StemCell Therapy

For those who dont know, integrative medicine is the blending of conventional medicine with complementary or alternative medicine.

Essentially, an integrative treatment is one that utilizes traditional drugs and surgery in combination with other holistic therapies such as Ayurveda, homeopathy, acupuncture, yoga, meditation and massages.

This medical practice doesnt just remedy a patients disease or pain. It also dives deeply into the patients physical, emotional, spiritual and pathophysiological wellness.

Integrative medicine is preventative and curative, just like conventional medicine, but it also brings forth a dimension of healing that conventional medicine and alternative medicine simply cant reach on their own.

It is understandable why people tend to be skeptical about alternative medicine. After all, the scientific evidence proving the legitimacy of alternative treatments is just beginning to roll out.

Additionally, alternative medical treatments are known to take much longer to work than conventional treatments. This is because every health issue is dealt with at its root by promoting lifestyle changes, emotional/spiritual wellness therapies and natural (non-lab-made) medication. Therefore, alternative medicine is not the best option in emergency situations.

On the other side, alternative medicine patients do receive personal attention and tailored treatment plans to heal not only their ailments but also their body and mind.

Patients often feel long-term betterment due to the fact that they are given the lifestyle tools to promote further healing. Alternative medicine patients also tend to suffer less from the side effects of their medication.

Last but not least, alternative medicine is much more affordable than conventional medicine.

On the other hand, conventional medicine is widely accepted throughout the world, especially in western societies. There is a lot of scientific evidence proving the effectiveness of conventional medicine.

It is especially great in emergency situations and can be helpful if a patient wants to treat an illness and its symptoms quickly.

Unfortunately, conventional medicine does fall short since treatment is often localized to where the disease or pain is rather than treating a patient on the whole.

In these ways, conventional medicine might not be the best in cases of chronic pain and illness.

Alternative medicine and conventional medicine both have drawbacks and benefits, but together they make an incredible treatment plan.

Where one falls short the other pulls through and vice versa. The best example is a cancer patient.

Telling a cancer patient to only take natural medication and to practice yoga to rid themselves of the cancer is impractical.

Telling a cancer patient to go through chemotherapy without accounting for other facets of their wellness is also impractical.

A patient should go through chemo while also focusing on alternative medicine treatments such as inflammatory food avoidance.

As time passes, studies increasingly show that there is a strong connection between mind and body when it comes to illness.

For example, studies have demonstrated that depression is a risk factor for heart disease.

The mind and body affect one another, so a successful, sustainable treatment would address mind-body related health issues along with physical issues.

For example, studies show that Cognitive Behavioral Therapy in combination with highly active antiretroviral therapy is a great combination to treat HIV-positive men.

In this treatment, both mind and body are looked after to foster the long-term healing of HIV-positive men.

While alternative medicine works best for some people, and conventional medicine works better for others, it is the gap that integrative medicine bridges that truly promotes sustainable and successful health and wellness.

Original post:
Choose integrative medicine for health and wellness - Technique

When victims of rape or sexual violence seek emergency medical assistance following an attack, they may be saddled with hundreds or even thousands of dollars in medical bills, a new study published this week in the New England Journal of Medicine found.

These bills can further traumatize victims, the study authors warn, and deter others from seeking professional help. Only one-fifth of sexual violence victims are estimated to seek medical care following an attack.

Researchers affiliated with Harvard analyzed a nationwide data set of more than 35 million emergency room visits in 2019, the most recent year such information was available. They looked specifically at visits where doctors billed with codes related to care after sexual assault, and found more than 112,000 such patients. Nearly 90 percent of those patients were female, and 38 percent were children under 18.

When victims of sexual violence go to the ER, there are two kinds of care theyd typically receive. The first is a sexual assault forensic exam, or more colloquially, a rape kit. Thats where a medical professional collects evidence from a victim, such as conducting a pelvic, rectal, or throat exam, taking samples for a DNA test, and looking for semen or any other evidence of violent injury.

Under the Violence Against Women Act (VAWA) of 1994, the costs associated with a forensic exam are paid for with public funds, and while survivors are sometimes erroneously billed, the federal law prohibits charging victims for the cost of their evidence collection.

But VAWA does not cover the second category of care and thats therapeutic care, or whatever is medically necessary for a persons health following an attack.

So for instance, doctors frequently give victims preventative medication for STDs, like antibiotics to prevent syphilis, gonorrhea, or HIV medication if thats a possibility, said Stephanie Woolhandler, one of the lead authors of the study. ER physicians may also provide emergency contraception to victims if pregnancy is a concern, and in other cases victims may have vaginal or rectal lacerations that need to be sewn up, other injuries, or broken bones.

The researchers findings on the costs of such care are sobering. Uninsured victims, who numbered over 17,000 in 2019, faced out-of-pocket charges averaging $3,673.

For all the roughly 112,800 patients seen for sexual assault who visited the ER that year, charges averaged $3,551, with even higher averages for pregnant patients ($4,553). Insured patients had lower out-of-pocket bills, but how much lower depends on the structure of their insurance plan. Prior research suggests that even those with private insurance paid about 14 percent of their bill on average, roughly $500. That can be an enormous sum of money given that a disproportionate share of sexual assault victims are low-income women and girls, Woolhandler told Vox.

The findings, published less than three months following the Supreme Courts overturn of Roe v. Wade, come as states move to restrict not only access to abortion but other basic sexual health care treatments, like emergency contraception and drugs used to manage miscarriages.

Samuel Dickman, an abortion provider and lead study author, told Vox that when he used to provide care in Texas (he relocated to Montana in May), he personally encountered patients who came in following sexual attacks who were then vulnerable to catastrophic medical bills. Texas has the highest uninsured rate in the country, and this research is a start towards quantifying that vulnerability, he said.

The vulnerability isnt limited to the uninsured, though. Dickman recalls one of his former patients who had been raped and became pregnant, and was seeking an abortion. She was on Medicaid, and under the Hyde Amendment, rape victims should have had that procedure covered but Texas has made it so hard that we were looking at charging this victim more than $1,000 out of pocket, he said. Those charges were just shocking to her, and on top of having just been raped, frankly, it was haunting.

The study authors are urging policies that ensure affordable access to all essential medical services including abortion and emergency contraception for survivors of rape, and for everyone else who needs that care, said Dickman.

One option they suggest in their paper to help survivors of sexual violence would be to expand VAWA to cover therapeutic services, not just evidence collection. Woolhandler told Vox that that would be a step in the right direction but that ultimately more comprehensive reform, including universal health care coverage, is needed to eliminate barriers.

Sexual health care is health care and we, like other developed nations, ought to be making all health care free at the time of use, Woolhandler added. In a post-Roe world, an unwanted pregnancy can mean an unwanted childbirth, and so the government has the power to force you as someone with a vagina to bear all the consequences of your attack, not just a $500 or $3,000 medical charge, but you have to also bear this child. Its frankly outrageous.

Paying greater attention to privacy concerns of survivors, the study authors urge, is also paramount to ensuring victims feel they can seek the care they need. Emergency department charges may discourage the reporting of rape and seeking of medical care for both short-term and long-term sequelae of sexual assault, the NEJM study states. Incurring such charges may further harm survivors even those with full insurance coverage by serving to disclose a potentially stigmatizing event to parents, partners, or employers.

Dickman said theres no reason we couldnt have a system where every individual has their own insurance card that entitles them to private care. Ive seen insured patients say theyll pay for their care out of pocket even if that means theyll have to skip rent or groceries, because they cant have that kind of disclosure to their family or employer about abortion or sexual assault, he said. If youre a minor seeking emergency room care, theres a good chance the primary insurance policy holder will be getting a list of what services you received, and very plausibly, that person could be the person who committed the assault.

Woolhandler said some of the privacy concerns stem from private insurance, because insurers are entitled to know what procedures were done and diagnoses made. Part of the thing with single-payer is hospitals dont send bills, she said. In Canada, hospitals get a lump sum that they use to pay all their operations; presumably, theres a record at the hospital about who you are and your [medical] record, but it doesnt have to leave the hospital.

We need to not tie people to their jobs or their family members in terms of medical care, added Dickman. Its just a crazy way to structure a system.

See more here:
The high hospital bills we make victims of rape and sexual violence pay - Vox.com

Before you apply yet another anti-aging cream, serum, or other product, stop right there you could be using it all wrong. Many people are unknowingly applying some of the most effective ingredients to their skin all wrong. As a result, they are wasting both precious time and money on products that could be effective if used correctly. From sunscreen tips to retinol mistakes, these are the anti-aging products skincare experts say youre using all wrong.

For starters, you are probably not applying sunscreen daily, which means youre missing out on opportunities to protect your skin from the damaging, aging effects of UV light, whether its July or December.

Preventative care is the most important step inanti-aging, says Dr. Adrienne OConnell, medical director and president ofLaguna Beach Aesthetics. You must wear sunscreen that protects against both UVA and UVB rays (broad spectrum) with an SPF 30 or higher every single day, no matter the weather. I highly recommend a 100% mineral sunscreen, which is much safer for sensitive skin and contains no added chemicals.

The second most misused product is Retinol, according to Dr. OConnell.As the ultimate go-to skincare ingredient for a younger look, retinol speeds up your cell turnover so your body can replace damaged surface cells with brighter, younger skin cells, Dr. OConnell says.More is not better when it comes to this product. It can over-dry or irritate your skin.It is also dangerous to use in the morning because it makes your skin more sensitive to sunlight.

If you choose to use a Retinol product, Dr. OConnell says it is best used at night and washed off in the morning.You also must apply sunscreen in the morning as an added precaution, Dr. OConnell says.Also, start slow.Use the product once a week and gradually increase until you are using it according to the products instructions and never use more than the instructions direct you to.

Often, people buy the products they see on TV or are advertised by a favorite celebrity without caution, warns Dr. Nadir Qazi, DO, a board-certified physician, cosmetic dermatology surgeon, and owner ofQazi Clinic. Then when you look at the ingredient list it can contain ingredients known to cause harm to skin instead. For example, a product may contain retinol to combat wrinkles, Dr. Qazi says. However, if that same product contains a coconut oil derivative like Coco-Caprylate, the product might slow wrinkling but clog the pores and cause acne.Or they may only put a small amount of active ingredients in the product. Suppose an under-eye cream advertises vitamin C as its main active ingredient. Then, using a name like sodium ascorbate, they put it at the bottom of the ingredients list. All the while, that product uses silica as a main ingredient and filler to smooth the appearance of under-eye circles while using the product without treating them.

Thats why Dr. Qazi says its imperative to look at ingredients and do your own research on whether a product can be harmful or beneficial.

Exfoliation is wonderful it makes the skin fresh and rejuvenated, Dr. Qazi says. It feels so nice and vibrant that people are often tempted to exfoliate more often than they should, and with products that do more harm than good.

Over-exfoliation makes the skin sensitive and inflamed, and the skin can begin to flake and peel away, Dr. Qazi says. In addition, as skin becomes dehydrated from over-exfoliating, collagen breaks down, which causes the skin to lose its firmness and elasticity, creating wrinkles.

To maintain a youthful glow, chemical exfoliants are a good substitute for the abrasive scrubs one might have used growing up, Dr. Qazi says. Look for alpha-hydroxy acids like glycolic and mandelic acids. These acids exfoliate efficiently, and it is easy to find lower concentrations or limit how often you use them to avoid over-exfoliation. Mandelic acid can be especially beneficial for sensitive skin as it has a larger molecular structure and is very gentle as an exfoliant.

It isnt enough to own a bathroom medicine cabinets worth of expensive anti-aging skincare products. Learning which ones you could be using wrong is key to getting healthier, more glowy skin at any age.

Read more:
4 Anti-Aging Products Youre Using All Wrong, According To Skincare Experts - SheFinds

Dr. Ron Moody, Chief Medical Officer, Accenture Federal Services

For an industry that traditionally embraces change at a glacial pace, the pandemic has been a wake-up call for healthcare. Once COVID-19 struck, the shift to video, telephone engagement and remote patient monitoring spiked seemingly overnight.

This surging demand for virtual care resulted, in many cases, in increased provider efficiency, provider-patient interactions, and satisfaction. One national telehealth organization covering 2,000 hospitals and 81,000 doctors, for example, experienced an 86% decrease in time needed to complete the patient onboarding process, and 92% of providers said they expect to continue video visits post-pandemic. Access also improved a Johns Hopkins University study found that Medicare beneficiaries in poor neighborhoods increased their use of telemedicine during the pandemic.

In short, weve learned that virtual care is scalable, trusted, adaptable, and even preferable for many patients and clinicians alike.

No time to rest

But this isnt the time for the industry to go back to the old way of doing business. Healthcare organizations should leverage lessons learned from the pandemic to create fundamental change. That means shifting away from reactive medicine to proactive and preventative care, wellness, population health, and better support for chronic conditions.

We need to think differently because, frankly, incremental change around the same ideas hasnt worked. A recent studyby the Commonwealth Fund found that, despite spending far more of its gross domestic product on health care than 10 other high-income nations, the U.S. ranked last in access to care, administrative efficiency, equity, and healthcare outcomes.

Transforming the healthcare system wont be easy. Structural hurdles such as regulatory constraints and legacy payment models, as well as simple inertia, have conspired to block the path forward. Too often, providers are incentivized to provide direct, in-office care instead of using the best mode available to address a patients specific needs.

Federal agencies: catalysts of change

Federal healthcare providers, such as the Veterans Health Administration (VHA), Defense Health Agency, and Indian Health Service are uniquely positioned to lead this transformation. These agencies serve a large portion of the U.S. population and are dedicated to patient-centered, evidence-based care. Importantly, their financial models are different from those of commercial healthcare providers, enabling them to disrupt the status quo.

Because these federal agencies operate largely as integrated healthcare systems, they can more readily implement policy and procedural changes as well as the enabling technology which can minimize and manage potential disruption, while achieving improved outcomes.

Furthermore, they can more quickly capture cost savings and other efficiencies for reinvestment to expand adoption and improve care quality and convenience. Most agencies have already been making significant investments in virtual care.

VHA leads the way

Consider the VHA, for example. It is the largest integrated health care system in the U.S., providing care at nearly 1,300 health care facilities and more than 1,100 outpatient clinics, serving 9 million enrolled veterans each year. VHAs Connected Care program has been a pioneer and innovator in using video visits at scale, conducting more than 750,000 virtual visits per month in 2021.

Because they have laid the groundwork for virtual care, the VHA and other federal agencies will be able to accomplish more by tying those investments to a broader model we call Virtual First a strategic framework for transforming patient experiences and outcomes using data-driven innovation.

Reimagined approach

A Virtual First approach uses remote, digital engagement as the default care delivery method whenever appropriate to improve patient and provider experiences, reduce costs and improve outcomes.

It does not, of course, replace todays in-person ambulatory and critical care services. Rather, it complements, enhances, and where appropriate, replaces traditional in-person care. A Virtual First strategy matches the means of care delivery to the case, factoring in the specific patient, his or her condition, the urgency, and the needed staff.

