with a flurry of important publications, the work from his team has led not only to increased understanding of these tenacious cells, but to treatments that may change the standard of care for acute myeloid leukemia and perhaps other cancers as well. In a recent clinical trial, patients with acute myeloid leukemia who were not candidates for bone marrow transplant were treated with the drug venetoclax, which blocks cells’ ability to uptake amino acids.”Conventional chemotherapy is not effective for most patients with acute myeloid leukemia. The new results with venetoclax look very promising,” Jordan says. Clinical trial results are also published today in the journal Nature Medicine, with first author Daniel Pollyea, MD. The current study circles back to pinpoint why the clinical trial was so successful.Related StoriesMother calls for protein shake regulation after daughter diesStudy reveals link between inflammatory diet and colorectal cancer riskSugary drinks linked to cancer finds studyVery basically, a series of studies performed by first author Courtney Jones, PhD, and others in the Jordan lab showed that leukemia stem cells do not (or are perhaps unable) to switch from cellular respiration to glycolysis like more mature cancer cells. Instead, they switch from metabolizing glucose to metabolizing amino acids – in fact, they come to absolutely depend on metabolizing amino acids for energy, so much so that when the ability of leukemia stem cells to uptake amino acids is interrupted, these cells die.”Courtney’s research represents a key step in understanding how to better eradicate leukemia stem cells. With her findings as a foundation, I believe we can now move forward to create even more effective therapies,” Jordan says.The drug venetoclax stops leukemia stem cells from being able to use amino acids for energy. In the lab and now in the clinic, when researchers treated AML patients with venetoclax, leukemia stem cells died. Importantly, because healthy cells do not depend on amino acid metabolism, venetoclax killed leukemia stem cells without harming healthy cells.Interestingly, it was only AML patients who were treated with venetoclax as their first treatment that showed such a dramatic response.”When patients were treated with other therapies first, leukemia stem cells were pushed to diversify and some adopted lipid metabolism,” Jones says.When those patients were subsequently treated with venetoclax, the drug killed the cancer stem cells that continued to depend on amino acid metabolism, but was ineffective against cancer stem cells that had switched to lipid metabolism. It was as if lipid metabolism provided an avenue of escape for these cells, and when even a small population of leukemia stem cells was able to resist therapy, they were able to later restart the growth of the disease.The group’s future work hopes to explore the possibility of inhibiting lipid metabolism along with amino acid metabolism for use with AML patients whose cancers have resisted or relapsed after previous therapies.”In this paper, we report an important piece of science that describes a vulnerability of these leukemia stem cells, and in the Nature Medicine paper we describe a treatment that successfully exploits this vulnerability,” Jordan says. “We believe this type of therapy is just the beginning of what may become an entirely new way of treating leukemia. Now our challenge is to optimize this treatment in acute myeloid leukemia, while possibly expanding it for use in other settings where cancer stem cells continue to drive the development, growth and relapse of cancer.”last_img read more

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Optimization of drug dose sizes can reduce pharmaceutical wastage

first_imgReviewed by James Ives, M.Psych. (Editor)Dec 6 2018New study shows how drug manufacturers can reduce wastage, and therefore their costs, by altering the size of the vials they producePharmaceuticals are often dosed according to patient weight or body size which means that a dose must be individually measured. In a new study, lead author Anthony Hatswell of Delta Hat Limited and University College London in the UK, shows that by optimizing drug dose sizes available, wastage can be cut by as much as 50 per cent. The research is in the Adis journal Applied Health Economics and Health Policy, which is published by Springer Nature.Related StoriesLiving with advanced breast cancerStudy: Nearly a quarter of low-risk thyroid cancer patients receive more treatment than necessarySugary drinks linked to cancer finds studyMany pharmaceuticals, such as drugs used for cancer treatment, are only available in standard quantities, for example in 100 milligram packages. In this study, Hatswell and his co-author Joshua Porter investigated how the quantity of medicine in each package could be varied to reduce the overall wastage. This would allow manufacturers to cut their costs, helping to make medicines available to patients.To calculate the level of wastage, the authors looked at statistics from the Health Survey for England, which gives data on the height and weight of over 5000 individuals. Using this data they calculated how much drug would be wasted at every combination of vial sizes. The analysis was then tailored to the characteristics of patients with the disease (for example, males are heavier and taller than females on average), before the total wastage was aggregated over the population. By looking at all possible combinations of package sizes, Hatswell and Porter were then able to find those with low levels of wastage. The steps laid out in the publication can therefore be applied to any drug that does not have a fixed dose.The researchers found that wastage from the cancer drug pembrolizumab (Keytruda®, Merck, which is on track for sales of more than $5 billion in 2018) could be cut from 13.3 per cent to 8.7 per cent. Similarly the prostate cancer drug cabazitaxel (Jevtana®, Sanofi) could see wastage cut from a projected 19.4 per cent to 6.5 per cent.” We use methods such as integer programming and operations research which date back to the Second World War and are widely used in the manufacturing of consumer goods. Their application to healthcare represents a novel step which ultimately we hope will help patients access important new medicines,” explains Hatswell. Source:https://www.springer.com/gp/about-springer/media/research-news/all-english-research-news/researchers-investigate-how-vial-sizes-can-be-optimized-to-reduce-pharmaceutical-wastage/16315880last_img read more

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Ultrarestrictive opioid prescribing strategy linked with reduction in number of pills dispensed

first_img Source:https://media.jamanetwork.com/news-item/ultrarestrictive-opioid-prescribing-strategy-associated-with-fewer-pills-dispensed/ Reviewed by Kate Anderton, B.Sc. (Editor)Dec 9 2018An ultrarestrictive opioid prescribing strategy was associated with a reduction in the number of pills dispensed in a study of patients having surgery for gynecologic cancer, without changes in postoperative pain scores, complications or increases in prescription refill requests.Under the protocol, patients having ambulatory or minimally invasive surgery weren’t prescribed opioids at discharge unless they required more than five doses of oral or intravenous opioids while in the hospital. Surgical patients who had an abdominal incision (laparotomy) were given a three-day supply of opioids when they were discharged. The average number of opioid pills dispensed at discharge decreased after the ultrarestrictive prescribing protocol was implemented from 43.6 to 12.1 for patients who had a laparotomy; from 38.4 to 1.3 for patients who had minimally invasive surgery; and from 13.9 to 0.2 for patients who had ambulatory surgery. The findings reveal a promising strategy for decreasing postoperative opioid prescribing without increasing pain.​last_img read more

