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Imagine for a minute that you want to help animals, want to preserve history or serve as a volunteer firefighter or help veterans in Kerr County. So, the best possible solution is to ask the Kerr County Commissioners Court to help fund those endeavors.

If those areas interest you, just be warned that you better find alternative funding, because the Kerr County Commissioners cant seem to commit when it comes to funding those things. Using the excuse that they were required statutorily to spend money on certain services, the commissioners held up funding for volunteer fire departments, veterans and the historical commission. After pressure from residents, especially veterans, the county delivered the money although less than what was previously given to the groups.

When it comes to funding for themselves, the county commissioners were pretty quick to give themselves a raise. Well, its not really a raise if you believe the county but its a longevity increase, which will be doled out to every member of the commissioners court.

This was part of the 2021 budget approved by the commissioners on Monday. The salary part of the budget was voted on separately and approved unanimously. So heres how this breaks down:

During their meeting, the commissioners made it clear that this was a requirement based on a previous action the court made to grant longevity increases for elected officials.

Moser said it was very important for people to understand that this was a longevity increase. The total amount of money the commissioners gave themselves adds up to about $3,500.

You can call it anything you want. You can say its required. But it is within this courts authority to take action to reverse this.

Sure, its great that they will give longevity increases to all county employees, but you dont have to give one to yourselves. Take one for the team, and bypass the raise.

This move speaks to the problem with the court on the subject of fiscal responsibility. By comparison, the city of Kerrville adopted a budget that essentially froze salaries and will leave some positions unfilled.

The citys top management, led by City Manager Mark McDaniel, all took voluntary pay cuts. Others in the city staff attempted to volunteer to take pay cuts to help the citys bottom line, but those overtures, while appreciated, were rejected by the City Council.

In turn, the city has vowed not to reduce essential services when it comes to its 2021 budget.

In contrast, in recent weeks, the county has made it clear to organizations, such as volunteer fire departments, that it no longer has the money to provide funding for those efforts and that they should seek funding through other sources.

The county went through an arduous exercise last year in saying it could no longer afford some of the animal control services it provides the community. The countys answer has been to solicit nonprofit groups, such as Kerrville Pets Alive, to handle the work they dont want to do or to fund.

Earlier this year, county officials discussed defunding the veterans service office, which plays an essential role in helping Kerr County veterans navigate the complex Veterans Affairs Administration, along with other services. That drew appropriate outrage from many members of the veterans community.

This last week, the county asked the Historical Commission to defend its budget requests, before approving a meager $4,500.

The coronavirus pandemic has hurt Kerr County economically, but the region appears to be doing better than others. The uncertainty that the virus brings economically shouldnt be discounted.

The fiscally prudent course of action would be to hold off on raises, especially for elected officials, and especially if it means preserving services that benefit residents.

Drafting a budget is one of the courts most important responsibilities. It is within their realm of authority to forgo these raises and instead direct that money to services that will benefit their constituents.

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OPINION: Elected officials salary increase send the wrong message - dailytimes.com

Big Show recently chatted with WWE Now India and answered some fan questions about his career. You can view a video and some highlights of that chat here:

Big Show on his longevity for his career: Somebody said to that to me months ago. Big Show has been performing for four decades! I was just like, I had to take a breath and go, Wow. Okay. Yeah. Thats true. My approach has always been about being dependable and being universal. Everything cant be about yourself to be successful and to have a long career. Sure, you have to take the opportunities that youre given and make the most out of them, but also, its about supporting other talent and bringing other talent along. So for me, I think my willingness to try anything and my willingness to be dependable and my willingness to help others succeed is why Ive been around so long.

On if he wants to face Keith Lee: Keith has a ton of momentum behind him right now. I think hes a tremendous competitor. I think if there was an opportunity for me to step in the ring and help Keith on his journey in some way, shape or form, Id love to do. Plus, hes got a good chest for chopping.