Virtual First provides new opportunities for clinicians to consult with patients regularly and outside of traditional care settings. It allows for more effective monitoring and interventions. A providers ability to impact patient health is no longer bound by the limited time spent interacting with patients in medical offices, nor is it constrained by a lack of data.

Private sector innovation

Besides the federal healthcare providers cited above, private sector health organizations have also pioneered patient-centric models driven by technology.

A recent Harvard Business Review article The Telehealth Era Is Just Beginning, describes how two of the earliest telehealth adopters Kaiser Permanente and Intermountain Healthcare leverage sophisticated technology to improve access to care, deliver care more efficiently, and reduce unnecessary emergency room visits.

Kaiser members in some states can access a round-the-clock video health center connecting them with telehealth doctors who resolve the issue 60% of the time, thereby avoiding a costly trip to the ER. The doctor can also schedule an appointment with the members personal physician if follow-up care is needed and provide details of the patients issue before the appointment.

Similarly, using remote home monitoring technology and a telemedicine program during the pandemic, Intermountain avoided more than 1,800 hospital admissions and saved almost 4,800 hospital bed-days, which freed up beds for the sickest patients.

A word of caution

Virtual care has demonstrated its ability to serve as a catalyst and enabler for much-needed improvements of the healthcare system.

However, simply using it as an alternate way to deliver the same type of care wont change outcomes drastically. It will not address the growing doctor and nursing shortage. It may provide another avenue of convenient health access, but it will be yet another innovation that falls short of its promise unless it is accompanied by a true outcomes-based, patient-centric strategy, enabled by technology and data.

About Dr. Ron Moody

Dr. Ron Moody is currently the Chief Medical Officer at Accenture Federal Services. He is a retired Army Colonel who served in the military for more than two decades. Dr. Moody is board-certified in family medicine with a broad background in medicine, clinical operations, Healthcare administration, strategic planning, and health information technology.

Read the original:
Why Now is the Time to Double Down on Virtual Care - HIT Consultant

What are your thoughts about the clips going viral showing the newest King needing someone to clear his desk so he could sign some ridiculously sized documents? His facial expressions and gestures were a distasteful sight.

G: After my surprise at seeing what at first looked like an inelegant way to solve a problem, the thing that came to mind is wondering if this were a fake video intended to undermine his reign.

As is often the case when I receive a forwarded email or video that indicates some type of outlandish statement, claim or factoid, I do what they teach on Sesame Street when the kiddlings dont know something: I look it up.

Sometimes I resort to the major news outlets first, sometimes I resort to Snopes.com.

When I looked up the video, sure nuf, its real. Unfortunately, all too real.

The next thought was perhaps the organizers had overlooked that the way too-small desk would be a problem for King Charles. But perhaps they were too busy focusing on the bigger stuff like that of arranging a pageant funeral of grotesque proportions and extravagance to attend to that rather small detail which ended up presenting the King in quite unfavorable stead with his subjects.

This affords the opportunity to consider how we regard any of those who are in our lives that help to make our day-to-day reality function more smoothly. And I am not talking about personal aides or butlers.

I am talking about the electrician, the plumbers, the auto mechanics, the lawn service workers, the flight attendants, the nurses/docs/orderlies/caregivers, the garbage truck driver, the school teacher, the grocery clerk, housekeepers, the dry cleaner, the plow driver, the street cop, the emergency rescue teams, the beauticians and barbers, the carpet cleaners, the car service drivers, the newspaper-magazine-mail-package delivery folks, the customer service worker bees, etc. You get the idea.

I am also talking about our closest loved ones family, neighbors or friends who are there for us for every catastrophe or errand that require us, sometimes at the most inconvenient moments, to have to lean on them.

I am not talking about needing someone to move an ink well to make room for outrageously comically-sized state documents that need a performance signature.

I learned of a caregiver who has been used to receiving $20 an hour for her attentive duty to elderly people, some close to death, others needing home care as they age out of being able to tend to themselves.

Her latest employment opportunity only offered $15 an hour. She decided to take the job on the condition that she be reevaluated in a couple of weeks to see if it was a good fit for everyone, and if so, she had expected the pay would go to $20 an hour.

Its been about two years and she is still earning only $15 an hour.

Why?

Because she is unwilling to quit the job if she doesnt get more money. She is resentful of her employer, yet because she loves the person she is caring for and wants the best for them, and because she is a pure heart of compassion, she endures.

And so it may also be with that aide to the monarchy, who was being hand-fanned by King Charles in the most deprecating, slight-of-hand gesture, to set right the space on his wee tiny desk so he could put his signature on some gigantic sized paper.

Perhaps that monarchy aide is also feeling mistreated, underpaid, disrespected.

But perhaps not.

Or not enough to quit over this or any other incident that fails to regard their service as worthy of more dignity.

And so it is with many of the people we choose to employ, that we not only owe a fair wage to them that can be honestly regarded as a living wage, but also owe them the decency of respect and gratitude for the work they perform on our behalf.

My hope is as these video clips circumnavigate the realms of the commonwealth, as the Brits are wont to say, that new emphasis is placed upon our common humanity and the need for kindness and an equanimity of consideration as we all go about our duties.

Who knows how long that particular monarchy will endure.

What is more certain is the younglins who have been taught better are not going to put up with this or any kind of hierarchical abuse for too much longer.

* * *

Follow up to last weeks column about preventative medicine and cancer screenings.

This from a most thankful reader of TELL GISELLE: My father had colon cancer at age 57, so I appreciated your mention of the need for periodic colonoscopy. Lives could be saved if more people did this.

It is so true.

But persuading people, especially those close to us, to get screenings is sometimes a real challenge. People like to believe they dont need them or that they are the exception to the rule.

Not.

Go schedule those screenings and help yourself to a greater quality of life.

Youll also help keep the cost of your health care, and others insurance, down. Getting a cancer diagnosis is not only traumatic, the treatments are not cheap and can bankrupt families.

And, as to my dear friend waiting on the uterine tumor biopsy. Sadly, it is cancer. Even though the surgeon thinks they got it all she will begin preventative chemotherapy and radiation treatments as this type of cancer likes to come back elsewhere she was told.

Email Giselle with your question at [emailprotected] or send mail: Giselle Massi, P.O. Box 991, Evergreen, CO 80437. For more info and to read previous columns, go to http://www.gisellemassi.com

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Tell Giselle: The price of good help is priceless - Wilkes Barre Times-Leader

- APONVIE is the first and only intravenous (IV) formulation of a substance P/neurokinin-1 (NK1) receptor antagonist indicatedfor PONV -

- Delivered via a single 30-second IV injection, APONVIE has demonstrated rapid achievement of therapeutic drug levels ideally suited for the surgical setting -

SAN DIEGO, Sept. 16, 2022 /PRNewswire/ --Heron Therapeutics Inc. (NASDAQ: HRTX), a commercial-stage biotechnology company focused on improving the lives of patients by developing best-in-class treatments to address some of the most important unmet patient needs, today announced that the U.S. Food and Drug Administration (FDA) has approved APONVIE (aprepitant) injectable emulsion, for intravenous use for the prevention of postoperative nausea and vomiting (PONV) in adults.

APONVIE is the first and only IV formulation of aprepitant for PONV prevention. Administered via a single 30-second IV injection, APONVIE reaches drug levels associated with 97% receptor occupancy in the brain within five minutes and maintains therapeutic plasma concentrations for at least 48 hours. APONVIE is provided in a single-dose vial that delivers the full 32 mg dose approved for PONV. This ready-to-use, easy to administer, innovative IV formulation ensures rapid and consistent exposure in patients undergoing surgery.

An important component of the FDA approval of APONVIE were results from two multicenter, randomized, double-blind clinical studies comparing oral aprepitant to current standard of care, IV ondansetron, for the prevention of PONV in patients during the 48 hours following open abdominal surgery demonstrating that aprepitant was more effective than ondansetron in preventing vomiting. Treatment with aprepitant resulted in approximately 50% fewer patients vomiting in the first 24 and 48 hours compared to ondansetron. In clinical studies, APONVIE was well-tolerated and presented a safety profile comparable to oral aprepitant.

In a 2020 Cochrane meta-analysis, aprepitant was ranked as the most effective drug approved for PONV prophylaxis, being the most effective for the prevention of vomiting in the first 24 hours post-surgery and the drug with the fewest adverse events.

"With the approval of APONVIE our acute care portfolio now addresses the two most common concerns of patients and clinicians after surgery, postoperative pain and postoperative nausea and vomiting. This marks an important milestone for our expanding acute care portfolio and is a testament to our ongoing commitment to developing innovative solutions to help improve the overall patient experience after surgery," said Barry Quart, Pharm.D., Chairman and Chief Executive Officer of Heron. "With approximately 36 million procedures in the U.S. each year in patients with high to moderate risk for PONV, the approval of APONVIE provides an easy to use, highly effective option for these patients that fits seamlessly into our acute care franchise."

PONV are common adverse effects of anesthesia and surgery, with an estimated 30 percent of patients receiving general anesthesia and up to 80 percent of high-risk patients experiencing these symptoms, necessitating more effective preventative agents. PONV is a major cause of patient dissatisfaction after surgery, with patients frequently ranking vomiting as the most undesirable outcome of anesthesia. Additionally, PONV presents a significant risk in outpatient surgeries as patients are often discharged within hours after surgery and no longer have access to highly effective antiemetics.

"PONV is commonly experienced after surgery and may result in increased hospital stays, prolonged recovery time, and decreased patient satisfaction" said Ashraf Habib, MBBCh, MSc, MHSc, FRCA, Chief, Division of Women's Anesthesia at Duke University Hospital. "Oral aprepitant has been used to prevent postoperative nausea and vomiting for more than 16 years and it is exciting to see that, with the approval of APONVIE, physicians can now offer patients a more convenient IV injection that delivers the same effective treatment, with a 48-hour duration of effect, in a rapid, consistent and reliable way, ensuring a better experience for patients postoperatively."

Conference Call and Webcast

Heron will host a conference call and webcast on September 19, 2022 at 8:30 a.m. ET. The conference call can be accessed by dialing 646-307-1963 for domestic callers and 800-715-9871 for international callers. Please provide the operator with the passcode 4538096 to join the conference call. The conference call will also be available via webcast under the Investor Relations section of Heron's website at http://www.herontx.com. An archive of the teleconference and webcast will also be made available on Heron's website for 60 days following the call.

Important Safety Information

APONVIE should not be used:

APONVIE may cause serious side effects. Tell your doctor or nurse right away if you have any of these signs or symptoms of an allergic reaction:

APONVIE may affect how other medicines work. Other medicines may affect how APONVIE works. Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, or herbal supplements. If you take the blood-thinner medicine warfarin, your doctor may do blood tests after you receive APONVIE to check your blood clotting.

Women who use birth control medicines containing hormones to prevent pregnancy (birth control pills, skin patches, implants, and certain IUDs) should also use back-up methods of birth control (such as condoms and spermicides) for 1 month after receiving APONVIE.

Before you receive APONVIE, tell your doctor if you are pregnant or plan to become pregnant. APONVIE contains alcohol and may harm your unborn baby.

Before you receive APONVIE, tell your doctor if you are breast-feeding or plan to breastfeed because it is likely APONVIE passes into your milk, and it is not known if it can harm your baby. You and your doctor should decide if you will receive APONVIE, if breast-feeding.

The most common side effects of APONVIE are constipation, low blood pressure, tiredness, and headache.

Talk to your healthcare provider for medical advice about side effects. Report side effects to Heron at 1-844-437-6611 or to FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch.

The information provided here is not comprehensive. Please see full Prescribing Information.

About APONVIE for PONV

APONVIE (aprepitant) injectable emulsion is a substance P/neurokinin-1 (NK1) receptor antagonist, indicated for the prevention of postoperative nausea and vomiting (PONV) in adults. Delivered via a 30-second intravenous (IV) injection, APONVIE 32 mg was demonstrated to be bioequivalent to oral aprepitant 40 mg with rapid achievement of therapeutic drug levels. APONVIE is the same formulation as Heron's approved CINVANTI (aprepitant) injectable emulsion formulation for prevention of chemotherapy-induced nausea and vomiting (CINV). APONVIE is supplied in a single-dose vial that delivers the full 32 mg dose for PONV. APONVIE was approved by the U.S. Food and Drug Administration (FDA) in September 2022.

About Heron Therapeutics, Inc.

Heron Therapeutics, Inc. is a commercial-stage biotechnology company focused on improving the lives of patients by developing best-in-class treatments to address some of the most important unmet patient needs. Our advanced science, patented technologies, and innovative approach to drug discovery and development have allowed us to create and commercialize a portfolio of products that aim to advance the standard-of-care for acute care and oncology patients. For more information, visit http://www.herontx.com.

Forward-looking Statements

This news release contains "forward-looking statements" as defined by the Private Securities Litigation Reform Act of 1995. Heron cautions readers that forward-looking statements are based on management's expectations and assumptions as of the date of this news release and are subject to certain risks and uncertainties that could cause actual results to differ materially, including, but not limited to, the timing of the commercial launch of APONVIE; the potential market opportunity for APONVIE; the extent of the impact of the ongoing COVID-19 pandemic on our business; and other risks and uncertainties identified in the Company's filings with the U.S. Securities and Exchange Commission. Forward-looking statements reflect our analysis only on their stated date, and Heron takes no obligation to update or revise these statements except as may be required by law.

Investor Relations and Media Contact:

David SzekeresExecutive Vice President, Chief Operating OfficerHeron Therapeutics, Inc.dszekeres@herontx.com858-251-4447

View original content:https://www.prnewswire.com/news-releases/heron-therapeutics-announces-us-fda-approval-of-aponvie-htx-019-for-the-prevention-of-postoperative-nausea-and-vomiting-ponv-301626450.html

SOURCE Heron Therapeutics, Inc.

Read more:
Heron Therapeutics Announces U.S. FDA Approval of APONVIE (HTX-019) for the Prevention of Postoperative Nausea and Vomiting (PONV) - BioSpace

Pickleball is Americas favorite emerging recreational sport at the moment. The game that was first developed on Washingtons Bainbridge Island in 1965 is taking the country by storm for its ease of access, fun, quick action, and social attraction.

Whats lost in the hype, however, is that the sport is leading to numerous injuries. An analysis of pickleball-related injuries using data from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission found the annual estimated number of injuries rising precipitously from 2013 to 2017.

Even though the court is much smaller, and requires much less ground to cover, numbers show that pickleball-related emergency room visits are quickly catching up tennis-related traumas, especially for seniors. Using data from 2001 to 2019 (as reported by the NEISS), analysts found a weighted total of 28,984 pickleball injuries as compared with 58,836 tennis injuries.

Although pickleball-related injuries have many similarities with those associated with other racquet sports, there were various differences (e.g., increasing trend and older patient age) that may need to be considered for the prevention and management of injuries related to the sport, concluded the article.

This was especially true for seniors as 85% of medical stresses occurred in people over 60. Still, all players risk any number of athletic impairments including ankle sprains, muscle strains, tendon pulls/tears, shoulder problems, rotator cuff injuries, and lower back problems such as disc injuries and strains.