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BUs servicelearning program to teach handsonly CPR for high school students is

first_imgReviewed by James Ives, M.Psych. (Editor)Jan 7 2019PumpStart, a community service-learning program created by students at Boston University School of Medicine (BUSM), that teaches hands-only CPR to the general public, is effective for both teaching high school students a life-saving skill and providing medical students with an opportunity to engage in public health and medical education.It is estimated that 600,000 people die from cardiac arrest at home each year. Predictably, the survival rate for out-of-hospital cardiac arrests are much lower than those that occur at in-hospital setting.High school students throughout the metro-Boston area who participated in the PumpStart program completed anonymous pre-/post surveys. The pre-surveys were administered prior to their viewing a 60-minute training session on hands-only CPR in addition to receiving hands-on, small group practice time run by BUSM students. The post survey was administered after the training session. Medical students also completed surveys assessing their comfort in teaching CPR both before and after participation.Related StoriesExperts release scientific statement on predicting survival for cardiac arrest survivorsAn active brain and body associated with reduced risk of dementiaStudy looks at impact of hospital readmissions penalties on targeted surgical conditionsThe high school students reported significant improvements in CPR technique and confidence in acquired skills following their completion of PumpStart. The medical students reported significantly higher confidence levels regarding abilities to answer questions about CPR, serving as mentors and facilitating training sessions for new medical students after participating in PumpStart.”Getting the general public to feel comfortable performing bystander CPR is vital to overall improved survival from cardiac arrest events,” explained Anita Knopov, a fourth-year medical student at BUSM who co-authored the study. “Harnessing educational resources provided by a major urban medical center and offering training to inner-city high school students allows medical students to serve as both educators and mentors within the community, while generating interest for high school youths into a career in the healthcare profession.”Knopov believes PumpStart can serve as a model for other organizations and can have a long-term public heath impact as bystander CPR continues to be a predominant predictor in out of hospital cardiac arrest survival. “Although PumpStart is offered only in Boston, we hope that our work will stimulate the development of similar programs in other regions.”Source: http://www.bmc.org/last_img read more

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New drug for sleeping sickness approved in the Democratic Republic of Congo

first_img Source:https://www.dndi.org/2019/media-centre/press-releases/fexinidazole-sleeping-sickness-approved-democratic-republic-congo/ Reviewed by James Ives, M.Psych. (Editor)Jan 31 2019Marketing authorization of fexinidazole for the treatment of Trypanosoma brucei gambiense human African trypanosomiasis (HAT), more commonly known as sleeping sickness, has been granted in the Democratic Republic of Congo (DRC). This approval paves the way for the distribution of fexinidazole in endemic countries this year, with another submission planned in Uganda.Sleeping sickness is usually fatal without treatment. Transmitted by the bite of a tsetse fly, it causes neuropsychiatric symptoms; including aggression, psychosis, and a debilitating disruption of sleep patterns that have given this neglected disease its name. About 65 million people in sub-Saharan Africa are at risk.”I have a personal connection to sleeping sickness. Growing up in East Africa, my mother was always worried that sleeping sickness would impact us as a family,” says Ameet Nathwani, M.D., Chief Medical Officer and Executive Vice President Sanofi Medical. “The approval of fexinidazole in the Democratic Republic of Congo gives me great hope for our efforts to eliminate sleeping sickness by next year.”The current treatment option for sleeping sickness, while effective, was burdensome for patients and health workers – requiring logistical challenges of hospitalization, especially challenging for people living in remote areas.Fexinidazole is approved in the DRC as a 10-day once-a-day treatment for T.b. gambiense sleeping sickness (the most common form of the disease, found in West and Central Africa). Importantly, fexinidazole is the first all-oral treatment that works both for (i) the early stage of the disease as well as the (ii) second stage of the disease in which the parasites have crossed the blood-brain barrier, causing patients to suffer from neuropsychiatric symptoms. Fexinidazole could, therefore, eliminate the need for patients’ systematic hospitalization.Related StoriesSleep quality and fatigue among women with premature ovarian insufficiencyMore than 936 million people have sleep apnea, ResMed-led analysis revealsTAU’s new Translational Medical Research Center acquires MILabs’ VECTor PET/SPECT/CTOn 16 November 2018, The European Medicines Agency (EMA) adopted a positive scientific opinion of fexinidazole – a result of clinical trials led by the non-profit research and development organization, the Drugs for Neglected Diseases initiative (DNDi), and an application submitted by Sanofi.”We look forward to the implementation of fexinidazole as a first-line treatment and welcome this rapid approval of fexinidazole in the DRC very shortly after the EMA opinion, a testament to the dedication of the DRC Government through the Ministry of Health to eliminate HAT as a public health problem by 2020,” says Dr Nathalie Strub-Wourgaft, Director of Neglected Tropical Diseases at DNDi. “This shows the value of Article 58, an innovative regulatory mechanism intended for the review of new medicines destined for use outside of the European Union.”Sanofi had submitted a regulatory dossier to the EMA under Article 58 of Regulation 726/2004 in December 2017. By allowing for the participation of endemic countries (DRC and Uganda) and of the WHO in the evaluation of the fexinidazole regulatory dossier, approval under Article 58 also facilitates and could accelerate future national product registrations and patient access.last_img read more