Big Show on the best advice he got in the business: I would say one of the earlier pieces of advice I got was from the legendary Big Boss Man, Ray Traylor. I had been in the business about six months, maybe, and this is when I was with WCW. I was going into the gym as he was coming out and we talked for a bit. He was a super nice guy. He said, Kid, Im going to tell you something. Be nice to everyone and be humble on the way up because you meet the same people on the way down. And hes right because no one stays on top forever. That mountain top is always changing. So, if youre rude and a jerk on the way to the top, theres going to be no support for you when you have to step aside for someone else whenever that time comes. And thats strong advice for treating everyone else the way you want to be treated. That and Macho Man Randy Savage used to tell me all the time, Keep that credit card in your wallet, and dont try to run with the Jones. Save your money, kid. So, that was Macho Man all the time. I think Macho Man still had his tooth fair money. He was very frugal, extremely frugal.

On his plans after he retires from the ring: Knowing me, if I retire from WWE, competing in the ring, Ill still be involved somehow. Either helping young Superstars behind the scenes, or Ill roll into some kind of project that stays busy. Im a whats today, whats tomorrow kind of guy. I dont look into the past. You cant change the past. You can learn from your mistakes and try not to repeat them. But living in past glories or past accolades limits you from creating any new memorable moments. So, my attitude is always one of onward and upward. Whats today. Whats tomorrow. What are are going, what are doing? It will be something fast paced and something positive, for sure because I cant sit still.

If using any of the above quotes, please credit WWE Now India, with a h/t to 411mania.com for the transcription.

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Big Show on His Longevity: 'My Approach Has Always Been About Being Dependable and Universal' - 411mania.com

LONDON--(BUSINESS WIRE)--Technavio has been monitoring the precision medicine software market and it is poised to grow by USD 882.65 mn during 2020-2024, progressing at a CAGR of about 11% during the forecast period. The report offers an up-to-date analysis regarding the current market scenario, latest trends and drivers, and the overall market environment.

Although the COVID-19 pandemic continues to transform the growth of various industries, the immediate impact of the outbreak is varied. While a few industries will register a drop in demand, numerous others will continue to remain unscathed and show promising growth opportunities. Technavios in-depth research has all your needs covered as our research reports include all foreseeable market scenarios, including pre- & post-COVID-19 analysis. Download a Free Sample Report on COVID-19 Impacts

Frequently Asked Questions:

The market is fragmented, and the degree of fragmentation will accelerate during the forecast period. F. Hoffmann-La Roche Ltd., Fabric Genomics Inc., Gene42 Inc., Human Longevity Inc., International Business Machines Corp., Koninklijke Philips NV, NantHealth Inc., Roper Technologies Inc., SOPHiA GENETICS SA, and Syapse Inc. are some of the major market participants. The benefits of precision medicine will offer immense growth opportunities. To make most of the opportunities, market vendors should focus more on the growth prospects in the fast-growing segments, while maintaining their positions in the slow-growing segments.

Buy 1 Technavio report and get the second for 50% off. Buy 2 Technavio reports and get the third for free.

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Technavio's custom research reports offer detailed insights on the impact of COVID-19 at an industry level, a regional level, and subsequent supply chain operations. This customized report will also help clients keep up with new product launches in direct & indirect COVID-19 related markets, upcoming vaccines and pipeline analysis, and significant developments in vendor operations and government regulations.

Precision Medicine Software Market 2020-2024: Segmentation

Precision Medicine Software Market is segmented as below:

To learn more about the global trends impacting the future of market research, download a free sample: https://www.technavio.com/talk-to-us?report=IRTNTR40844

Precision Medicine Software Market 2020-2024: Scope

Technavio presents a detailed picture of the market by the way of study, synthesis, and summation of data from multiple sources. The precision medicine software market report covers the following areas:

This study identifies the digitization of healthcare as one of the prime reasons driving the Precision Medicine Software Market growth during the next few years.

Technavio suggests three forecast scenarios (optimistic, probable, and pessimistic) considering the impact of COVID-19. Technavios in-depth research has direct and indirect COVID-19 impacted market research reports.