No need to stress, though. The Manual is here with a guide on how to prevent devastating pickleball injuries.

Any sport that you play, youre going to want to support that condition with cross-training. The United States Office of Disease Prevention and Health Promotion recommends 150 minutes of moderate-intensity aerobic physical activity per week. High-impact cardiovascular exercise includes running, jogging, and sports like basketball, or skiing. While these will work wonders for physical shape, they can be hard on limbs and joints. Lower impact activities such as biking, elliptical machines, pool walking, or swimming can promote fitness with less destructive contact with the ground and other bodies.

Sleep is key to mental and physical recovery.

The ODPHPs Physical Activity Guidelines note that moderate to vigorous activity improves the quality of sleep in adults.

You break your body down with activity, which leads to improved physical conditioning and a mental calm that encourages healthy, healing sleep. Its a beautiful system.

For optimal health, the American Academy of Sleep Medicine and Sleep Research contends that adults should get at least seven hours of sleep. This varies, of course, from person to person and according to the sleepers age, but the body will rest as it should as long as you keep a regular schedule of proper diet and exercise. In turn, youll be actively promoting quicker recovery, better blood flow, and improved focus, all from under the covers.

Warming up is an obvious preventative step. At the same time, it can be a big pain in the butt.

Everybody remembers those half-hearted first 10 minutes of gym class and/or practice, lackadaisically limbering body parts before the real play could begin. Dedicate yourself to active stretching, and you can flip that half-assed practice and not only help avert injury, but improve performance.

Elite movement coaches have found increased athletic achievement in concert with fewer injuries with targeted, non-repetitive, and dynamic stretching before, during, and after workouts. Straining muscles by elongating instead of flexing will have the same effect: youll get better movement and stronger, more defined musculature.

In turn, this can level up your pickleball game. A broad 2010 comprehensive analysis found that warming-up enhanced athletic execution in 79 percent of the criteria examined over several studies.

Core muscles your abs, inner and outer obliques, the diaphragm on top, and pelvic floor on the bottom stabilize your body as you bend, stretch, jump, and leap toward, say, yellow Wiffle balls on the pickleball court. It stands to reason that the more control you have over your extremities, the better shape your body is going to be in at the end of the activity.

Stabilizer, mobilizer, and load transfer core muscles assist in understanding injury risk, assessing core muscle function, and developing injury prevention programs, a National Library of Medicine paper concluded. Moderate evidence of alterations in core muscle recruitment and injury risk exists. Exercise programs to improve core stability should focus on muscle activation, neuromuscular control, static stabilization, and dynamic stability.

Similar to stretching, core workouts not only can help you prevent a strained back or pulled hamstring, but they can also boost your athletic capacity.

Whacking a plastic ball with a short, wood and graphite paddle might seem easy enough to do without practice, but that repetitive, chaotic motion can take a serious toll, especially if youre not doing it right.

Tennis elbow tendinitis that flares up when you dont warm and swing your arm correctly can affect pickleball players just as much as their hardcourt brethren. Seeing as tennis elbow can linger for six to 12 months, this is a common injury youre going to want to avoid. Knowing how to properly swing your paddle is key. For new players, break into the sport easily. Its no fun waking up with sore elbow tendons that could signal stepping away from the sport for a half or full year.

Mount Sinai Hospitals orthopedic department suggests balanc(ing) your body weight without over-extending your arms, legs, or your back. Use proper footwork to help you avoid injuries to the ankle and the Achilles tendon. Play with the proper equipment for your size and ability.

Pickleball, like any sport, can be a blast. Competition fires adrenaline, endorphins, testosterone, and other critical hormones. Whats good for the body is just as good for the mind. Theres no reason to get too excited, though. Youve got a lifetime to smack balls around. Make sure that youre prepared and on point to not only prevent injury, but give the game the best you got.

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Pickleball injuries are on the rise: 5 preventive tips to keep you on the court - The Manual

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Congrats to Elizabeth Ralph, our fearless leader here at Women Rule, for being named editor of POLITICO Magazine this week! Shes our second woman editorafter founding editor Susan B. Glasserand Im so excited to see what she does with the place. Thanks to Maya Parthasarathy for your help finding and curating these interesting articles below!

On Thursday, POLITICO held its regular Women Rule: The Exchange meeting to discuss pressing issues concerning women and communities. In panels, small group discussions and interviews, we touched on everything from involving more young people in movement-building to getting more women to run for office to gender and racial inequities in health, and we also heard from White House Gender Policy Council Director Jennifer Klein and Georgia gubernatorial candidate Stacy Abrams. (Well share more from those interviews next week.) Join us next time if you can. Here were some of the takeaways from Thursday.

How to get more young people into organizing: Many separate discussions came back to one question: How do we get young people on board with movement-building?

Young people are asking more from companies and employers, one participant said she had found. It is important for them to know a companys values.They dont want nice volunteerism anymore, the participant said. A company has to demonstrate its making progress toward corporate social responsibility goals, the participant continued.

Other participants discussed how, in their experience, a lot of young people see working in politics as a little bit dirty, or unethical, or ineffective, as one participant said. The task for others, she continued, is convincing young people that theres still power in making those decisions from inside.

Participants in one discussion were also asked what the next big social movement would be. A few answers: Refugee rights, racial equity and higher education reform.

How can technology be a better tool in social movements? I heard several times throughout the day from women who felt that technology is a useful tool, but that it could also be ineffective and shallow. Some efforts to incorporate technology more have led organizations at times to focus on vanity metrics, or how many impressions or likes posts get on social media, said one participant

Another participant in a roundtable discussion said too much of the action that technology drives on advocacy was shallow action, without real substance. Instead of just a static programmatic ad, can you have someone watch a video, and that unlocks a donation, and your company is giving out real money to a cause the person cares about? she asked.

How to get more women into the C-suite: One executive wanted to know how to get more women into the top roles of her company and asked others how to help. She outlined a story from her company where two senior employees one woman and one man had a difficult task to complete. The man eventually went to a company leader to ask for help; the woman didnt, explaining that she didnt want that leader, who was male, to think of her as incompetent. The man, who had forged a better relationship with this key company leader as a result of this collaboration and completed his task more quickly, ultimately benefited from this challenge; the woman, who did not complete the task as quickly, did not.

This story made the executive who was outlining this story at the event yesterday understand that mentorship is key to whether women advance, or dont, at a company.

She asked the other participants: How can her company encourage more such relationships for women? Some suggested formalizing the relationships with mentoring programs. Interestingly, others wondered if the organization leader, in her story, had set the proper tone for engaging with lower-level employees, pointing out that such relationships can only flourish under certain cultures. How are you creating a culture across the board that embraces things like asking questions? one participant asked. That participant pointed out that representation often flows from culture, rather than the other way around.

Has corporate social responsibility reached a high-water mark? During one discussion about boosting social impact at companies, one participant asked about the lack of progress on climate and the blowback in states to companies environmental, social and governance investments. She asked if the general push for companies to invest in meeting corporate social responsibility goals had peaked. If you look at the full picture, for sure, the needle is moving very slowly. But it comes back to building a new muscle, one participant answered. A lot of the folks whove been at these companies have never heard of these things before. Theres going to be a lag, across the board, understanding what it [corporate social responsibility] is.

BOOK RECOMMENDATIONS We also asked our business and impact leaders for recommendations, and they had some interesting books in particular to share. Here are their picks:

Regenerative Leadership by Giles Hutchins and Laura Storm; The Confidence Code: The Science and Art of Self-AssuranceWhat Women Should Know by Katty Kay and Claire Shipman; The Great Believers by Rebecca Makkai; The Night Watchman by Louise Erdrich; The Gap and the Gain: The High Achievers Guide to Happiness, Confidence, and Success by Dan Sullivan and Dr. Benjamin Hardy; Deep Purpose: The Heart and Soul of High-Performance Companies by Ranjay Gulati

AP Photo/Rogelio V. Solis

A New Approach to Domestic Violence, by Joanne Kenen for Politico Magazine: Keisha Walcott started slipping through the cracks as a baby.

Separated from her mother in Jamaica and brought to the United States as an infant, Walcott was exposed to sexual abuse, sexual trauma, hospitalizations and so on and so forth, she says, from the start. She lived with her father, but it was a chaotic life. At age nine, she required surgery after a particularly violent sexual assault by a close family friend. Looking back, shes not really surprised that she got into one damaging relationship after another as a teen, then as an adult.

One day, about six years ago, she looked in the mirror and saw a stranger. I was asking the person in the mirror, Who are you? I dont know you, recalled Walcott, now 44.

That moment began her multiyear path toward escape, safety, independence and self-respect. She eventually left her husband and went to a womens shelter, which helped her enroll in a job training program. A lawyer helped her address her immigration status, enabling her to work legally. The lawyer also connected her with a health care clinic that would change her life.

Walcott went to see Anita Ravi, who runs an unusual clinic dedicated to treating women who have endured intimate partner violence, sexual assault and human trafficking. At her clinic, PurpLE Family Health, in New York City the name stands for Purpose: Listen and Engage Ravi treats these patients immediate medical needs, connects them to a network of social and behavioral health services that can help them get out these relationships if they want or need to, or help them reduce the harm if they decide to stay. All the care is free, paid for by the PurpLE Health Foundation, which Ravi also started.

Domestic violence has long been thought of as a criminal justice problem. Health care was there to patch up the wounds, maybe provide some mental health support, maybe dispense some information about shelters. But Ravis clinic is part of a growing albeit unofficial network of clinics and medical centers that are recognizing they have a crucial role to play in identifying, treating and ultimately reducing domestic violence.

Poll: Americans say politicians aren't informed enough to set abortion policy, by Elena Schneider for POLITICO: As Republicans in state capitals and Washington race to enact new restrictions on abortion following the fall of Roe v. Wade, a new poll shows that Americans have a message for lawmakers: Slow down and learn.

Seven in 10 Americans dont think politicians are informed enough about abortion to create fair policies a position held by majorities of both Democrats and Republicans, according tothe survey of more than 20,000 adults by The 19th, a news organization focused on gender and politics, and SurveyMonkey. A majority of Americans also said they think abortion should be legal in all or most cases, while 35 percent said abortion should be illegal in all or most cases.

The data sheds new light on a top issue for both parties in the final weeks ahead of the November election. By overturning Roe v. Wade, the U.S. Supreme Court sent the power to determine abortion policy back to the states, triggering new abortion restrictions across the country and juicing interest in the midterm elections among Democrats and women more broadly. Abortion has shot up as a key issue among voters, and it has partially fueled an improved outlook for Democrats in November.

Republican Graham introduces bill that would restrict abortions nationwide, by Alice Miranda Ollstein for POLITICO Graham's abortion ban stuns Senate GOP, by Burgess Everett, Marianne LeVine and Sarah Ferris for POLITICO GOP pollster warns party on total abortion bans, by Elena Schneider for POLITICO

Read more here.

Rape victims can face huge hospital bills if they seek help, by Rachel M. Cohen for Vox: When victims of rape or sexual violence seek emergency medical assistance following an attack, they may be saddled with hundreds or even thousands of dollars in medical bills, a new study published this week in the New England Journal of Medicine found.

These bills can further traumatize victims, the study authors warn, and deter others from seeking professional help. Only one-fifth of sexual violence victims are estimated to seek medical care following an attack.

Researchers affiliated with Harvard analyzed a nationwide data set of more than 35 million emergency room visits in 2019, the most recent year such information was available. They looked specifically at visits where doctors billed with codes related to care after sexual assault, and found more than 112,000 such patients. Nearly 90 percent of those patients were female, and 38 percent were children under 18.

When victims of sexual violence go to the ER, there are two kinds of care theyd typically receive. The first is a sexual assault forensic exam, or more colloquially, a rape kit. Thats where a medical professional collects evidence from a victim, such as conducting a pelvic, rectal, or throat exam, taking samples for a DNA test, and looking for semen or any other evidence of violent injury.

Under the Violence Against Women Act (VAWA) of 1994, the costs associated with a forensic exam are paid for with public funds, and while survivors are sometimes erroneously billed, the federal law prohibits charging victims for the cost of their evidence collection.

But VAWA does not cover the second category of care and thats therapeutic care, or whatever is medically necessary for a persons health following an attack.

So for instance, doctors frequently give victims preventative medication for STDs, like antibiotics to prevent syphilis, gonorrhea, or HIV medication if thats a possibility, said Stephanie Woolhandler, one of the lead authors of the study. ER physicians may also provide emergency contraception to victims if pregnancy is a concern, and in other cases victims may have vaginal or rectal lacerations that need to be sewn up, other injuries, or broken bones.

The researchers findings on the costs of such care are sobering. Uninsured victims, who numbered over 17,000 in 2019, faced out-of-pocket charges averaging $3,673.

What Happened After I Quit: Five women reflect on the financial fallout of their own Great Resignation, a year later, by Charlotte Cowles for the Cut

Op-Ed: Why the lack of diversity in drug industry leadership is hurting women and people of color, by Lindsay Androski for the Los Angeles Times: Dr. Lynn Seely, the female chief executive officer of Myovant, a biopharmaceutical company that develops new treatments for womens diseases, was speaking about chronic pelvic pain and painful periods associated with endometriosis. As many as 10% of women between age 15 and 45 experience it, and many of them miss school or work because of debilitating pain. Yet treatments often end with the removal of the uterus, ending hopes of childbearing.

Why, Seely asked, had pharma not developed a better treatment that didnt involve infertility?

Silence ensued.

She kept going, saying she could see the discomfort visible on the faces of many of the male leaders in this room because she was talking about womens periods and pelvic pain. Then she dropped the hammer: That is why this health problem hasnt been solved.

Her point? A lack of diversity in healthcare leadership is directly related to the lack of progress on womens health challenges.

From 'Dreamgirls' to 'Abbott Elementary,' Sheryl Lee Ralph forged her own path, by Terry Gross for NPR

Sponsored by Business Leader members of Women Rule: The Exchange:

As inflation rates soar and disruptions to the global supply chain persist, all eyes are on the nations economic recovery. But getting back on track in an inclusive and sustainable way is no easy feat. POLITICO Focus connected with members of Women Rule: The Exchange to learn about the strategies and solutions that will power an economy that benefits all. Join the Conversation.

Read more here.

Jennifer Griffin will be chief national security correspondent at Fox News. She previously was national security correspondent. More from The Hollywood Reporter Sarah Matthews is now a senior adviser with Merrimack Potomac + Charles. She previously was comms director for the House Select Committee on the Climate Crisis Republicans and is a Trump White House alum. (h/t Playbook)

Theresa Bradley is now a speechwriter for the White House. She most recently was a freelance writer and is a Biden campaign alum. Anna Chu has been hired as executive director of We The Action. She most recently was VP for strategy and policy at the National Womens Law Center. (h/t Playbook)

Jessica Medeiros Garrison has been named president of the Land Betterment Exchange and LBX Carbon Offsets. She most recently was VP of government affairs at Clearview AI. Natalie Armijo is now a strategist with Federal Street Strategies. She most recently was a senior adviser to New Mexico Gov. Michelle Lujan Grisham Cecilia Narrett is now a development associate at the Physicians Committee for Responsible Medicine. She most recently was a humane educator at Farm Sanctuary. (h/t Playbook)

Sponsored by Business Leader members of Women Rule: The Exchange:

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The next big social movement and other takeaways from our regular meeting - POLITICO

Delicious, medicinal, psychedelic, or sometimes deadly, mushrooms are equal parts fascinating and mysterious. Mushrooms and their mycelium still elude us, but weve become regular mycophiles in all aspects. The days of only finding white button, cremini, and portabello mushrooms at the grocery store are over. Its not unusual to find fresh shiitakes or oyster mushrooms among them and the farmers market brings even more varieties.