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Selfcare techniques should be first line of treatment for patients with facial

first_imgReviewed by James Ives, M.Psych. (Editor)Feb 5 2019NYU Dentistry study also explores treatment differences for those with both TMD and fibromyalgiaWhile oral appliances such as splints and bite guards are the most common treatment for facial pain from temporomandibular disorders (TMD), patients rate them as less helpful than self-care treatments, such as jaw exercises or warm compresses, finds a new study by researchers at NYU College of Dentistry.The study, published in the journal Clinical Oral Investigations, suggests that self-care techniques should be the first line of treatment for muscle-related TMD.TMD (sometimes called TMJ after the temporomandibular joint) is a group of common pain conditions that occur in the jaw joint and surrounding muscles. The muscular condition, called myofascial temporomandibular disorder (mTMD), affects over 10 percent of women. People with TMD often have other pain conditions; research shows that 7 to 18 percent of people with TMD also meet criteria for fibromyalgia, a condition characterized by widespread pain.Dentists and patients use a variety of treatments to manage facial pain, including oral appliances, such as splints and bite guards, pain medications, such as nonsteroidal anti-inflammatory drugs, and self-care techniques, such as jaw exercises and warm compresses.”Oral appliances are a common first-line treatment for TMD, despite mixed research results regarding their benefit. Even when oral splints have been found to have some benefit, they have not been found as effective for patients who also have widespread pain in the treatment of mTMD,” said Vivian Santiago, assistant research scientist in the Department of Oral and Maxillofacial Pathology, Radiology, and Medicine at NYU College of Dentistry and the study’s lead author.In this study, the researchers examined what non-medication treatments women with mTMD use to manage their pain and how effective patients perceive the treatments to be. The researchers examined and interviewed a total of 125 women with mTMD, including 26 who had both mTMD and fibromyalgia, in order to determine whether treatment differed for patients with widespread pain.The most common treatments reported were oral appliances (used by 59 percent of participants), physical therapy (54 percent), and at-home jaw exercises (34 percent). Less common treatments included acupuncture (20 percent), seeing a chiropractor (18 percent), trigger point injection (14 percent), exercise or yoga (7 percent), and meditation or breathing (6 percent). Participants often used more than one treatment (2.4 on average).Related StoriesOpioid overdose deaths on the decline says CDC but the real picture may still be grimSleep quality and fatigue among women with premature ovarian insufficiencyEngineered stem cells offer new treatment for metastatic bone cancerParticipants reported the most improvement in their pain from common self-care activities, including jaw exercises, yoga or exercise, meditation, massage, and warm compresses, with over 84 percent reporting that these activities helped them at least a little. In contrast, only 64 percent of those who used oral appliances–the most popular treatment–reported that they helped at least a little. A small proportion of women who used oral appliances (11 percent) said that oral appliances made their pain worse, an area that warrants further research.”Oral appliances did not outperform self-management care techniques in improving facial pain. Our results support the use of self-management as the first line of treatment for mTMD before considering more expensive interventions,” said Karen Raphael, professor in the Department of Oral and Maxillofacial Pathology, Radiology and Medicine at NYU College of Dentistry and the study’s co-author.The researchers did not find significant differences between the number of treatments reported by women with and without fibromyalgia. While the use of alternative treatments, such as acupuncture and seeing a chiropractor, was reported more frequently among women with fibromyalgia and mTMD, they did not necessarily find more relief. Interestingly, physical therapy was used equally by women with and without fibromyalgia, but self-reported improvement tended to be higher for those with fibromyalgia.”While fibromyalgia is diagnosed by a physician, usually a rheumatologist, TMD is usually diagnosed and treated by a dentist. Our research suggests that dentists should ask patients with facial pain about whether they also have widespread pain, as this could provide more information to help plan their treatment,” said Santiago.”Although clinical trials are critical for understanding treatment efficacy, our study highlights the importance of listening to people suffering with TMD to understand which treatments are the most beneficial,” added Raphael. Source:https://www.nyu.edu/last_img read more

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Bronchiectasis patients often display high sensitivity to airborne allergens