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Precision Medicine Software Market 2020-2024: Key Highlights

Table of Contents:

PART 01: EXECUTIVE SUMMARY

PART 02: SCOPE OF THE REPORT

PART 03: MARKET LANDSCAPE

PART 04: MARKET SIZING

PART 05: FIVE FORCES ANALYSIS

PART 06: MARKET SEGMENTATION BY DELIVERY MODE

PART 07: CUSTOMER LANDSCAPE

PART 08: GEOGRAPHIC LANDSCAPE

PART 09: DECISION FRAMEWORK

PART 10: DRIVERS AND CHALLENGES

PART 11: MARKET TRENDS

PART 12: VENDOR LANDSCAPE

PART 13: VENDOR ANALYSIS

PART 14: APPENDIX

PART 15: EXPLORE TECHNAVIO

About Us

Technavio is a leading global technology research and advisory company. Their research and analysis focuses on emerging market trends and provides actionable insights to help businesses identify market opportunities and develop effective strategies to optimize their market positions. With over 500 specialized analysts, Technavios report library consists of more than 17,000 reports and counting, covering 800 technologies, spanning across 50 countries. Their client base consists of enterprises of all sizes, including more than 100 Fortune 500 companies. This growing client base relies on Technavios comprehensive coverage, extensive research, and actionable market insights to identify opportunities in existing and potential markets and assess their competitive positions within changing market scenarios.

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Precision Medicine Software Market- Roadmap for Recovery from COVID-19|Benefits Of Precision Medicine to Boost the Market Growth | Technavio -...

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For my review of the latest Motorola Razrset for release this fall, I tested the updated foldable phone for 10 days in September. Occasionally when I opened or closed the phone, an onlooker would react with disbelief. One woman working behind the register of a coffee shops to-go window actually gathered her (masked and socially distanced) co-workers and asked me to show them how the Razr folded in half. When I demonstrated the screen folding like paper, her response was: That is amazing. Where do I get one?

And thts the mgic of foldble phones t their core. They seemingly do the impossible by letting you tke something rectngulr nd rigid nd fold it into something smller thn drink coster. Tht mgic comes from yers of design, testing nd revisions. And the engineers nd designers who worked on the upcoming Motorol Rzr know its nything but mgic to mke 6.2-inch phone fold in hlf.

But ll tht work cn be esily overshdowed. The review units of 2019s Smsung Glxy Foldrised the flg bout how folding screens would work in the rel world. A number of them hddefectsn>tht let dust or other prticles get underneth the screen nd wrek hvoc. Any concerns people hd bout folding displys were instntly mplified.

Then in Februry 2020 fter months of delys, Motorol relesed its Rzr (2019) with foldble screen nd CNETs video tem tested the displys durbility. My collegue Chris Prker used FoldBot nd ttempted to open nd close the phone 100,000 times. After 27,000 folds the Rzr (2019) wsnt ble to be tested further. Reflecting on tht test nd how SqureTrde modified its FoldBot to hndle the Rzrn>, Prker concluded:

Does [it] feel like durble, resilient phone tht will stnd up to extended rel-world use? To me it does.

These incidents might mke you wonder if foldble screens re durble. And if so, how do we know? Jeff Snow, generl mnger of innovtion products t Motorol, thinks its nturl to sk durbility questions bout foldble screens.

The new thing bout the phone is the fct tht the screen folds open nd you cn light it up, sid Snow. People re not used to phones with those folding screens. So the questions in their minds re, Is it going to lst? How mny times cn I ctully do tht ction?'

Motorol clims the screen on its upcoming, updted Rzr (2020) cn be folded 200,000 times. To give you n ide how mny times tht is, you could open nd close the phone 100 times dy for five yers nd still not hit tht number.

To show me how the compny determined nd tested the number of times the upcoming Rzrs screen could be folded, I visited lb t Motorol in Chicgo while wering msk nd socil distncing to meet Snow nd Tom Gitzinger, director nd principl engineer of innovtion nd rchitecture for Motorol. I got to see for myself how Motorol tests the screen on the upcoming Rzr.

In room tht looks like college blck box theter re number of lights ll focused on roughly 10-foot-wide mchine. There is cmer on tripod pointing t the mchine which gives the entire spce n odd television show vibe. On the top of the wist-high mchine on their bcks, re four Rzr (2020) phones. The mchine fully opens nd closes ll four phones t the sme time over nd over.

Throughout the design nd mnufcturing process, Motorol uses similr mchines to test the folds on the Rzr (2020). Unlike the Smsung Glxy Z Flip, which is designed to be opened to vriety of positions, the Rzr is built to either be fully open nd flt or completely closed. And unlike the Foldbot, Motorols mchine uses wire to open the Rzrs perfectly flt nd n rm to close them shut. The wire is thin enough to nestle between the two hlves of the phone when its closed.