If youve ever read a recipe that uses mushrooms, you might have come across advice that you should never wash them because they absorb water. Instead, many cookbooks advise you to clean them with a damp cloth. But, the cooking magazine Cooks Illustrated advises washing them with water. While there is some absorption, the amount is negligible.

There are just over 2,000 species of edible mushroom species. This guide doesnt cover all of them, but we selected some of the most common types that youll find in the grocery store or farmers market.

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If youre familiar with only one kind of mushroom, its probably white button, or Agaricus bisporus. White button mushrooms are a type of gilled mushroom and they are actually the same as creminis and portabellaswhich well get to belowbut they are harvested at an earlier stage during their growth cycle.

White button mushrooms are practically flavorless in their raw state, but they shine when theyre used as an addition to a dish. Slice them up for a hearty vegan stew or dice them up and add them to a plant-based bolognese for a meaty texture. They are also a good addition to tofu scrambles. If you want to enjoy white button mushrooms in a purer form, slice them, then saut them in oil or dairy-free butter with minced garlic and fresh, chopped parsley.

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Also known as baby bella mushrooms, cremini mushrooms are Agaricus bisporus harvested later in their growth cycle. Due to this, they have a deeper, more savory flavor than white button mushrooms and are better suited to eating raw in salads. But, if youre an umami fiend, then cook them the same way that you would cook white button mushrooms. They can also be stuffed with a variety of fillings, such as vegan crab and dairy-free cream cheese.

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Noticeably bigger than the younger Agaricus bisporus, portabello mushrooms have a heartiness to their flavor that might make shroom-haters shirk. Its common to remove their stems and just cook the caps, either marinated or plain. They are versatile, so if a recipe calls for white buttons or creminis, you can use portabellos.

Portabellos are great stuffed, like in these spinach and mashed potato-stuffed mushrooms. But, they are also a classic veggie burger ingredienteither using the whole cap or dicing and mixing it with other ingredients such as legumes and grains to form a patty.

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Shiitake mushroomsLentinula edodesare small brown mushrooms native to East Asia that are traditionally cultivated on logs. Now available worldwide, modern shiitake mushrooms are usually grown in controlled conditions, either on logs or in an artificial substrate.

These mushrooms, which are available fresh or dried, have a deep umami flavor and can be used in a wide variety of dishes, from hot pots and stir-frys to pasta sauces and vegan BLT sandwiches. Their woody stems are typically removed before they are cooked. If youre using dried shiitake mushrooms, save the cooking liquid as a soup stockyou can do the same with the raw stems. Always ensure that shiitake mushrooms are cooked thoroughly. Theyre known to cause a rash when eaten raw or undercooked.

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Also known as hen of the woods or Grifola frondosa, maitake mushroomswhich is Japanese for dancing mushroomshave a golden brown color and grow in delicate, ruffled conks. They are polypore mushrooms, meaning they inhabit live or dead trees. Polypores help the wood rot and play a critical role in forest ecosystems.

Maitake are best when young, as they become tough and woody when left to age. They can be baked, battered and fried, sauted, grilled, or cooked and used as toppings, either on pizza or on a buttery crostini for a dinner party or a night in with loved ones.

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A staple of farmers markets, oyster mushrooms (Pleurotus ostreatus) are distinct from king oysters, which well get to below. These gilled mushrooms are usually white or light tan and the shelves grow in overlapping, round clusters. In the wild, these mushrooms grow on decaying trees in temperate and subtropical forests. They can even decompose plastic! Oyster mushrooms are commonly foraged, but most of the ones youll find are cultivated.

Oyster mushrooms turn slimy when cooked in a lot of liquid, so theyre not suited for soup or stew, but otherwise, they can be grilled, sauted, or friedespecially when coated with a crispy batter. They make an especially great substitute for seafood, either in a buttery linguine dish with fresh parsley or in a sandwich, like this oyster mushroom poboy.

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Flammulina velutipes, or enoki mushrooms, grow in clusters with long, slender white stems and a small pin-cushion tip. Their flavor is mild and not particularly noteworthy, but they have a pleasantly chewy texture that makes them suited to sauteing, grilling, braising, and adding to hot pots, noodle soups, and sundubu jjigae (Korean soft spicy soft tofu stew). They are also fantastic in warm, mixed mushroom salads.

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Wildly different-looking from oyster mushrooms, king oyster mushroomsalso known as king trumpet, French horn mushrooms, or Pleurotus eryngiihave thin brown caps and thick white stalks that give them a tree-like silhouette. They have a meaty, chewy texture that makes them the go-to shroom when replacing meat or seafood. The mushrooms can be cut vertically into thin slices to make vegan bacon or the stalks can be cut into coins to make a substitute for scallops. But, king oysters can also take sauting, frying, braising, grilling, as well as being cooked in soups, stews, and sauces.

Casarsa Guru

PorciniItalian for pigletmushrooms have round brown caps and thick white stalks that grow at the base of trees. The earthy, nutty Boletus edulis is prized in Italian and French cuisine, so they are especially good in both cuisines, be it pasta, risottos, hearty soups like minestrone, and mushroom gravies. They are usually available in fresh or dried varieties. As with shiitakes, dried porcini mushrooms are typically used to elevate the flavor of stews.

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One of the holy grails of mushroom foraging, the morel mushroom, or Morchella, is light tan in color with a conical, honeycomb-like cap. It is actually more closely related to truffles than they are to mushrooms. This charismatic fungi sprouts from moist soil in forests between the months of March and May. This short harvesting period means that they can be fairly expensive at $20 per pound when theyre in season.

These luxury mushrooms have a savory flavor when cooked and they add depth to any dish. Theyre suited to most forms of cooking but because theyre so pricey and distinctive, you might want to use them in a way that showcases the whole fungus.

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The lovely chanterelle, genus Cantharellus, is the golden child of the mushroom-foraging world. These funnel-shaped woodland mushrooms are commonly found near hardwood trees, with which they share a strong mycorrhizal (symbiotic) relationship. Theyre also really delicious. Chanterelles emit a fruity aroma and have a peppery bite to them with notes of apricot, some say.

Chanterelles are best in simple dishes where their flavor wont be outshined. Try cooking them with gnocchi in a dairy-free garlic butter sauce with salt, pepper, fresh parsley, or thyme, and a squeeze of lemon. When you cook them, the mushrooms become tender, but maintain some firmness.

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Also known as Hypsizygus tessellatus, or beech mushrooms due to how they grow from dead or dying beech trees, shimeji mushrooms are native to East Asia. These edible fungi have long, thin stems and small caps. They come in white or brown varieties. As with the mushrooms from the Agaricus bisporus family, the latter has a more obvious flavor.

These mushrooms have a somewhat crunchy texture with a mild, nutty flavor when cooked. They are good in hot pots, rice bowls, soups, and stir-frys.

Stieglitz4

Hericium erinaceus, the lions mane mushroom, is a big, white mushroom made up of long, thin strands that resemble the eponymous big cats name. Practitioners of Chinese traditional medicine have used this tree-borne fungus for centuries. Lions mane mushrooms contain substances that stimulate the growth of brain cells, and studies show they may improve cognitive function and reduce symptoms of anxiety and depression.

When cooked, this mushroom is said to taste similar to crab or lobster meat. So, its best browned in a little bit of olive oil with salt, pepper, and minimal seasoning.

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Wood ear mushrooms, also known by their scientific classification, Auricularia heimuer, are a crinkly type of fungus with a color that ranges from light to dark brown. The wild variety grows on deciduous trees, but is also cultivated for commercial purposes on sawdust logs.

Popular in Chinese cuisine, they have a gelatinous texture and mild flavor. Typically, they are sold dried and must be rehydrated before cooking. Use wood ear mushrooms in hot pots, soups, and stir-frys.

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The coveted chicken of the woods mushroom (Laetiporus sulphureus) is easily spotted by its overlapping goldenrod-colored shelves, ruffled edges, and large size. Foragers can find these saprotrophic (feeds on dead trees), parasitic mushrooms at the base of dead or dying hardwood trees. They grow in North America and Europe and there are seven varieties in the former.

Chicken of the woods gets its name from its flavor, which people say is reminiscent of chicken meat and lemon. In vegan cooking, you could use it to replace chicken in chicken piccata or saut it in olive oil and add it to a pasta dish, like this angel hair pasta with dairy-free feta, kale, and lemon.

This list is just a snippet of the flavors and textures of the edible fungus world. Youre likely to find rare varieties at the farmers market. If you do, ask the seller how best to cook them.

For more on vegan cooking, read:5 Meaty Swaps That Arent Vegan MeatThe Comprehensive Guide to Vegan Butter10 High-Protein Vegan Recipes

Kat Smith is a Queens, NY-based freelance writer and editor who loves cooking and discovering local vegan hidden gems.

Original post:
15 Mushrooms and How to Use Them in Vegan Cooking - VegNews

Introduction

Cancer is among the leading causes of death globally, accounting for nearly 10 million deaths in the year 2020, or nearly one in six deaths (Ref. WHO, 2022). Globally, nearly 300,000 children aged 017 are diagnosed with cancer every year.1 Chemotherapy has been reported to be efficient for such conditions.2 One of the potential limitations for chemotherapy drugs is that they do not only act on malignant cells but also on normal cells,3 which may lead to oral mucositis (OM), especially in paediatric patients. In severe cases, OM development can increase mortality by almost 40%.4 The OM is an acute inflammation of the oral mucosa with haemorrhage, erythema and edema.5 The development of such inflammatory conditions is higher (up to 4580%) in paediatric cancer patients compared to adult cancer patients.4 Moreover, children have differed from adults in relation to compliance, acceptance, and reaction to various preventive agents6 due to their compromised immune system. These conditions are dose-limiting, and high-cost effectiveness, which may result in undermining the ideal cancer treatment plan for patients, and ultimately decreasing the chances of survival.7 Keeping in mind, the facts management of OM in children is particularly critical. OM conditions are treated with some mucosal coating agents, analgesia, and cryotherapy in adult patients; nevertheless, paediatric patients have a limited choice.8 Nevertheless, cryotherapy was previously indicated to be performed only on older and cooperative pediatric patients.9 Honey has attracted the attention of medical care in the past decades because of its tissue healing, antibacterial and antioxidant properties,10 and has been shown to be an acceptable traditional medicine (Natural Product) globally.11 Based on the present knowledge, honey is efficiently used to treat chemotherapy-induced OM.12 Honey comprises ~200 substances, including water and carbohydrates, along with other vitamins and enzymes.13,14 Previous studies have indicated that honey enhances tissue healing (conditions: wound, burn, surgical site and ulcer) by stimulating monocytes, which helps to release cytokines.15,16 The inclusion of honey or its products could be optional for chemotherapy-induced OM in cancer patients.17 Several studies reported that conventional honey, including natural honey and commercially available marketed honey, could be effective only for chemotherapy-induced OM but also on radiation- and chemoradiation-induced OM.13,1719 In contrast, although evidences have demonstrated that Manuka honey has healing properties, four published studies reported on Manuka honey have shown negative results on prophylaxis and treatment of OM.1821 The reasons for this negative effect remain uncertain, and it may be because that Manuka honey contains unusually high content of methylglyoxal, which is considered a cytotoxic agent.22 Moreover, the intervention for OM requires high compliance; however, the peculiar taste of Manuka honey, which is bitter taste and lower water content, could be likely the reason for a high dropout rate (57.4%) in the trial conducted by Hawley et al.20 Given the lack of intervention for prophylaxis and treatment of OM in children, this report highlights proven evidences of honey in paediatric care to prevent and treat chemotherapy-induced OM. Summarizing pieces of evidence for paediatric clinical practice and the use of honey may open avenues for further studies in this field.

In this study, we selected published studies based on oral care with honey or honey products in the treatment and prophylaxis of chemotherapy-induced OM in child patients. We included randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) of honey or honey products that treat or prevent chemotherapy-induced OM in paediatric patients.

For searching English literature, we used the following keywords: honey, stomatitis, oral mucositis, oral ulcer, child, paediatric, pediatric, adolescent, and chemotherapy. We used the CINAHL, CENTRAL, EMBASE, and MEDLINE PubMed as our healthcare search databases from April 2010 to April 2020. Data were analyzed using GraphPad PRISMA-8 California, USA. Thus, the present review included a 27-item checklist, which was performed to assess the quality of included studies, which were described earlier.23 The checklist was divided into five sections: reporting, external validity, internal validity-bias, internal validity-confounding (selection bias), and power. The score ranges of Downs and Black were given the following corresponding quality levels: excellent (2628); good (2025); fair (1519); and poor (14).

The population was defined as children and adolescents with cancer aged 117 years with chemotherapy-induced OM or during the phase of chemotherapy treatment. Interventions: Honey-made products as therapy interventions include natural honey, commercially available marketed honey, and honey ice cube, all these product types were included in this review, whereby, honey was applied between the 7th day and the 14th day after the initiation of chemotherapy treatment when OM peaked or developed. For prophylaxis therapy, honey was applied before the start of chemotherapy and the development of OM.

The primary outcomes were the recovery time and the severity of OM. Various types of outcome measurement can cause clinical heterogeneity. Thus, only studies using National Cancer Institute Common Toxicity Criteria (NCI-CTC) Table S1 and scales developed by the World Health Organization (WHO) were included and the details of the scales were presented in Table S2.24

The present report includes studies comparing the effect of honey, routine mouth care, no treatment, or any other treatment for the prophylaxis and treatment of OM. Data (published scientific evidences) of all children and adolescents with cancer aged 117 years with chemotherapy-induced OM or during the phase of chemotherapy treatment, were included in this review. Studies were selected by whether they meet the inclusion criteria for the studies outlined as follows: RCTs and NRSs that investigated the effectiveness of honey products for patients with chemotherapy-induced OM in preventative or curative groups compared with control groups were included. All studies were in English language, full-text and released before April 2020.