Reviewed by James Ives, M.Psych. (Editor)Apr 4 2019An international research team led by Nanyang Technological University, Singapore (NTU Singapore) has found that patients with the lung disease bronchiectasis also often display sensitivity to airborne allergens, and has highlighted the particular role that fungi appear to play.Their discovery suggests that doctors should examine bronchiectasis patients for a range of allergies, since the treatment for allergies already exists and controlling them could prevent the bronchiectasis from worsening.Bronchiectasis is a chronic disease in which parts of the airways have enlarged, due to irreversible damage to the lungs. Patients find it hard to cough out phlegm and are more prone to bacterial, viral or fungal infection. These complications can be fatal if left untreated, and the disease itself has no effective cure.Led by Assistant Professor Sanjay Haresh Chotirmall from the Lee Kong Chian School of Medicine (LKCMedicine) at NTU, the team included researchers from Tan Tock Seng Hospital, Singapore General Hospital, Changi General Hospital, National University of Singapore, Agency for Science, Technology and Research (A*STAR), National University of Malaysia, and the University of Dundee in Scotland. Their findings were published in the peer-reviewed medical journal American Journal of Respiratory and Critical Care Medicine on 1 April 2019.They assessed fungal infection in over 200 bronchiectasis patients from Singapore, Malaysia and Scotland. While previous bronchiectasis research focused on non-Asian populations, this new study matched patients in Asia (Singapore and Malaysia) to patients in Europe (Scotland) in terms of age, gender and the severity of bronchiectasis.The matching of patients allowed researchers to control the influence of these factors and hence show that the types and causes of allergies associated with bronchiectasis vary across regions.They found that overall, bronchiectasis patients have high allergy rates to fungi and the common house dust mite. The study showed that 58 per cent of bronchiectasis patients were sensitive to at least one allergen, compared to a group of patients with allergic rhinitis (also known as hay fever) where 27 per cent were sensitive.Asst Prof Chotirmall, NTU Provost’s Chair in Molecular Medicine, said, “We have found that bronchiectasis is often associated with allergic reactions to fungi and to the house dust mite. There are already existing treatments for these allergies, for example, steroids are commonly used to treat fungal allergy. Our finding is important for improving the quality of life of those with bronchiectasis, as currently there are no licensed treatments for it.”While there is no data on the prevalence of bronchiectasis in the Singapore population, the disease sometimes coexists with chronic obstructive pulmonary disease (COPD).Published studies elsewhere showed that globally, bronchiectasis among COPD patients can range between 4 per cent and 69 per cent. According to data from Singapore’s Ministry of Health website, COPD ranked 10th among principal causes of death in 2017.Allergies differ across regionsAlthough allergy is well studied in respiratory diseases such as asthma, the link to bronchiectasis has been confined to patients in single locations and in smaller cohort sizes. In addition, while the genetic make-up of bacteria or viruses is well-known, few have looked at the DNA sequencing of the fungal community in bronchiectasis patients, which was performed for the first time by the same group of authors from Singapore and published in the European Respiratory Journal in July 2018.Related StoriesScripps CHAVD wins $129 million NIH grant to advance new HIV vaccine approachElectronic consultations in allergy and immunology may reduce need for specialist visitsNovel method can help clinicians identify individuals most in need of PrEPThe NTU-led study compared over 100 patients each from two regions. Bronchiectasis patients in Singapore and Malaysia showed greater sensitivity to the house dust mite and major allergens of the species Aspergillus fumigatus, while patients from Scotland showed greater sensitivity to the minor allergens of Aspergillus fumigatus. A major allergen refers to a specific protein of the fungus where a detected allergy is more common, and a minor allergen is one where the allergy it causes is less common.Asst Prof Chotirmall said, “It is clear that we need to understand our local diseases better, as our research findings clearly illustrate that Asian patients with bronchiectasis are different to those seen in other countries. By understanding such differences, we can tailor our treatment appropriately.”Associate Professor John Arputhan Abisheganaden, Head of Department, Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, a co-author of both studies, said, “These findings may change the way we treat patients with bronchiectasis. In Tan Tock Seng Hospital, we manage about 30 existing and new cases each week in our clinics. The high prevalence of allergen sensitisation found will help us focus on environmental factors and therapeutic interventions in the appropriate patients. This will also allow us better categorisation of our patients.”An example of intervention, if patients are found to be allergic to the house dust mite, would be to reduce house dust mite in their home, through measures such as using allergen-proof bed covers, or regular vacuuming.Assistant Professor Pamela McShane, who specialises in bronchiectasis research at the University of Chicago and who is not part of either study, said, “Dr. Chotirmall’s research presents a novel approach to elucidating bronchiectasis pathophysiology. The data adds additional dimensions to the traditionally accepted paradigm of acquisition of the disease by revealing allergic mechanisms as a pathway by which patients develop bronchiectasis. Furthermore, it has the potential to provide a basis for new therapies that may be effective in bronchiectasis management.”The research, spanning over 30 months, was funded by a Transition Award from Singapore Ministry of Health’s National Medical Research Council, which Asst Prof Chotirmall received in 2016.The research is also part of The Academic Respiratory Initiative for Pulmonary Health (TARIPH), a research initiative by LKCMedicine with local and international partners that aims to improve the lung health of Singaporeans.The Singapore team members will next look at understanding further differences in Singaporean patients and the environmental factors that affect bronchiectasis. Source:http://news.ntu.edu.sg/pages/newsdetail.aspx?URL=http://news.ntu.edu.sg/news/Pages/NR2019_Apr04.aspx&Guid=57c61170-3dbf-44af-936a-c72885ad5fa6&Category=News+Releases read more

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Research shows how dopamine contributes to sex differences in worms

first_imgApr 16 2019Dopamine is responsible for sex-specific variations in common behaviors, finds a study of worm movements published in JNeurosci. The research demonstrates how the same neurotransmitter can contribute to sex differences, a finding that could have implications for mental disorders. Male and hermaphrodite roundworms (Caenorhabditis elegans) have distinct strategies for finding food and mates. Satoshi Suo and colleagues found the neurotransmitter dopamine has opposite effects on these behaviors that supports each sex’s strategy. Dopamine increases locomotor activity in males, which need to move around to find a mate, while reducing the same activity in hermaphrodites, which can reproduce asexually and may conserve energy by staying in place. The researchers show that dopamine acts through different molecular pathways to give rise to these sex differences.Source: http://www.sfn.org/last_img read more

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A plan to cover immigrants would divert public health dollars

first_img This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente. Reviewed by James Ives, M.Psych. (Editor)May 8 2019California Gov. Gavin Newsom wants the state to provide health coverage to low-income young adults who are in the country illegally, but his plan would siphon public health dollars from several counties battling surging rates of sexually transmitted diseases and, in some cases, measles outbreaks.Public health officials describe the proposed reallocation of state dollars as a well-meaning initiative that nonetheless would have “dire consequences” to core public health services.There have been 764 confirmed cases of measles this year through May 3 in 23 states, including California, the highest number since 1994, the Centers for Disease Control and Prevention reported Monday. State public health officials also are struggling to address record rates of sexually transmitted diseases, with more than 300,000 cases of gonorrhea, chlamydia and syphilis reported in 2017.The reallocation of state money “would exacerbate our already limited capacity to respond to outbreaks and public health emergencies,” said Jeff Brown, director of Placer County’s Health and Human Services Department, which has responded to three measles cases so far this year.California already allows eligible immigrant children up to age 19 to participate in Medi-Cal, the state’s Medicaid program for low-income residents, regardless of their immigration status. The current budget sets aside $365.2 million to pay for the coverage.In his 2019-20 budget plan, Newsom proposes expanding eligibility to unauthorized young adult immigrants from age 19 through 25.His office estimates it would cost nearly $260 million to cover them in 2019-20. While state and federal governments usually share Medicaid costs, California would have to bear the full cost of covering this population.To help pay for it, Newsom proposes to redirect about $63 million in state funds from 39 counties, arguing they would no longer need to provide health benefits to low-income young adults covered by the state.”As the state takes on responsibility for providing health care to undocumented adults, counties’ costs and responsibilities on indigent health care are expected to decrease,” Jenny Nguyen, a budget analyst at the state Department of Finance, told lawmakers at a recent legislative hearing.Under the governor’s 2019-20 budget plan, which requires legislative approval, 35 mostly small and rural counties expect to lose about $45 million in state money that funds health services for uninsured residents, including undocumented immigrants. Those counties — which participate in something called the County Medical Services Program — aren’t expected to feel an immediate financial impact because the program has a budget surplus.But four counties — Placer, Sacramento, Santa Barbara and Stanislaus — would take big and immediate hits to their public health budgets, officials say.The amount of money the governor wants to divert from them to cover unauthorized immigrants under Medi-Cal is far more than the counties now spend on comprehensive health services for those immigrants, local health officials said.Related StoriesLong-acting contraceptives do not increase risk of HIV, concludes new studyIncreasing iron intake does not improve the chances of conceptionIt’s never too late to take up exercise, advise researchers”The idea that these dollars would be offset is just not accurate,” said Mary Ann Lee, managing director of Stanislaus County Health Services Agency, who described the governor’s budget proposal as “alarming.”For example, Stanislaus County estimates it would lose $2.5 million under the governor’s budget plan. When officials studied the population served by their health centers, they found only 18 individuals were young adults who might not have legal immigration status. The total cost to provide care to them: just $1,700 a year.Sacramento County, which reported a 300% increase in syphilis cases in the past four years, would have to shutter its newly opened STD clinic if the county loses an estimated $7.5 million in state funding, Dr. Peter Beilenson, the county Health Services Director, told lawmakers.And while Sacramento County provides primary health care to an estimated 4,000 undocumented immigrant adults, just 100 are ages 19 to 25, and they are the least expensive to cover, Beilenson said.”We agree with the idea behind this, increasing coverage for [those who are] undocumented,” Beilenson said. But losing those funds would force the county to close its STD clinic and terminate some communicable disease investigators “at a time when we now have measles cases in the region and we don’t want to be shutting those services down.”The 40 confirmed cases of measles reported in California as of May 1 include three in Sacramento County.As a result of the reduced funding, Sacramento County also would have to slash health services to its unauthorized immigrant residents — the very people Newsom aims to help — by an estimated 75%, Beilenson added.Whether lawmakers will approve the governor’s proposal is unclear.Several already have expressed concern, including state Assemblywoman Eloise Reyes (D-Grand Terrace), who said, “I think it is clear that this would be terrible for those counties.”Officials with the Department of Finance told lawmakers at the hearing that they were aware of counties’ concerns but that the “governor’s budget stands as it is.”The governor is scheduled to release a revised budget proposal by May 14, before the legislature votes on it this summer.”I hope there will be some reconsideration,” said state Sen. Richard Pan (D-Sacramento), chairman of the Senate Health Committee. “There’s a disconnect there.”This KHN story first published on California Healthline, a service of the California Health Care Foundation.last_img read more

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Exposure to artificial light at bedtime linked with weight gain in women

first_imgCo-author Chandra Jackson, Ph.D., head of the NIEHS Social and Environmental Determinants of Health Equity Group, is interested in racial disparities in sleep health. She notes that for many who live in urban environments, light at night is more common and should be considered. Streetlights, store front neon signs, and other light sources can suppress the sleep hormone melatonin and the natural 24-hour light-dark cycle of circadian rhythms.Related StoriesResearch sheds light on sun-induced DNA damage and repairUsing NMR to Study Protein Structure, Dynamics and MechanismsRetina can restructure itself following gene therapy”Humans are genetically adapted to a natural environment consisting of sunlight during the day and darkness at night,” Jackson said. “Exposure to artificial light at night may alter hormones and other biological processes in ways that raise the risk of health conditions like obesity.”The authors acknowledge that other confounding factors could explain the associations between artificial light at night and weight gain. However, their findings did not change when analyses controlled for characteristics that may be associated with exposure to light at night. These factors included age, having an older spouse or children in the home, race, socioeconomic status, calories consumed, and physical activity. Also, the study did not include men.Lead author Yong-Moon (Mark) Park, M.D., Ph.D., is a postdoctoral fellow in Sandler’s group. He said the research suggests a viable public health strategy to reduce obesity incidence in women.”Unhealthy high-calorie diet and sedentary behaviors have been the most commonly cited factors to explain the continuing rise in obesity,” Park said. “This study highlights the importance of artificial light at night and gives women who sleep with lights or the television on a way to improve their health.”Source:NIH/National Institute of Environmental Health SciencesJournal reference:Jackson, C.L. et al. (2019) Association of Exposure to Artificial Light at Night While Sleeping With Risk of Obesity in Women. JAMA Internal Medicine. doi.org/10.1001/jamainternmed.2019.0571. Reviewed by James Ives, M.Psych. (Editor)Jun 11 2019Sleeping with a television or light on in the room may be a risk factor for gaining weight or developing obesity, according to scientists at the National Institutes of Health. The research, which was published online June 10 in JAMA Internal Medicine, is the first to find an association between any exposure to artificial light at night while sleeping and weight gain in women. The results suggest that cutting off lights at bedtime could reduce women’s chances of becoming obese.The research team used questionnaire data from 43,722 women in the Sister Study, a cohort study that examines risk factors for breast cancer and other diseases. The participants, aged 35-74 years, had no history of cancer or cardiovascular disease and were not shift workers, daytime sleepers, or pregnant when the study began. The study questionnaire asked whether the women slept with no light, a small nightlight, light outside of the room, or a light or television on in the room.The scientists used weight, height, waist and hip circumference, and body mass index measurements taken at baseline, as well as self-reported information on weight at baseline and follow-up five years later. Using this information, the scientists were able to study obesity and weight gain in women exposed to artificial light at night with women who reported sleeping in dark rooms.The results varied with the level of artificial light at night exposure. For example, using a small nightlight was not associated with weight gain, whereas women who slept with a light or television on were 17% more likely to have gained 5 kilograms, approximately 11 pounds, or more over the follow-up period. The association with having light coming from outside the room was more modest.Also, the scientists wondered if not getting enough rest factored into the findings. Although poor sleep by itself was associated with obesity and weight gain, it did not explain the associations between exposure to artificial light while sleeping and weight.”Corresponding author Dale Sandler, Ph.D., chief of the Epidemiology Branch at the National Institute of Environmental Health Sciences (NIEHS), part of NIHlast_img read more