Patients who were aged less than 1 year and over 17 years, had no capacity for oral feeding, were allergic to honey, with evidence of confirmed co-infection, and were diagnosed with diabetes were excluded. Details of exclusion criteria are shown in Table 1. In addition, studies that used Manuka honey as an intervention were excluded due to its taste and high content of methylglyoxal.22

Table 1 Detailed Exclusion Criteria for the Present Study

Data were extracted from a database that met the objectives of the study and presented in a Microsoft Excel format Table S3. The key extracted data is based on basic information, study characteristics, study design, participants, intervention, and outcomes. The mini-review was performed to integrate each sample to review the effects of treatment compared to the other, especially in RCTs; a large number of patients allow to be included, and thus the smaller, but clinically significant differences may be identified.22 In addition, compare to the short review, we have performed the narrative synthesis is essentially more subjective. Therefore, to avoid potential bias, the Centre for Reviews and Dissemination (CRD) (2009) suggested that the method applied should be transparent and rigorous.25 However, there was heterogeneity within and between studies, including not only the methodology but also the cancer type, OM cause, control arm, assessment scales, and study design. Therefore, data synthesis as part of this study adopted narrative synthesis that would be more appropriate to describe the results. A framework for narrative synthesis is the developing a preliminary synthesis of the findings of included studies; the researcher brought extracted data together and organised and described the findings. Exploring relationships within and between studies the relationship between characteristics and findings of individual studies, and the findings of different studies were explored, and assessing the robustness of the synthesis it was the end of the data synthesis process, and the related analysis resulted in a comprehensive assessment of the quality of the evidence.

All experimental groups in the studies used honey as an intervention, two studies used natural honey,26,27 two studies used commercial honey,12,28 and one study used honey and tulsi in ice cubes as an intervention.28 Tulsi is a herb that has robust evidences supporting its anti-cancer, anti-inflammatory, and anti-stress effects and can protect the bodys DNA against radiation. Except for one study that divided patients into three groups, all studies divided patients into experiment groups and control groups.27 The ice cubes study did not mention the application of routine mouth care,29 all experimental groups in the other three studies received routine mouth care along with honey,2628 and instead of performing routine mouth care, one study performed the routine practice of analgesic and antiseptic gel application along with honey.12 The control groups in three studies performed the same protocols as the experiment groups but did not use honey.12,26,28 The other two studies performed Benzocaine 7.5% gel27 and plain ice cubes29 as comparisons. Except for the ice cube study that used honey 5 minutes before receiving the MTX treatment,29 all studies performed the honey more than three times a day.12,2628 The experiment group in two studies received 0.51g honey/kg,26,27 one study received 12mL each time,12 and the rest of the two studies did not mention the dose of honey.28,29

All studies used OM scales to assess the grade of OM and evaluated the effectiveness of honey in treatment and prophylaxis from different angles. It is difficult to conclude due to numerous variables being involved. In terms of recovery time, four studies reported it, which is defined as the number of days from the beginning of treatment until all ulcers have healed completely.12,2628 Among them, instead of reporting the recovery time, one study reported the duration of hospitalization.28 In terms of the severity of OM, Bulut and Tfekci assessed the severity of OM before each session of chemotherapy and on the 1st, 4th, 8th, 12th, 16th, and 21st days after chemotherapy.26 Mishra and Nayak focused on the occurrence of OM from the initiation of MTX administration.29 Thus, the severity of OM was assessed on the 5th and 15th days of the administration of ice cubes. In the study of Al Jaouni et al, OM was assessed before and after chemotherapy, as well as a week after the initiation of chemotherapy.28 Singh et al evaluated OM every other day from the first day of enrollment until OM had healed completely.12

All included studies were in the fair range based on the Down and black (1998)23; the scores for Singh et al and Abdulrhman et al were 16 and 18,12,27 and another 3 studies were 17.26,28,29 Table S4, presents the detail of the quality assessment of each included study. All studies failed to describe how patients were selected, it is not possible to determine whether the chosen participants were representative of their population12,27,29 Bulut and Tfekci and Abdulrhman et al included almost all source populations that met the inclusion criteria26,27; Mishra and Nayak recruited almost all participants who were receiving MTX chemotherapy due to few numbers of children with MTX chemotherapy in the Hematology and oncology department.29 Therefore, it cannot be determined whether the participants of the above three studies are representative or not because this appears to be a convenience sampling. Only two studies12,26 blinded the people who assessed the outcomes of the intervention to avoid personal bias.30 Moreover, all studies failed to blind participants to the intervention they received which may have an impact on the reliability of their results.12,2629 In addition, only three studies in this review were RCTs, and the participants were randomized into groups.2729 However, none of the studies mentioned whether randomized intervention assignments were concealed from health-care staff and patients.

All included studies confirmed the effectiveness of honey in the prophylaxis and treatment of OM among child patients with chemotherapy.12,2629 The actual results will be presented by narrative synthesis due to the existing clinical and methodological heterogeneity that was explained in the Methodology section. P-value is a statistical approach that was used for measuring the effect of honey application in this mini-review. The characteristics of the experimental and control groups of each study are presented in Table 2. The overall data on recovery time and the OM status can be seen in Table 3.

Table 2 Detailed Characteristics of Participants Included in the Present Studies (Experimental and Control Groups)

Table 3 Characteristics of Recovery Time and the Severity of OM

A total of 51 original studies were recorded from the electronic databases by performing PRISM-8 (Figure 1). Among which 8 results were obtained from CENTRAL, 9 from MEDLINE, 12 from CINAHL, 12 results from EMBASE and 10 from Web of Science. After the analysis of each article, 16 studies that included adults or non-cancer patients, and used propolis as intervention, were excluded due to the inconsistency with the predefined inclusion criteria for this short review. Furthermore, 7 studies were excluded due to the following reasons: three studies investigated the effectiveness of radiation-reduced OM, one piece of grey literature did not report results, two studies were published in the symposium without sufficient information and one study has no full-text access S5.

Figure 1 The study selection process is presented as PRISMA flow diagram.

Notes: Adapted from: Page MJ, McKenzie JE, Bossuyt PM, Boutron I et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71. Creative Commons Attribution (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/legalcode).33

A total of 51 studies were included, which was published so far. The detailed data are present in Table 2. All participants did not suffer from OM in the phase of prophylaxis; participants in the treatment phase had varying grades of chemotherapy-induced OM that are present in Table 2. Instead of only reporting chemotherapy, two studies reported the specific chemotherapy drugs that patients were undergoing, which was methotrexate (MTX). Moreover, one study enrolled participants who were treated with chemo/radiotherapy; the limitation of this study was that they failed to report the ratio of chemotherapy and radiotherapy.

Three studies assessed the effectiveness of honey by investigating the recovery time. One study focused on the duration of hospitalisation for OM patients.28 In the study of Abdulrahman et al, in grade II OM, the recovery time was 3.60.8 days in the honey group, and 4.60.9 days in the control group, which is a statistical significance between the honey group and control group (P=0.0017).27 In grade III OM, the recovery time between the honey and control groups, which were 5.41.11 days in the honey group, and 8.61.0 days in the control group, differ significantly (P=0.0001). It shows significantly faster healing in the honey group compared to the control group. Combining grades II and III, the recovery time was 4.251.25 days in the honey group and 6.202.47 days in the control group, which shows honey can produce faster healing compared with the control group (P=0.0005; with a statistical power of 96.2%). Bulut and Tfekci reported that the recovery duration in the honey group was 4.8694.341 days before OM developed and 14.8572.905 days after OM developed, which was shorter than the control group was 19.2821.805 days.26 The recovery duration differs significantly between the two groups (p=0.000). Al Jaouni et al compared the duration of hospitalization between the honey group and the control group.28 The duration of hospitalization for OM children was significantly reduced in the honey group (mean 73 days) as compared to the control group (mean 135 days) (p<0.001). The study by Singh et al (2019) compared the duration of OM between the honey group and the control group. The median duration of OM in the honey group was 4 days (IQR: 46 days) and was 6d (IQR: 68 days) in the control group. All the above findings show significantly faster healing in the honey group (p<0.01).

Four of the five included studies assessed the effectiveness of honey by investigating the severity of OM.12,26,28,29 One study set two honey groups.26 The OM degree decreased gradually in the honey group (patients with grade III and V OM) after the fourth follow-up day (p<0.001). The severity of OM was higher in the honey group compared to the control group on day 4 (3.580.47 vs 1.791.08, p=0.000); however, the OM degree was noticeably lower on day 21 (0.140.36 vs 1.761.03, p= 0.000). And, 92.9% of the children achieved full recovery and 7.1% at a mild level in the honey group. In the control group, only 5.1% of the children obtained full recovery and the rate of mild-level OM was 71.8%; the remaining 23.1% of the children experienced severe OM. However, none of the children developed severe OM in the honey group after the eighth follow-up day. Recovery status differs significantly between the two groups (p<0.01), which indicates honey can reduce the severity of OM. Meanwhile, the severity of OM was significantly lower in the other honey group (patients without OM and before chemotherapy was initiated) compared to the control group (0.430.58 vs 1.791.08, p=0.000) on day 4 and day 21 (0.170.38 vs 1.761.03, p= 0.000). The OM grade increased gradually on the 4th, 8th, and 12th days and slightly decreased on the 16th and 21st days in the control group, and a significant difference in OM degree on the different follow-up days (p<0.001). Also, 82.6% of the children achieved full recovery and 17.4% at a mild level in the honey group before OM occurred. In the control group, only 5.1% of the children obtained full recovery and the rate of mild-level OM was 71.8%; the remaining 23.1% of the children experienced severe OM. However, none of the children developed severe OM in the honey group. Recovery status differed significantly between the two groups (p<0.01).

Al Jaouni et al recruited participants before OM was developed.28 The prophylaxis and treatment were not investigated separately, and participants were receiving honey before OM occurred, and when the children experienced OM with grades III and V. Compared with the control group, the incidence of grade III and V OM was significantly reduced in the honey group (20% in honey versus 55% in control; P=0.02). Mishra and Nayak enrolled participants before OM occurred.29 The incidence of OM was considerably lower in the experimental group (honey and tulsi ice cubes) as compared to the control group (plain ice cubes). Forty percent of the children experienced OM (mild-moderate) in the experimental group and 90% (65% mild-moderate OM and 25% severe OM) in the control group on day 5 (p<0.001). As well as the assessment on the 15th day showed that all OM was at mild-moderate grade, and the incidence of OM was 15% in the experimental group and 80% in the control group (p<0.001). The severity of OM was significantly reduced in the experimental group compared to the control group (0.40.50 vs 1.750.96, p=0.001) on day 5 and day 15 (0.150.36 vs 1.10.71, p= 0.001). The severity of OM was significantly reduced on follow-up days in the honey group compared to the control group (p<0.01), and 12% of the children achieve a recovery on the third day in the experiment group. The rate of the grade 0 differs significantly between both the groups, which was 50% on the 5th day and 92% on the 7th day in the honey group, and 8% on the 5th day and 54% on the 7th day in the control group (p<0.01). All children recovered from OM on day 9 in the honey group and on day 13 in the control group.

We focused on the effect of oral care treatment with honey products in the treatment of chemotherapy-induced OM in paediatric patients. Based on the evidence reported in our study, honey products have a beneficial effect on the treatment and prophylaxis of OM. Honey significantly decreased the OM grade and provided faster healing for OM in included studies. Honey can treat grade I, II, and III chemotherapy-induced OM, and prevent patients from developing severe chemotherapy-induced OM in children. To the best of our knowledge, no data was reported on the disadvantages of conventional honey in OM patients except for Manuka honey, which failed to show positive results. Our report represents the recovery time of OM and the severity of OM was different from lab to lab or hospital to hospital. However, in terms of treatment, the recovery time of OM was reported in four studies and showed statistical significance between the honey group and the control group.12,2628 Concerning grades of OM, very limited data is available. The present report reflects that honey treatment in grade V OM may not be significant compared to grade I, II, and III OM.12,2628 However, the severity of such conditions may decrease during chemotherapy.12,2629 So far co-infection has not been considered by any researcher except Al Jaouni et al and the results of this study showed a statistically significant reduction of bacterial and fungal infections among paediatric cancer patients undergoing chemo/radiotherapy who are receiving honey as an intervention for OM.28 Honey + Tulsi (ratio not reported) showed the best effect as compared to cryotherapy.29

The potential limitation of our present search is the limited number of data, while no data are available on chemotherapy drugs used in recovery. Moreover, yet to explain the effectiveness of honey products in the prevention and treatment of OM, authors accept scientific flora carry out further investigations that are needed. Honey as a more economical treatment enables it to be the intervention of choice for OM.31 Honey shows a significant effect without sex disparity.32 Globally, studies have proven that radiotherapy, chemotherapy, or a combination of both can cause OM.22

Honey reduced the recovery time and the stage of OM, which made it an effective intervention in the prevention and treatment of OM in paediatric oncology patients. Furthermore, not only has been shown to have the capability for healing injured tissues but it is also a more economical treatment, and it has fewer side effects compared to synthetic drugs.

In conclusion, this study suggests that honey must be included as one of the treatments or prevention of choice for the grade I, II, and III chemotherapy-induced OM. However, further studies on the treatment and prevention of chemotherapy-induced OM in children are needed due to the different pathomechanism between radiotherapy and chemotherapy and the characteristics of OM in children healing faster than in adults.

All data files mentioned in this manuscript are available.

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Ethics Committee, Shenzhen Childrens Hospital, Reference number: 2018 (013) on dated 2018/09/03.

Due to the retrospective nature of the study, the Ethics Committee of Shenzhen Childrens Hospital, Shenzhen determined that patients consent was not required. Data were kept confidentially and in compliance with the Declaration of Helsinki.

We would like to thank Prof. Liu from the Department of Hematology and Oncology, Shenzhen Childrens Hospital and Samantha Toland from Birmingham City University for their constant support.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and also agree to be accountable for all aspects of the work.

This work was supported by Shenzhen Fund for Guangdong Provincial High-Level Clinical Key Specialties (No. SZGSP012) and Shenzhen Key Medical Discipline Construction Fund (No. SZXK034).

The authors declare no conflicts of interest in relation to this work

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Use of honey in the management of Chemotherapy | CMAR - Dove Medical Press

Michael Ringel, PhD, JD, Managing Director & Senior Partner, Boston Consulting Group (BCG), ... [+] presenting at the 9th Aging Research and Drug Discovery meeting organized by the University of Copenhagen and Insilico Medicine. Presentation title "The Emerging Commercial Landscape for Aging Biology-Based Therapeutics"

While I had very high expectations traveling to the 9th Aging Research and Drug Discovery (ARDD) forum, the largest five-day annual gathering of the longevity biotechnology industry organized by the University of Copenhagen, the event did not fail to impress. I can spend endless hours covering the lectures of top-tier academics, pharmaceutical industry leaders, and venture capitalists, but these would be better covered in the conference proceedings. However, one lecture titled The Emerging Commercial Landscape for Aging Biology-Based Therapeutics by Dr. Michael Ringel, captivated even the most experienced industry executives and the established aging researchers.

Dr. Michael Ringel at the 9th ARDD conference

The sheer fact that Boston Consulting Group (BCG), the worlds most venerated consulting firm specializing primarily in strategy and management consulting, became a knowledge partner of the ARDD indicates that the meeting has reached a certain level of credibility and longevity biotechnology is a clear trend. BCG is known for being very impartial, knowledge- and experience-driven, and providing valuable strategic insights to the boards and CEOs of the worlds largest corporations. The firm is used by governments all around the world when they want to get deep industry insights or when they want to formulate a national strategy around a specific trend. From what I know, BCG was used by the Kingdom of Saudi Arabia to help formulate their famous Longevity Strategy, which resulted in the creation of the $1 Billion a year non-profit, Hevolution Foundation.