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A beginners guide to better understand curative and transformative therapies

first_imgIn their editorial, Husereau and Reed note several crosscutting themes that will need to be addressed by those in health technology assessment and outcomes research, including payers’ concerns about duration of effect, perceptions of unaffordability, social values, and the desirability and feasibility of performance-based risk-sharing agreements.”At the advent of this new era, we are all beginners,” write the editors. “It is our hope that these articles provide ISPOR members and others with an up-to-date understanding of what we are about to face: what the potential impact of curative therapies might be, whether HTA bodies and payers are ready for them, what aspects of evaluation may need to be modified or expanded, and how we might pay for them.” Source:ISPOR Reviewed by Alina Shrourou, B.Sc. (Editor)Jun 17 2019Value in Health, the official journal of ISPOR, the professional society for health economics and outcomes research, announced today the publication of a series of articles offering important insight regarding the current state of curative and transformative therapies. The special themed section appears in the June 2019 issue of Value in Health. Guest editors for the themed section are Don Husereau, BSc Pharm, MSc, University of Ottawa, Ottawa, ON, Canada, and Shelby D. Reed, RPh, PhD, Duke University, Durham, NC, USA.The themed section commences with an editorial in which Husereau and Reed provide historical perspective and introduce the 8 themed articles in the series:Related StoriesRevolutionary gene replacement surgery restores vision in patients with retinal degenerationSlug serves as ‘command central’ for determining breast stem cell healthExciting study shows how centrioles center the process of cell division Estimating the Clinical Pipeline of Cell and Gene Therapies and Their Potential Economic Impact on the US Healthcare System, by Casey Quinn, et al Are Global Health Systems Ready for Transformative Therapies?, by Eric Faulkner, et al Are Payers Ready, Willing, and Able to Provide Access to New Durable Gene Therapies?, by Jane F. Barlow, Mo Yang, and J. Russell Teagarden Defining and Managing High-Priced Cures: Healthcare Payers’ Opinions, by Kai Yeung, et al New Cost-Effectiveness Methods to Determine Value-Based Prices for Potential Cures: What Are the Options?, by Steven D. Pearson, Daniel A. Ollendorf, and Richard H. Chapman Analytic Considerations in Applying a General Economic Evaluation Reference Case to Gene Therapy, by Michael F. Drummond, et al How Does Treating Chronic Hepatitis C Affect Individuals in Need of Organ Transplants in the United Kingdom?, by Anupam Bapu Jena, et al Uncertainty and Cures: Discontinuation, Irreversibility, and Outcomes-Based Payments: What Is Different About a One-Off Treatment?, by Adrian Towse and Elisabeth Fenwicklast_img read more

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Perspectives on how to communicate to older adults about stopping cancer screening

first_imgReviewed by James Ives, M.Psych. (Editor)Jul 3 2019Over the past decades, the idea that all adults should get regularly screened for cancer — with mammograms, colonoscopies and prostate specific antigen blood tests — has been conveyed to the public time after time. But current clinical guidelines recommend against screening many older adults, such as those with less than 10 years’ life expectancy. For doctors, talking to a patient about the idea that they’ve “aged out” of cancer screening can be a challenging conversation. Schoenborn is also the lead author of the two new papersMammograms, colonoscopies and prostate cancer screening have been credited with preventing cancer-related deaths by detecting cancers before they are advanced enough to cause severe symptoms. One study published online Feb. 11, 2019, for instance, concluded that mammograms have prevented up to 600,000 breast cancer deaths since 1990. But the screening methods also come with a cost; the U.S. health care system spends an estimated $7.8 billion on mammograms each year.Studies have found that cancer screening in adults with limited life expectancy can present unnecessary risks and lead to unnecessary treatments. That’s because the tests may detect slow-growing tumors that aren’t likely to affect an older person’s lifespan. The U.S. Preventive Services Task Force currently recommends routine breast cancer screening for women ages 50-74 and colorectal cancer screening for adults ages 50-75. Above that age, the guidelines suggest that whether screening is beneficial depends on a person’s unique health situation. For prostate cancer screening, the guidelines suggests that whether or not to screen men ages 55-69 should be tailored to a person’s health situation and recommend against screening in other age groups. But how should doctors discuss this with patients when they reach the upper boundaries of routine cancer screening?To better understand this conundrum, Schoenborn and her colleagues interviewed 28 clinicians and 40 older adults, ages 65-92, about their viewpoints on cancer screening discussions. The patients were recruited from four clinical programs associated with Johns Hopkins Bayview Medical Center and were 57.5% female, 62.5% white and had a range of educational levels and life expectancies. The clinicians included physicians, certified registered nurse practitioners and physician assistants who were all associated with Johns Hopkins Community Physicians. Interviews with clinicians were 40-60 minutes long and conducted between January and May 2015; interviews with patients were 30-60 minutes long and conducted in private offices, clinic rooms or