Dr. Michael Ringel, BCG presenting at the 9th ARDD in Copenhagen

One differentiating feature of BCG is the quality of its slides. They often manage to turn a very complicated story into a set of visually appealing, easy-to-comprehend slides that provide a clear problem definition, recommendation, situation assessment, and alternatives. These slides are rarely shared by the customers as they usually represent a substantial investment and intellectual property.

Therefore, when during his 30-minute talk, Dr. Ringel went through over thirty of these valuable slides, those of us who understand the value made sure to get the recording of the lecture.

Here are some of the top takeaways from Dr. Ringels presentation that Im able to share:

Michael Ringel, PhD, JD, Managing Partner, BCG, presenting at the 9th Aging Research and Drug ... [+] Discovery meeting

I knew Dr. Michael Ringel prior to the ARDD as a well-known strategy and management consultant in the pharmaceutical industry. After almost 25 years at BCG in healthcare practice, he is on a first-name basis with every pharma CEO, board member, investor, and government official, and is a walking encyclopedia who also knows most of the emerging technologies and their applications.

From left to right: Eric Verdin, MD, CEO of the Buck Institute for Research on Aging, Mehmood Khan, ... [+] MD, CEO, Hevolution Foundation, Michael Ringel, PhD, JD, Managing Director, BCG, Alex Zhavoronkov, CEO, Insilico Medicine

Here, I asked Dr. Ringel a few questions to get his perspective on longevity biotechnology and the future of this exciting new field:

Alex Zhavoronkov: Michael, I know that aging biology is not only your professional focus but also your personal interest. What made you interested in this field?

Dr. Michael Ringel: Alex, thanks so much for having me. It truly is a pleasure to sit down with you. One disclosure before we start the discussion. One of the investors in your company, Insilico Medicine, is B Capital Group. My company, BCG, is a partner to B Capital Group, and so I have an indirect and small financial stake in your company that we need to mention.

As to my interest in the field, Ive spent my career working in healthcare, trying to help companies bring better medicines to people. And when I found out there is an area of biology that underpins not just one, but the majority of the chronic diseases that burden us, I realized the impact it might have on human health. Preventing multiple diseases with one intervention is a potential game-changer, if you can make it work. The key word being *if*. But when you dig into the science, you find out in fact theres really good evidence to support the notion. We just have to do the work to translate what weve seen in the lab to humans.

Alex Zhavoronkov: You have been in biopharma for over 25 years and you have seen everything. You saw Geron, Sirtris, ResTORbio, Unity, and many other companies in this area. How do you see the field of aging biology evolving and propagating into the biopharma industry and how did the field change over the past decade?

Dr. Michael Ringel: Understanding a new area of science can sometimes take a long time and then sometimes there are these great leaps forward. In my youth in the 70s we knew about caloric restriction, which is still one of the best-validated interventions. But we didnt know much about how it works. That began to change in the 90s, kicked off in part by Cynthia Kenyons seminal work in worms, as we began to understand the biological pathways involved. We saw the first pharmaceutical intervention proven to work in a mammal, in mice, just over a decade ago with the NIHs Interventions Testing Program. Today there is a small but growing pipeline of drug candidates in clinical testing. I believe we are on the cusp of the first demonstrated effective intervention in humans, which I believe will be one of those great leap-forward moments that galvanize interest in the field.

Alex Zhavoronkov: In your opinion, how long will it take the pharmaceutical industry to buy into the concept of utilizing aging biology as a platform for drug discovery for a range of therapeutic areas?

Dr. Michael Ringel: We are already seeing activity. We know from publicly available information that many companies have external partnerships or internal units, including AbbVie, Novartis, Regeneron, and others. For instance, UCB has partnered with your own company, Insilico Medicine. So it has already started. I believe that over the next decade, we will see a burgeoning pipeline focused on various pathways of longevity biology, and once the first clinical studies demonstrate proof-of-concept, we will really see interest grow.

Alex Zhavoronkov: Of course, you can not talk about Saudi Arabia and Hevolution since these are clients but I was one of the key opinion leaders interviewed for this project in 2019, and BCG was clearly involved. Why is longevity biotechnology so important for any emerging economy and do you think other countries should prioritize longevity in a similar way?

Dr. Michael Ringel:I cant give opinions on specific companies or foundations and would refer you to their leadership for questions about them. But as to the general point of why this matters all over the world, in developed and emerging economies, it is because it has the promise of being such a powerful way to improve human health. Weve seen that just throwing more money at the current healthcare system has not improved lifespan or healthspan, and we even have had retrograde motion in some areas, with lifespans declining. In part, that is due to the growing burden of metabolic disorders like diabetes. What we need is a better way, more focused on prevention an ounce of prevention is worth a pound of cure. And thats where longevity biology is critical. It is, at heart, a preventative approach. And the core pathways are the very same ones that are implicated in the metabolic disorders that are a growing issue all over the world.

Alex Zhavoronkov: What is your advice to the young entrepreneurs in this nascent longevity biotechnology industry?

Dr. Michael Ringel: Theres a lot that you need to do as an entrepreneur you need to figure out funding, build a team, set up operations, choose your preclinical and development plans, develop partnerships, and a million other things Im always incredibly impressed by how much thesel young entrepreneurs can accomplish, juggling all these things at once. But the sine qua non, the thing you cannot do without in biotech, is good science. All the rest of the work is built on the foundation of a good idea, a new way to help people. So my advice is make sure youre investing your time and energy getting as deep into the science as you can.

Alex Zhavoronkov: Finally, how did you like the ARDD conference, what were your major takeaways, and will you come again next year?

Dr. Michael Ringel: To me ARDD is a unique conference in longevity, bringing a heavyweight mix of the most impressive scientists in the field together with the most promising start-ups and a great set of investors. For anyone already in the field, it is the place to be, and for anyone looking to learn more, I cannot think of a better place to get a crash course. Particularly the large pharmaceutical companies would benefit by bolstering their attendance to get deeper into this field.

The 9th Aging Research and Drug Discovery meeting, Grand Hall, University of Copenhagen, September ... [+] 2022

Michael Ringel, PhD, JD, Managing Director and Senior Partner, Boston Consulting Group

Michael Ringel, PhD, JD, is Boston Consulting Group's global leader for innovation analytics and research and product development, and is a core member of the firms Corporate Finance & Strategy practice. Michael is a frequent contributor to industry journals, including Nature Reviews Drug Discovery, and has coauthored numerous BCG reports on innovation, R&D, and corporate strategy. He received a BA in biology from Princeton, a PhD in biology from Imperial College London, and a JD from Harvard Law School.

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Celebrity Strategy Consultant Predicts What Will Be The Most Impactful Area In The Pharmaceutical Industry - Forbes

Participants will be introduced to the identification, degradation, and preservation of common photographic print materials, including the salted paper, albumen, silver gelatin, and chromogenic color processes. Ethical and other factors to consider in the preventative care of at-risk print materials will be outlined. We will address early direct positive processes the daguerreotype, ambrotype and tintype briefly. Well also discuss details pertaining to the manufacture, identification and preservation of gelatin dry plate and film-base negatives, along with basic considerations in the care of photographic albums. Well review preservation challenges related to large and diverse photographic collections with attention paid to the importance of proper environments and storage materials, emergency planning, and risk analysis. The value and significance of photography, global initiatives, and the pressing need to secure external funding and support through effective preservation advocacy will be emphasized throughout the webinar. Participants will receive a small selection of historic prints, to be returned at the conclusion of the webinar, for in-depth study. A listing of key publications and online resources will be provided. While each session will start with a webinar presentation, but we will include time for discussions with questions welcomed during or following each session using Zoom meeting.

The statements and opinions expressed by panelists, hosts, attendees, or other participants of this event are their own and do not necessarily reflect the opinions of, nor are endorsed by, the American Alliance of Museums.

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C2C Care Course The Preservation of Our Global Photographic Heritage: Here, There and Everywhere - aam-us.org

The American Psychological Association (APA) defines loneliness as the affective and cognitive discomfort or uneasiness from being or perceiving oneself to be alone or otherwise solitary.

In other words, loneliness is the mental or emotional discomfort you may experience from either being alone or feeling as though you are alone. This feeling stems from your social needs not being met and/or an inability to get the social connection you desire.

Although loneliness and being alone are commonly confused, being alone doesnt necessarily mean someone is lonely. Loneliness is a feeling, while being alone is a situation or state of being, which is not inherently negative, says Nina Vasan, M.D., psychiatrist and professor at Stanford University School of Medicine and chief medical officer at Real, an online mental wellness membership site.

You can feel lonely even when youre surrounded by other peoplesuch as a partner, family, co-workers or friends, continues Dr. Vasan.

Its also possible to be alone, but not feel lonely, she adds. For example, if youre by yourself but connecting to others through good communication or activities like volunteering, you dont feel lonely.

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Loneliness: Causes, Effects And Prevention Forbes Health - Forbes

Emily Moorhead is the chief operating officer of the central market at Detroit-based Henry Ford Health System.

Ms. Moorhead will serve on the panel "Building a Resilient, High-Reliability Organization With Accountable Leaders" at Becker's 10th Annual CEO + CFO Roundtable. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference on Nov. 7-10 in Chicago.

To learn more and register, click here.

Becker's Healthcare aims to foster peer-to-peer conversation between healthcare's brightest leaders and thinkers. In that vein, responses to our Speaker Series are published straight from interviewees. Here is what our speakers had to say.

Question: What is the smartest thing you've done in the last year to set your system up for success?

Emily Moorhead: The smartest thing I could've done was foster a culture of belonging and supporting leaders so they can best front-line support staff. After two or more years of living through COVID-19, the great resignation, staffing crises, supply shortages, and now high inflation rates, the financial challenges and staff burnout are prevalent throughout all departments in the care continuum. Leaders must pause, breathe and ensure that we care for one another. Strengthening our culture to create a strong foundation will be vital to preparing for a large amount of change that will be required to be successful in the future.

Q: What are you most excited about right now and what makes you nervous?

EM: Value-based care is exciting. We've talked about the evolution from fee-for-service to value-based care for over a decade. Moving the industry away from sick care and focusing on prevention gets me out of bed in the morning!

Q: How are you thinking about growth and investments for the next year or two?

EM: Growth is about meeting the broader community's needs, which means expanding virtual care platforms to areas not easily served in the past. Having a data-driven approach to anticipate upcoming provider shortages to be proactive about unmet care needs and how we can help fill the voids through provider access and create more streamlined care models. Investments in technology make it easier for people to access the care they need. We must reduce the friction patients experience when seeking care.

Prevention and wellness is the new model we as healthcare leaders need to evolve that thinking to be true healthcare partners to the communities we serve. We need to align care with the patient's preferences to make getting the preventative care they need easier. Examples include virtual visits with a specialist in the ED, during the primary care visit before leaving, or same-day appointments.

Q: What will healthcare executives need to be effective leaders for the next five years?

EM: I think leading through a large amount of change and evolution needed in our industry will be leaders' primary focus for the next several years. This will require some tough decisions but can be done in a way that fosters integrity, respect and kindness. At its core, leadership is about caring for everyone in our sphere of influence. That means making sure they feel safe, valued, and purposeful. Leaders should strive for authenticity over perfection. Future health care leaders need to be more "heart grounded." Would our processes be the same if we were leading with our hearts? I'd argue they wouldn't; they'd be centered a little more closely around our patients, peers, and families. I think Simon Sinek says it best, "Leadership is not about being in charge. Leadership is about taking care of those in your charge."

Q: How are you building resilient and diverse teams?

EM: As it relates to diversity, we have an enterprise-wide DEIJ strategy that leads to the local committee work, including action plans related to intentional recruitment, unconscious bias training for all staff, governance members and providers, educational partnerships, the establishment of a voice of the community work group, and strategic planning efforts to improve access for under-represented communities.

Diversity makes us smarter, more innovative, and less married to the status quo. Diversity also offers the opportunity to see with new eyes. Diversity is broader than gender and race; we must tap into diverse experiences and cultures. The more varied the experiences around the table, the better the chance of change being successful and sustainable!

In terms of resiliency: fostering a culture of belonging, caring for one another and regular leadership check-ins. People stay in supportive, fun and collaborative environments, so fostering a strong culture is the foundation of a resilient team. But we must also be accountable for knowing when we are approaching burnout and need to unplug, rejuvenate and seek help.

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Prevention and wellness is the new model, a leader from Henry Ford Health System says - Becker's Hospital Review

With more employees resuming pre-pandemic lives, employers have an opportunity to offer routine health and wellbeing services.

During the pandemic, employers focused on Covid mitigation, social distancing and remote work, shares Susan Kirks, RN BSN COHN, manager of Employee Health and Wellness. With more employees back in person, we have a great opportunity to help people get back on track, especially when it comes to preventative and routine healthcare.

According to the CDC, more than four in 10 U.S. adults avoided getting necessary medical care during the height of the pandemic. While many Americans are ready to resume routine medical visits, rising costs and inflation have them thinking twice.

With many employees looking for work flexibility and support, resuming or offering new occupational health services can be a win-win opportunity for employers offering:

Convenient onsite services: With Cone Health onsite providers, employers can offer initial baseline physicals and one-on-ones to help employees choose a primary care provider. According to the governments Office of Disease Prevention and Health Promotion, having access to primary careis associated with positivehealthoutcomes. Primary care providers support preventative care, early diagnosis and treatment of disease and chronic disease management.

Screenings and vaccinations: Employers hosting mobile screening[HS1], flus shot clinics, or biometric screenings for cholesterol, glucose, blood pressure and BMI send a strong message that they care about employee health and wellbeing.

Listen and learn presentations: With Cone Healths new virtual sessions, employees can log in from work, home or on-the-go to join to hear from experts on a range of topics, including nutrition, preventative health and exercise.

Onsite training: Make sure supervisors and staff are prepared with CPR or first aid training. Whether you want a refresher course or first-time training, our providers are ready to assist you with your workplace needs.

To learn more about occupational health offerings, contact Jacqueline Heyward at (336) 832-7315.

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Getting Back to Employer Health and Wellness Programs - Cone Health

Today, the White House and U.S. Department of Treasury are hosting a White House Summit on Building Lasting Eviction Prevention Reform. As funds for Emergency Rental Assistance (ERA) are beginning to wind down, the Summit will focus on the need for an all-out effort to build lasting reform including through the use of remaining American Rescue Plan (ARP) funds from ERA and State and Local Fiscal Recovery Fund (SLFRF) assistance. Having created a first-ever national infrastructure for eviction prevention, now is the time to ensure we build on this progress and prevent a return to an eviction system that allowed 3.6 million eviction filings a year, often for small amounts of funds and without any legal representation or eviction diversion options. The Summit will feature top Administration officials, Chairman of the Senate Banking, Housing, and Urban Affairs Committee Sherrod Brown, Eviction Lab Founder Matthew Desmond, and will include State Supreme Court Justices and national, state, and local leaders who have pioneered lasting reform approaches that can serve as national models (see Appendix).

The Biden-Harris Administration is also highlighting the most current data on the impact of the Emergency Rental Assistance available as of this moment.

The White House Summit Will Highlight Overall Progress of the Emergency Rental Assistance Program and Top Models of Reform at the State and Local Court and Government Levels.

The Summit will feature overall policy views from top Administration Officials, Matthew Desmond, President and CEO of the National Low Income Housing Coalition Diane Yentel, and Chairman of the Senate Banking Committee Sherrod Brown, as well as models of visionary court-led reform, presented by Michigan Supreme Court Chief Justice Bridget Mary McCormack, New Mexico Supreme Court Chief Justice C. Shannon Bacon, and New Orleans First City Court Chief Judge Veronica Henry. The Summit will also highlight top eviction prevention innovations in Chicago, IL, presented by Mayor Lori Lightfoot; Philadelphia, PA, presented by Councilmember Helen Gym (At Large); Cleveland, OH; Colorado; and Oregon.

The program will begin at 12:30 pm ET and is scheduled to conclude at 2:30pm ET.

The Urgent Need for Eviction System Reform

Visionary Court-Led Eviction System Reform

Innovations in State and Local Eviction Prevention

Charge to Invest Remaining American Rescue Plan Funds in Housing Stability

Congressional Efforts to Secure Housing Stability and Eviction Prevention

The Path Forward on Eviction Protections and Closing Remarks

APPENDIX: Eight Models of Top State and Local Innovations that Build on the Emergency Rental Assistance Infrastructure to Sustain Eviction Reform

Visionary Court-Led Eviction System Reform

Michigan: Adopting Long-Term Court-Based Eviction Diversion to Prevent Avoidable Evictions

Michigan Supreme Court Chief Justice Bridget Mary McCormack issued one of the earliest standing orders during the pandemic to pause the eviction process once a rental assistance application has been submitted. Building on these best practices, the Michigan Supreme Court has proposed a new statewide order permanently adopting the stay of eviction action when a tenant applies for assistance. The proposed order requires a mandatory pre-trial convening to ensure tenants have access to rights and resources and prevents default judgments. It also prohibits five-day eviction orders, offers remote hearings for tenants with barriers to accessing courts, and attaches detailed information about assistance to every summons, among other best practices. The state also dedicated ERA housing stability funds to increase tenant access to legal counsel, with Detroit legislatively adopting right to counsel in 2022.

New Mexico: Leveraging American Rescue Plan Funding and Collaborating with Landlords and Tenants to Design Sustainable Eviction Diversion Programs

New Mexico Supreme Court Chief Justice C. Shannon Bacon created a task force of tenant and landlord groups, ERA program administrators, housing programs and state and local officials to design and launch one of the longest, most successful court-ordered eviction diversion programs in the country, including a mandatory extension of the lease term where landlords accept rental assistance. The eviction diversion program includes increased access to legal representation, mediation, and financial navigators to provide holistic services to tenants at risk of eviction. Due to the success of the program in reducing evictions, the state will continue to fund the eviction diversion program with state funds initially made possible with American Rescue Plan funds.

New Orleans: Implementing Eviction Diversion and Right to Counsel to Secure Court-Based Reform

Chief Judge Veronica Henry developed the First and Second City Courts award-winning Eviction Diversion Program, a partnership between the City of New Orleans, First and Second City Courts, Southeast Louisiana Legal Services, Louisiana Fair Housing Action Center (LFHAC), Jane Place Neighborhood Sustainability Initiative, and Parochial Offices of the Court. The program diverts eviction cases to on-site ERA administrators, Eviction Help Desks, the Right to Counsel Program, and other supportive services to prevent eviction and stabilize housing. New Orleans built on the diversion program by legislatively adopting the right to counsel for tenants facing eviction in 2022 and initially funding the intervention with $2 million in ERA funds.

State and Local Innovations in Eviction Prevention

Philadelphia, Pennsylvania: Mandating Pre-filing Eviction Diversion and Prohibiting Harmful Tenant Screening Practices

Philadelphia Councilmember Helen Gym (At Large) introduced thenations first city ordinancemandating pre-filing eviction diversion, which went into effect in August 2020. As a result, tenants at risk of eviction receive access to rental assistance and legal representation and tenants and landlords are required to participate in a free mediation session with the goal of resolution through an agreement. The diversion program has changed the culture to one where eviction litigation is a last resort. The city is committing long-term funding for rental assistance, a key component of diversion. In addition, Philadelphia adopted the Renters Access Act, which prohibits screening of tenants based on certain eviction filings and requireslandlords to tell tenants why they were rejected and provide an opportunity to correct errors.

Chicago, Illinois: Access to Legal Services for Tenants and Landlords and Early Eviction Resolution

In July 2022, Chicago dedicated $8 million in ERA housing stability funds to adopt a three-year Right to Counsel pilot. The city is collaborating with legal service providers Lawyers Committee for Better Housing, Legal Aid Chicago, and CARPLS to provide legal representation and increase housing stability. The program is expected to double the number of tenants who have access to attorneys, serving 2,000 to 3,000 tenants per year, and greatly reduce eviction orders. Chicago landlords and tenants have also benefited from the Cook County Early Resolution Program that diverts eviction cases to mediation and provides free legal aid to both tenants and unrepresented landlords. These programs have also effectively leveraged state law to seal pandemic-era eviction filing records for tenants, preventing the Scarlet E of eviction that results in a downward move and long-term hardship.

Cleveland, Ohio: Permanently Adopting Right to Counsel and Serving Tenants at Highest Risk of Eviction

The City of Clevelandwas among the first cities in the United States to legislatively adopt right to counsel, immediately prior to the onset of the COVID-19 pandemic, initially funding the program through a public-private partnership including the City of Cleveland, United Way and the Cleveland Foundation, among others. As private funds sunset, Cleveland has allocated Emergency Rental Assistance funds and is working to sustain right to counsel with long-term government support and additional American Rescue Plan funding, and amplifying its effectiveness through the development of an eviction diversion program that includes pre-filing mediation. To ensure services reach those with the greatest need, partners have combined data analysis with canvassing and door knocking. Zip code data on eviction rates and the lowest number of requests for assistance allows partners to identify and target outreach to the most marginalized, highest risk tenants.

Colorado: Partnering with Nonprofits to Provide Immediate Eviction Prevention and Rental Assistance

In Colorado, the COVID-19 Eviction Defense Project launched the Colorado Stability Fund, a unique revolving rental assistance fund capable of issuing quick, accurate ERA payments in less than 24 hours through a new partnership between the COVID-19 Eviction Defense Project (CEDP), Colorado Housing and Finance Authority (CHFA), and Colorados Division of Housing (DOH). The Stability Fund is available to all Colorado renters and gives those facing eviction a single point of contact for housing stability services and integrates intake and navigation, rapid rental aid payments, eviction legal defense, and, when necessary, rehousing support. The initiative is strengthened by partnerships with legal aid organizations and organizations by and for Black, Indigenous, people of color (BIPOC) communities to ensure resources reach those at greatest risk of displacement with deference to cultural context. In Denver, the program works seamlessly with the right to counsel, adopted in 2021. To ensure continued eviction prevention, partners are working to sustain the program long-term with funds from the state and are expanding to other housing areas, including foreclosure.

Oregon: Community Partnerships to Provide Rapid Eviction Prevention to the Highest Risk Tenants

Oregon was one of the first states to supplement ERA funds with SLFRF and state funding. In addition, the state developed and funds the Eviction Prevention Rapid Response Program, a partnership between the Oregon Law Center and the Oregon Housing and Community Services (OHCS) that serves as a critical element of the Eviction Defense Project. The program allows for rapid financial assistance to prevent eviction and homelessness, since legal aid can verify tenant eligibility and provide flexible funds to prevent evictions, including rental assistance, cleaning services, moving expenses, and more.OHCS also partners with community-based tenant organizations and nonprofits, including Unite Oregon, Bienestar, and the Springfield Eugene Tenants Association. During the height of the pandemic, these trusted community groups conduct outreach to community members at risk of eviction, including engaging in multi-lingualdoor knocking, and connecting their neighbors with resources to avoid eviction. As part of ongoing eviction prevention efforts, OHCS is also partnering with the Urban League of Portland, Immigrant and Refugee Organization (IRCO), and other community organizations statewide to conduct community outreach and provide critical eviction prevention services.

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FACT SHEET: White House Summit on Building Lasting Eviction Prevention Reform - The White House

Contemporary guidelines highly recommend patients with heart failure with reduced ejection fraction (HFrEF) be on all four drug classes that together have shown clinical clout, including improved survival, in major randomized trials.

Although many such patients don't receive all four drug classes, the more that are prescribed to those with primary prevention implantable defibrillators (ICD), the better their odds of survival, a new analysis suggests.

The cohort study of almost 5000 patients with HFrEF and such devices saw their all-cause mortality risk improve stepwise with each additional prescription they were given toward the full quadruple drug combo at the core of modern HFrEF guideline-directed medical therapy (GDMT). The four classes are SGLT2 inhibitors, betablockers, mineralocorticoid receptor antagonists (MRA), and renin-angiotensin system (RAS) inhibitors.

That inverse relation between risk and number of GDMT meds held whether patients had solo-ICD or defibrillating cardiac resynchronization therapy (CRT-D) implants; independently of device-implantation year and comorbidities; and regardless of HFrEF etiology.

"If anybody had doubts about really pushing forward as much of these guideline-directed medical therapies as the patient tolerates, these data confirm that by doing so, we definitely do better than with two medications or one medication," Samir Saba, MD, University of Pittsburgh Medical Center, Pennsylvania, told theheart.org| Medscape Cardiology.

The analysis begs an old and challenging question: Do primary prevention ICDs confer clinically important survival gains over those provided by increasingly life-preserving recommended HFrEF medical therapy?

Given the study's incremental survival bumps with each added GDMT med, "one ought to consider whether ICD therapy can still have an impact on overall survival in this population," proposes a report published online July27 in JACC Clinical Electrophysiology, with Saba as senior author and Mehak Dhande, MD, also from University of Pittsburgh Medical Center, as lead author.

In the adjusted analysis, the 2-year risk for death from any cause in HFrEF patients with primary prevention devices fell 36% in those with ICDs and 30% in those with CRT-D devices for each added prescribed GDMT drug, from none up to either three or four such agents (P< .001 in both cases).

Only so much can be made of nonrandomized study results, Saba observed in an interview. But they are enough to justify asking whether primary prevention ICDs are "still valuable" in HFrEF given today's GDMT. One interpretation of the study, the published report notes, is that contemporary GDMT improves HFrEF survival so much that it eclipses any such benefit from a primary prevention ICD.

Both defibrillators and the four core drug therapies boost survival in such cases, "so the fundamental question is, are they additive. Do we save more lives by having a defibrillator on top of the medications, or is it overlapping?" Saba asked. "We don't know the answer."

For now, at least, the findings could reassure clinicians as they consider whether to recommended a primary prevention ICD when there might be reasons not to, as long there is full GDMT on board, "especially what we today define as quadruple guideline-directed medical therapy."

Recently announced North American guidelines defining an HFrEF quadruple regimen prefer beyond a betablocker, MRA, and SGLT2 inhibitor that the selected RAS inhibitor be sacubitril/valsartan (Entresto, Novartis), with ACE inhibitors or angiotensin-receptor blockers (ARBs) as a substitute, if needed.

Nearly identical European guidelines on HFrEF quad therapy, unveiled last year, include but do not necessarily prefer sacubitril/valsartan over ACE inhibitors as the RAS inhibitor of choice.

Primary prevention defibrillators entered practice at a time when expected background GDMT consisted of betablockers and either ACE inhibitors or ARBs, the current report notes. In practice, many patients receive the devices without both drug classes optimally on board. Moreover, many who otherwise meet guidelines for such ICDs won't tolerate the kind of maximally tolerated GDMT used in the major primary prevention device trials.

Yet current guidelines give such devices a classI recommendation, based on the highest level of evidence, in HFrEF patients who remain symptomatic despite quad GDMT, observed GreggC. Fonarow, MD, University of California Los Angeles Medical Center.

The current analysis "further reinforces the importance of providing all four foundational GDMTs" to all eligible HFrEF patients without contraindications who can tolerate them, he told theheart.org| Medscape Cardiology. Such quad therapy, he said, "is associated with incremental 1-year survival advantages" in patients with primary prevention devices. And in the major trials, "there were reductions in sudden deaths, as well as progressive heart failure deaths."

But the current study also suggests that in practice, "very few patients can actually get to all four drugs on GDMT," said Roderick Tung, MD, University of Arizona College of Medicine, Phoenix. Optimized GDMT in randomized trials probably represents the best-case scenario, he told theheart.org| Medscape Cardiology. "There is a difference between randomized data and real-world data, which is why we need both."

And it asserts that "the more GDMT you're on, the better you do," he said. "But does that obviate the need for an ICD? I think that's not clear," in part because of potential confounding in the analysis. For example, patients who can take all four agents tend to be less sick than those who cannot.

"The ones who can get up to four are preselected, because they're healthier," Tung said. "There are real limitations such as metabolic disturbances, acute kidney injury and cardiorenal syndrome, and hypotension that actually make it difficult to initiate and titrate these medications."

Indeed, the major primary prevention ICD trials usually excluded the sickest patients with the most comorbidities, Saba observed, which raises issues about their relevance to clinical practice. But his group's study controlled for many potential confounders by adjusting for, among other things, Elixhauser comorbidity score, ejection fraction, type of cardiomyopathy, and year of device implantation.

"We tried to level the playing field that way, to see if despite all of this adjustment the incremental number of heart failure medicines stills make a difference," Saba said. "And our results suggest that yes, they still do."

The analysis of patients with HFrEF involved 3210 with ICD-only implants and 1762 with CRT-D devices for primary prevention at a major medical center from 2010 to 2021. Of the total, 5% had not been prescribed any of the four GDMT agents, 20% had been prescribed only one, 52% were prescribed two, and 23% were prescribed three or four. Only 113 patients had been prescribed SGLT2 inhibitors, which have only recently been indicated for HFrEF.

Adjusted hazard ratios for death from any cause at 2years for each added GDMT drug (P< .001 in each case), were:

0.64 (95%CI, 0.56- 0.74) for ICD recipients

0.70 (95%CI, 0.58- 0.86) for those with a CRT-D device

0.70 (95%CI, 0.60- 0.81) for those with ischemic cardiomyopathy

0.61 (95%CI, 0.51- 0.73) for patients with nonischemic disease

The results "raise questions rather than answers," Saba said. "At some point, someone will need to take patients who are optimized on their heart failure medications and then randomize them to defibrillator versus no defibrillator to see whether there is still an additive impact."

Current best evidence suggests that primary prevention ICDs in patients with guideline-based indications confer benefits that far outweigh any risks. But if the major primary prevention ICD trials were to be repeated in patients on contemporary quad-therapy GDMT, Tung said, "would the benefit of ICD be attenuated? I think most of us believe it likely would."

Still, he said, a background of modern GDMT could potentially "optimize" such trials by attenuating mortality from heart failure progression and thereby expanding the proportion of deaths that are arrhythmic, "which the defibrillator can prevent."