patients’ homes between December 2015 and March 2016. All interviews were audio recorded and transcribed.Schoenborn’s group reported that both clinicians and patients thought it was important to frame discussions around stopping cancer screening in terms of risks and benefits. While screening can reveal tumors, it can also lead to complications from screening — such as colon perforations during a colonoscopy — and to risks and side effects from follow-up tests and treatment — such as the infection, fatigue and bleeding associated with chemotherapy. Cancer diagnosis may also lead to diverted attention from other health priorities, increased psychological stress and a financial burden on patients.Related StoriesNew protein target for deadly ovarian cancerSugary drinks linked to cancer finds studyTrends in colonoscopy rates not aligned with increase in early onset colorectal cancerPatients and clinicians also agreed that patients should play an active role in making the decision to stop screening. Clinicians tended to worry that patients might perceive the recommendation to stop screening in a negative light and that it would make patients angry. However, patients mostly responded that if they trusted their clinician, they would not think negatively of them for initiating the conversation.”I hope that’s reassuring for doctors,” says Schoenborn. “And makes them a little bit more comfortable going into these conversations.”While clinicians almost unanimously reported that they didn’t bring up life expectancy in the context of stopping cancer screening, older adults were split on the idea — some wanted to hear about life expectancy, others thought it was acceptable not to bring it up and a third group was actively against it. We’d like to continue to look in a larger population at preferred phrases to use in these discussions. There are still some challenges for clinicians learning how to talk about these things and we want to encourage discussion.”Nancy Schoenborn In an effort to learn more about which physicians might be prescribing later-in-life screening, Schoenborn and her team turned to breast cancer screening and mammography. A commonly held belief was that specialists tend to order more screening mammograms than primary care clinicians. But, in the Journal of General Internal Medicine paper, Schoenborn and her team report that the type of doctor did not make a difference in whether a doctor continued to prescribe mammograms for patients past the life expectancy recommendation. They did find that internal medicine, family medicine and obstetrics/gynecologic specialists were the most common prescribers of mammograms to patients regardless of life expectancy.Understanding which doctors are ordering mammograms in women who may not benefit from the screening tests can help researchers determine who to target with education, says Schoenborn.For their study, Schoenborn and her colleagues used previously published data from the 2011 National Health and Aging Trends Study (NHATS) to identify 2,041 women age 65 and over who had no history of breast cancer to ask how many continued to have mammograms despite having limited life expectancy. Of the women in the study, 86% were white, 7.1% black and 3.9% Hispanic. Medicare data linked to NHATS let the researchers identify which patients had a mammogram in the 24 months following the NHATS survey and who had ordered that mammogram — a clinician in family medicine, internal medicine, other primary care, obstetrics and gynecology, or other specialties such as radiology or cardiology. The researchers calculated life expectancy using a previously validated life expectancy prediction model. They grouped patients into those with greater than 10 years’ life expectancy and fewer than 10 years’ life expectancy.Among the 2,140 women, 48.0% received a screening mammogram during the study period, with a screening rate of 60.2% for women with a life expectancy of more than 10 years and 27.0% for women with a shorter life expectancy. The most common clinician specialties who referred women to get mammograms were internal medicine, family medicine, and obstetrics/gynecology. There was no significant difference in who referred mammograms for women with shorter versus longer life expectancies.”If we already have a curriculum on communicating with patients about stopping cancer screening, then it’s not that much added cost to disseminate that to specialists as well as primary care providers,” she says. Source:Johns Hopkins MedicineJournal reference:Schoenborn, N. et al. (2019) Who Orders Screening Mammograms in Older Women with Limited Life Expectancy?. Journal of General Internal Medicine. doi.org/10.1007/s11606-019-05044-0 Now, to better inform these conversations, Johns Hopkins researchers have studied the perspectives of both clinicians and older adults on how to communicate about stopping cancer screening. The results of this study were published in the June 2019 issue of The Gerontologist. In a separate study, other Johns Hopkins researchers also show that primary care doctors and specialists are equally likely to continue to order mammograms in women with less than 10 years’ life expectancy. Results of this study were published in the May 14 issue of the Journal of General Internal Medicine. As we gain more scientific evidence, cancer screening is shifting to be more tailored to an individual, and for the elderly that means don’t screen if the patient really won’t benefit from it,” says . “These new findings help us learn how we can better support clinicians and improve patient care when it comes to personalizing cancer screening.”Nancy Schoenborn, M.D., Associate Professor of Medicine, Johns Hopkins University School of Medicine Credit: Getty Imageslast_img read more

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Kale to go Amazon to roll out delivery at Whole Foods

Target buys same-day delivery service for $550 mn In this Aug. 28, 2017 file photo, a sign at a Whole Foods Market greets shoppers in Tampa, Fla. The online retailing giant plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. The move is the latest by Amazon to put its stamp on its recent purchase of Whole Foods. (AP Photo/Chris O’Meara, File) © 2018 The Associated Press. All rights reserved. Amazon Prime Now bags full of groceries are loaded for delivery by a part-time worker outside a Whole Foods store, Thursday, Feb. 8, 2018, in Cincinnati. Amazon, which owns Whole Foods, plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. Amazon.com Inc. said deliveries started Thursday in Austin, Texas; Cincinnati; Dallas; and Virginia Beach, Va. (AP Photo/John Minchillo) For Amazon, items will be pulled from Whole Foods stores, bagged and then delivered by Amazon drivers. Amazon, based in Seattle, said there’s no extra fee for two-hour deliveries above $35, but one-hour delivery will cost $8. The company isn’t saying where delivery will expand, but its Prime Now service is in more than 30 cities, including Chicago, Milwaukee and San Diego. In this Aug. 28, 2017, file photo, customers shop at a Whole Foods Market in Tampa, Fla. Amazon plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. Amazon.com Inc. said deliveries will start Thursday, Feb. 8, 2018, in Austin, Texas; Cincinnati; Dallas; and Virginia Beach, Va. The service will expand nationwide this year. (AP Photo/Chris O’Meara, File) “I like to get it myself,” she said outside a Whole Foods store. She worries about the possible mishaps: “Maybe the bananas are bruised or the cookies are all broken up, and you can’t really complain because you asked for it.”About 7 percent of U.S. households bought groceries online last year, according to NPD Group. Most of those—about three-quarters—get their orders delivered to their door; the rest pick it up at the store. NPD Group said it expects online grocery shopping to grow quickly, especially among young adults, who are more comfortable shopping online.And grocery chains don’t want to miss out when that happens.Walmart, the country’s largest grocer, is making it easier for customers to order groceries online and pick them up at the store. Target bought grocery-delivery company Shipt late last year. Kroger, the largest traditional supermarket chain, has been promoting store pickup for online orders and doing trials of home delivery. Explore further In this Nov. 9, 2017, file photo, Laila Ummelaila, left, a personal shopper at the Walmart store in Old Bridge, N.J., helps customer Vicky Soler verify her order at an online shopping pickup location. Amazon plans to roll out two-hour delivery at Whole Foods this year to those who pay for Amazon’s $99-a-year Prime membership. Rival grocers have been preparing for the day Amazon would expand Whole Foods grocery delivery. Walmart expanded its online ordering and store pickup service. (AP Photo/Julio Cortez, File) The online retail giant plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. It is the company’s biggest move since it bought the organic grocer last year.It’s also precisely the action rivals have been preparing for since the day Amazon—with the Prime program that’s been so successful in cementing customer loyalty—announced plans to buy Whole Foods.Amazon shoppers can order meat, seafood and other Whole Foods grocery items through the Prime Now app and website. Deliveries started Thursday in Austin, Texas; Cincinnati; Dallas; and Virginia Beach, Virginia; and will expand nationwide this year.One of the biggest hurdles for the growth of grocery delivery is that many people want to pick out their own eggs or fruit, said Darren Seifer, a food and beverage industry analyst at NPD Group.”There are always going to be people who want their bananas a little green,” he said.Ade Ogbomo, a teacher in Dallas, said she orders everything from Amazon—except food. A sign promoting the Amazon Prime Now delivery service is displayed outside a Whole Foods store, Thursday, Feb. 8, 2018, in Cincinnati. Amazon, which owns Whole Foods, plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. Amazon.com Inc. said deliveries started Thursday in Austin, Texas; Cincinnati; Dallas; and Virginia Beach, Va. (AP Photo/John Minchillo) The announcement gives Amazon yet another way to get groceries to customer’s doorsteps.It already does so through AmazonFresh, but that requires a $15-a-month fee. And Prime Now delivers groceries from its facilities, but it has also offered grocery delivery from other physical stores, including Whole Foods rival Sprouts Farmers Market.Whole Foods also offers delivery in some cities through a partnership with delivery service Instacart, which will continue.Buying Whole Foods was the biggest part of a push into physical retail for the chain known for online shopping. Right after taking over Whole Foods, Amazon made a splash by cutting prices on bananas, yogurt and other items. It also began selling Kindle e-readers in some of its 470 stores, and started selling Whole Foods-branded food on its site. This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only. Amazon Prime Now bags full of groceries are loaded for delivery by a part-time worker outside a Whole Foods store, Thursday, Feb. 8, 2018, in Cincinnati. Amazon, which owns Whole Foods, plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. Amazon.com Inc. said deliveries started Thursday in Austin, Texas; Cincinnati; Dallas; and Virginia Beach, Va. (AP Photo/John Minchillo) In this Aug. 28, 2017 file photo, a sign at a Whole Foods Market greets shoppers in Tampa, Fla. The online retailing giant plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. The move is the latest by Amazon to put its stamp on its recent purchase of Whole Foods. (AP Photo/Chris O’Meara, File) Amazon is bringing its speedy delivery to Whole Foods. Citation: Kale to go: Amazon to roll out delivery at Whole Foods (2018, February 8) retrieved 18 July 2019 from https://phys.org/news/2018-02-kale-amazon-delivery-foods.html Amazon Prime Now bags full of groceries are loaded for delivery by a part-time worker outside a Whole Foods store, Thursday, Feb. 8, 2018, in Cincinnati. Amazon, which owns Whole Foods, plans to roll out two-hour delivery at the organic grocer this year to those who pay for Amazon’s $99-a-year Prime membership. Amazon.com Inc. said deliveries started Thursday in Austin, Texas; Cincinnati; Dallas; and Virginia Beach, Va. (AP Photo/John Minchillo) read more

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Panel endorses bills for online sales tax special session

first_imgSouth Dakota would start collecting sales taxes from many out-of-state internet retailers this fall under a bill the Legislature’s budget-writing committee endorsed Tuesday ahead of this week’s special legislative session to implement a U.S. Supreme Court ruling that cleared the way for the changes. This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only. Explore further Citation: Panel endorses bills for online sales tax special session (2018, September 12) retrieved 17 July 2019 from https://phys.org/news/2018-09-panel-endorses-bills-online-sales.html South Dakota court rejects law aimed at online sales taxes © 2018 The Associated Press. All rights reserved. Lawmakers gather Wednesday at the Capitol for the special session to consider Gov. Dennis Daugaard’s legislation, which would allow the collections to start Nov. 1. A second bill the panel recommended would require marketplaces that handle payments such as eBay to collect sales taxes for sellers on their platforms.”After working with the Department of Revenue and consulting with legislative leaders, I am proposing two bills that will allow the state of South Dakota to benefit from the national tax fairness victory that we led,” Daugaard said in an earlier statement announcing the measures.It was a South Dakota case that led to the U.S. Supreme Court’s decision in June to overturn two decades-old high court decisions that have made it tougher for states to collect sales taxes for certain purchases online. But even after the victory, South Dakota hasn’t been able to enforce its online sales tax requirement because of an injunction in place under state law.That injunction would be lifted under the proposal allowing the state to start collecting the sales taxes, with the companies involved in the state’s case exempted as court proceedings continue.Members of the Legislature’s Interim Joint Committee on Appropriations convened Tuesday to discuss the legislation, endorsing the first unanimously and the second on a 15-3 vote. Republican Sen. Deb Peters urged support of the measure allowing the taxes to be collected, called Senate Bill 1, saying it’s time to “get moving and going forward.””Senate Bill 1 is … ‘Hooray we won, oh my gosh, now what do we do?'” Peters said.The sales tax obligation applies to sellers outside the state who do more than $100,000 of business in South Dakota or more than 200 transactions annually with state residents under a law passed in 2016.South Dakota has estimated it loses about $50 million annually to e-commerce. But any future sales tax windfall isn’t likely to result in major new state spending, because current state law aims to give gains from the new collections back to taxpayers.The governor has said the special session won’t address a provision in state law that requires a 2016 sales tax hike for teacher pay be scaled back if the state is able to collect tax on the online purchases. Under the law, the state’s 4.5 percent rate is to be rolled back by one-tenth of a percent for every additional $20 million the state reaps, with a floor of 4 percent.Decisions on changing or maintaining that law will fall to a new governor and set of state lawmakers after Daugaard leaves office in January 2019.Lawmakers at this week’s special session are also set to debate an unrelated third bill on the timing of the new governor’s inauguration in January. The proceedings will include an address from Daugaard to legislators during the joint session.The state’s last special session was held in 2017 to create rules governing the use of lakes on private land for recreation.last_img read more