Saba discloses receiving research support from Boston Scientific and Abbott; and serving on advisory boards for Medtronic and Boston Scientific. The other authors report they have no relevant relationships. Tung has disclosed receiving speaker fees from Abbott and Boston Scientific. Fonarow has reported receiving personal fees from Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Edwards, Janssen, Medtronic, Merck, and Novartis.

JJ Am Coll Cardiol EP. Published online July27, 2022. Abstract

Follow Steve Stiles on Twitter: @SteveStiles2. For more from theheart.org, follow us on Twitter and Facebook.

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Do ICDs Still Work in Primary Prevention Given Today's HF Meds? - Medscape

The combustible combination of lightning, a record-setting heat wave, a weeks-long dry spell and gale-force winds on Sunday afternoon, July 31, contributed to Baker Countys biggest wildfire so far this year.

The Big Rattlesnake fire burned 425 acres in the remote Powder River Canyon between Thief Valley Reservoir and Highway 203, and for a few hours posed a threat to several homes.

The Baker County Sheriffs Office issued a Level 2 evacuation notice be prepared to leave at a moments notice for five or six homes on the west side of Highway 203 on Sunday evening, and a Level 1 notice be ready for the possible need to evacuate for residents east of the highway along Miles Bridge Road.

No one was evacuated, and no structures were damaged, said Jason Yencopal, the countys emergency manager. The evacuation notice was canceled for areas east of the highway on Monday morning, Aug. 1, and reduced to Level 1 for homes west of the highway, Sheriff Travis Ash said.

There are three levels of evacuation notice. Under Level 3, which was not initiated for the Big Rattlesnake fire, residents are told to leave immediately.

Ash said on Monday morning that the preliminary evacuation notices were given as a precaution mainly due to the strong winds that initially caused the fire, which was reported a little before 5 p.m., to grow rapidly.

When the wind calmed later Sunday evening, the fire activity also slowed, Ash said.

Jonathan Dunbar, fire duty officer for the Bureau of Land Managements Vale District, said the fire did not grow overnight Sunday into Monday.

Crews will continue to secure the perimeter and mop up today, Dunbar said in a press release Monday morning.

Rancher grateful for fast work by firefighters

Mike McGinnis smelled the smoke and watched the powerful gusts bending the grass near the ranch he and his wife, Nicky, own just west of Highway 203 between the Powder River and Medical Springs.

McGinnis feared that if the flames crossed the Big Creek canyon, which is between his home and where the fire started, those winds could quickly push the fire toward his house and outbuildings.

But later on Sunday evening the wind shifted direction, he said, blowing the flames back toward areas that had already burned.

McGinnis said the fire didnt get closer than about a mile to his home.

On Monday morning McGinnis said he was grateful for the amazing response by firefighters, many of them volunteers from local districts.

You just cannot say enough about these rural volunteer firefighters, McGinnis said. Theyre willing to put everything on the line. Were blessed with a great community. People truly care. Its a great feeling.

McGinnis said he was home when the storm that sparked the fire passed through.

Terrain blocks his view of the spot where the lightning bolt struck, but McGinnis said a neighbor, John Wirth, saw the lightning and phoned after seeing the smoke rising.

Wirth said he was driving on Blue Mountain Ridge Road, which follows a spine of high ground east of Highway 203, when he saw the thunderstorm approaching.

Wirth said when lightning threatens he usually tries to find an elevated vantage point to watch for downstrikes and the fires that are likely to start as a result. He said he has seen that happen several times.

On Sunday evening, Wirth said he could see flames within just a few seconds of the bolt hitting west of Big Creek.

Its just about immediate fire, he said. Theres a lot of fuel, and there was a lot of wind then.

On Monday morning, McGinnis said he was watching through binoculars as firefighters worked on the blaze, which seemed to be mainly out, although he did see some smoke.

Theyre doing a great job, he said.

Winds caused major concern

Although there are no weather stations close to the fire, the wind gauge at the Baker City Airport recorded a peak gust of 62 mph at 7:38 p.m. on Sunday.

Winds propelled a dust cloud from a fallow field just north of Baker City a little after 7 p.m.

Buzz Harper, chief of the Keating Rural Fire Protection District, estimated winds were gusting between 45 and 50 mph when he arrived Sunday evening.

Colby Thompson, chief of the North Powder Rural Fire Protection District, said the wind direction shifted four times while he was working on the fire Sunday evening.

Three single-engine aircraft dropped retardant ahead of the fire on Sunday evening, said Larisa Bogardus, public affairs officer for the Bureau of Land Managements Vale District.

Harper served as incident commander for areas along Highway 203, and he assigned fire trucks to protect the McGinnis ranch and several other homes west of the highway, which leads north through Pondosa and Medical Springs to Union.

The trucks were reassigned later on Sunday evening after the threat eased, Ash said.

Highway 203 was closed temporarily except for fire vehicles and local traffic.

Everybody did really well, Harper said on Monday morning. We had a lot of resources.

He credited the Sheriffs Office and Oregon State Police for helping notify residents about evacuation levels, and the Oregon Department of Transportation for coordinating the highway closure.

Harper said the Sheriffs Offices mobile communications trailer was also a benefit to the multiple agencies that responded.

Fuels have dried during recent rainless stretch

The fire started about half a mile north of the Powder River and about a mile west of Big Creek.

Both the river and the creek flow through deep, steep canyons.

The fire burned in dense thickets of sagebrush, with lighter fuels on ridgetops, Bogardus said.

Fuels have dried considerably during a lengthy rainless stretch that followed the damp, cool spring.

The Baker City Airport has recorded just 0.08 of an inch of rain scarcely enough to dampen the ground since June 4.

Phil Whitley, chief of the Medical Springs Rural Fire Protection District, said rain fell in the area Sunday evening, but amounts were generally meager.

The fire burned on both public and private land, Bogardus said.

The area includes sage grouse habitat, she said.

The fire is within the BLMs 5,880-acre Powder River Canyon Area of Critical Environmental Concern. The agency manages the public land to protect raptor and wildlife habitat and scenic qualities, according to a BLM press release.

On Monday morning, six fire engines were working on the fire and two 20-person crews were en route, Bogardus said.

Single-engine tankers and helicopters were available if needed, she said.

Whitley, who lives near Medical Springs, said he saw several lightning bolts before receiving a page on his radio about the fire.

Whitley said seven volunteers from the Medical Springs district assembled. They tried to reach the fire from a dirt road that leads west from Highway 203, but Whitley said the road, which descends into the Big Creek canyon, crosses the creek and continues west up the Powder River, was too rough to negotiate with a truck laden with water.

Whitley said crews from other agencies were able to get to the fire via that route later.

Thompson, chief of the North Powder Rural Fire Protection District, said volunteers from the department used a bulldozer to make the road passable to fire engines, including four from the North Powder district. A total of 17 volunteers from the district worked on the fire Sunday, Thompson said.

A major focus initially was to protect the McGinnis ranch, Whitley said.

Their home was closest to the fire, and the powerful winds, which were shifting direction frequently, made it difficult to predict where the fire was moving, Whitley said.

Other agencies that responded to the Big Rattlesnake fire include the Baker Rural Fire Protection District, Lookout-Glasgow Rangeland Fire Protection Association and Eagle Valley Rural Fire Protection District.

Other, smaller fires reported

Lightning from a series of thunderstorms that moved through the region Sunday afternoon and evening sparked at least two other, much smaller, blazes.

One burned a quarter of an acre about 2.5 miles north of Anthony Lakes.

The other burned less than a tenth of an acre near the Kelly Mine, about 2 miles north of Bourne.

The combination of hot temperatures a record high was set at the Baker City Airport on July 29, and the record tied on July 30 and lack of rain has resulted in rapidly rising fire danger.

The Energy Release Component, a measurement of how fast a fire would spread, had been below average for most of the summer for each of the six regions that the Blue Mountain Interagency Dispatch Center in La Grande monitors.

But over the last week of July that figure, which is updated daily, climbed above average in each region.

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Wind-fanned lightning fire prompted precautionary evacuation notices near Medical Springs Sunday evening - Baker City Herald

Aliria Rosa Piedrahita de Villegas should have developed Alzheimers disease in her 40s and died from the disease in her 60s because of a rare genetic mutation.

Instead, she lived dementia-free into her 70s, and now her brain is yielding important clues about the pathology of dementia and possible treatments for Alzheimers disease.

As researchers at Massachusetts General Hospital and other centers first described in 2019, the woman, from Medellin, Colombia, was a member of an extended family with a mutation in a gene labeled PSEN1. The PSEN1 E280A mutation is autosomal dominant, meaning that only a single copy of the gene is required to cause disease. Carriers of the mutation typically exhibit symptoms of Alzheimers in their 40s or 50s, and die from the disease soon after, but this woman did not begin to show signs of Alzheimers until her early 70s. She died in 2020 from metastatic melanoma at the age of 77.

The key difference in the Colombian womans ability to fend off the disease for three decades appeared to be that in addition to having the PSEN1 E280A mutation, she was also a carrier of both copies of a mutation known as APOE3 Christchurch.

This exceptional case is an experiment designed by nature that teaches us a way to prevent Alzheimers: lets observe, learn, and imitate nature.

Francisco Lopera, director of the Neuroscience Group of Antioquia in Medelln, Colombia.

The APOE family of genes control production of apolipoproteins, which transport lipids (fats) in blood and other bodily fluids.The APOE2 variant is known to be protective against Alzheimers dementia, while the APOE4 variant is linked to an increased risk for the disease.

APOE3, the most common variant, is not typically associated with either reduced or increased risk for Alzheimers.

This is a ground-breaking case for Alzheimers disease and has already opened new paths for treatment and prevention, which were currently pursuing with some collaborators. This work is now bringing light into some of the mechanisms of resistance to Alzheimers disease says investigator Yakeel T. Quiroz

Quiroz is director of theMulticultural Alzheimer Prevention Program (MAPP) at Mass General, an associate professor of psychology at Harvard Medical School, andPaul B. and Sandra M. Edgerley MGH Research Scholar 2020-2025.

As Quiroz and colleagues now report in the neuropathology journalActa Neuropathologica, the woman did, in fact, have pathologic features of Alzheimers disease in her brain, but not in regions of the brain where the hallmarks of Alzheimers are typically found.

This patient gave us a window into many competing forces abnormal protein accumulation, inflammation, lipid metabolism, homeostatic mechanisms that either promote or protect against disease progression, and begin to explain why some brain regions were spared while others were not, says Justin Sanchez, co-first author, and an investigator at MGH Neurology.

Researchers identified in Alirias brain a distinct pattern of abnormal aggregation or clumping of tau, a protein known to be altered in Alzheimers disease and other neurologic disorders.

In this case, the tau pathology largely spared the frontal cortex, which is important for judgment and other executive functions, and the hippocampus, which is important for memory and learning. Instead, the tau pathology involved the occipital cortex, the area of the brain at the back of the head that controls visual perception.

The occipital cortex was the only major brain region to exhibit typical Alzheimers features, such as chronic inflammation of protective brain cells called microglia, and reduced levels of APOE expression.

Thus, the Christchurch variant may impact the distribution of tau pathology, modulates age at onset, severity, progression, and clinical presentation of [autosomal dominant Alzheimers disease], suggesting possible therapeutic strategies, the researchers write.

It is seldom that we have nice surprises while studying familial Alzheimers disease brains. This case showed an amazingly clear protected phenotype. I am sure our molecular and pathologic findings will at least suggest some avenues of research and elicit hope for a successful treatment against this disorder. says co-first author Diego Sepulveda-Falla, research lead at University Medical Center Hamburg-Eppendorf in Hamburg, Germany.

This exceptional case is an experiment designed by nature that teaches us a way to prevent Alzheimers: lets observe, learn, and imitate nature, concludes Francisco Lopera, director of the Neuroscience Group of Antioquia in Medelln, Colombia. Lopera is a co-senior author and the neurologist who discovered this family and has been following them for the last 30 years.

Quiroz is a co-senior author of the report, along with Kenneth S. Kosik, University of California, Santa Barbara; Lopera, and Sepulveda-Falla. Sanchez contributed equally to the study.

The study was supported by grants from the National Institutes of Health, MGH Executive Committee on Research (MGH Research Scholar Award), Alzheimers Association, the Deutsche Forschungsgemeinschaft, Universidad de Antioquia, the Werner Otto Stiftung, and the Gernam Federal Ministiry of Education and Research.

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Alzheimer's-defying brain offers clues to treatment, prevention - Harvard Gazette

Health awareness

In this Teal Talks episode, TV host and cancer survivor Samantha Harris leads the conversation about the advances in cancer screenings and early prevention with three renowned cancer specialists

You may know Samantha Harris from hosting eight seasons of Dancing with the Stars and her many years on Entertainment Tonight, but shes also a cancer survivor or cancer thriver, as she prefers to be called.

At age 40, Harris was diagnosed with stage II invasive breast cancer and underwent a double mastectomy. Since her diagnosis, the Emmy-winning TV personality has become a fierce advocate for living a healthier life to help prevent chronic diseases like cancer.

We need to be our own best health advocates by knowing our body so we can recognize any changes and then find the right expert in the medical field to assess if there is or isnt something to worry about, said Harris, whos been in remission since October 2014.

In episode 5 of Teal Talks, Harris sits down with Dr. Laura Makaroff, SVP, prevention and early detection, American Cancer Society, and Mercks Dr. Scot Ebbinghaus, VP, late-stage oncology, and Steve Keefe, AVP, global clinical development, oncology, to discuss cancer prevention and advances in screening.

According to the American Cancer Society, about 18% of cancers in the U.S. are related to modifiable risk factors, and thus could be preventable.

Screening tests are another component of cancer prevention. Certain screenings aim to find cancer before it causes symptoms and when it may be easier to treat. There arent currently screening tests for every type of cancer, but there are several tests that health agencies recommend for breast, cervical, colorectal and lung cancers.

Cancer screening recommendations vary from country to country, so its important to talk to your doctor about which tests are right for you.

There are some people who fit a high-risk category because they have a family history of cancer or some other inherited condition and might need to start screening earlier or do a different kind of screening test than the average-risk population, said Makaroff. Its an important topic to bring up with your doctor and make sure that you, as a patient, know to ask the right questions.

[Source: American Cancer Society]

The COVID-19 pandemic caused a significant interruption to cancer screening services. In the U.S., it is estimated that 9.4 million cancer screenings were missed from January through July 2020 vs the same period in 2019.

Theres no one-size-fits-all type solution to get things back on track, said Keefe. But community outreach can help get peoples awareness about the importance of screenings back on track and help reassure people that when they return to the doctors office or clinic, precautions will be in place to help keep them safe from COVID-19.

Despite some of the dire statistics around cancer care disruptions, the health care industry gained some valuable lessons from the pandemic.

One of the things that the pandemic has taught us is that we can reach our patients even if they cant come into the doctors office, Ebbinghaus said. Being able to leverage telemedicine to counsel patients and arrange for testing could really help improve cancer preventative care.

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Experts discuss importance of cancer screenings and early detection - Merck