To recrete those 200,000 folds in less thn five yers time, the mchine fully opens nd closes the phones once every 4 seconds. There is clming qulity to hering four phones shut closed every 4 seconds. Its like soft-sounding metronome. It tkes Motorol 10 dys to fold ech phone 200,000 times with this mchine.

Over the pst six months Motorol reched out to people who own the Rzr (2019) to lern how they use the phone. According to Snow, Rzr owners open nd close their phones on verge 40 times dy. And super users (the 99th percentile), verge 100 times dy. Hence, Motorol designed the upcoming Rzr (2020) to hndle 200,000 folds.

Were not chnging the prmeters of testing, sid Snow. But we wnt to mke sure tht were understnding people nd exceeding their expecttions.

The phones zero gp design, screen nd hinge llows the Rzr to chieve high level of screen durbility. The upcoming Rzr (2020) lrgely uses tht sme design s the Rzr (2019) lbeit with tweks. In fct, if you wnt to lern more bout the hinge tke look below t video I mde lst yer bout its design nd how it llows the Rzr (2019) to fold flt.

The screen itself is mde of five different lyers nd then spryed with hrd coting. When the lyers re combined the screen hs thickness of 355 microns (3.5 millimeters). To give you sense of how thin tht is, the Motorol Edge Plusn> uses similr OLED pnel stck for the curved edges of its screen which is three times the thickness of the Rzrs disply stck.

And its not just the disply tht is folding in hlf. There re number of connections including the four 5G ntenns tht hve to trverse the hinge. And like other foldble phones, the bttery in the Rzr is ctully two btteries, one on ech end. Not only does this help with blnce, but it dds nother level of complexity s both hve to connect through the Rzrs hinge mechnism.

When I reviewed the Rzr (2019) in Februry, it suffered from squek/crek. It ws like muffled crunching sound but loud. During my time with the upcoming Rzr (2020), the squek/crek ws mostly bsent until Fridy my eighth dy with the phone. And when it did squek, it ws quieter sound, more like breking in pir of new lether boots. Gitzinger explined the noise by compring it to bg of potto chips.

You cnt possibly open potto chip bg without mking noise. Its super thin. Its lot more crunchy nd crinkly thn something like this [the foldble disply]. But the sme principle pplies, sid Gitzinger. Youve got this big, significnt surfce tht moves round, nd its pushing ir tht cretes some of the noises. We were ble to eliminte other noises by putting in some old friction dhesives nd tpes nd surfces to enble everything to slide pst one nother bit more esily.

I sked friend how they felt bout the squek/crek on the upcoming Rzr (2020) nd they sid it didnt bother them. I guess when it comes to screen notches, foldble screen creses nd now foldble phone squeks, some people will get used to these things while others will be nnoyed.

With the improvements mde, Motorol is confident bout the upcoming Rzrs durbility. In fct, the compny runs 40 different lb checks to test both the design nd qulity of the phone during development nd mnufcturing.

Tht sid, the true indictor for how durble the screen on the Rzr (2020) or ny foldble phone is time. Until then, just like mgic, foldble phones require bit of fith.

For more detils mke sure to check out my review of the upcoming Motorol Rzrn>.

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Worried regarding foldable phones longevity? Heres just how Motorola evaluates the Razr joint - Entertainment Overdose

Singapore has launched the LumiHealth app with Apple, in an innovative move to help improve health and wellness outcomes. The collaboration was announced today as part of the countrys Smart Nation initiative. A national effort to leverage technology to deliver benefits to its citizens and businesses.

LumiHealth will use technology and behavioral insights to encourage Singaporeans to maintain healthy and complete wellness challenges through their Apple Watch and iPhone. The app was created by a team of physicians and public health experts.

According to Bloomberg, as part of the scheme, Singapore residents will be able to earn as much as S$380 ($280) in rewards and vouchers by completing goals and tasks set within the app. Goals can be accomplished by walking or doing other exercises like swimming or yoga. The LumiHealth app will offer personalized coaching and reminders for health screenings and immunizations. Wellness challenges will nudge users toward making better food choices and improving sleep habits.

The LumiHealth program is voluntary. While the issue of privacy of data is always debated when an initiative of this scale is initiated, Apple assured the media the app has been designed with user privacy and security at its core. All user data will be encrypted and none will be sold or shared for marketing purposes.

The Singapore government is known for its innovative approach to health and technology. Singapores Deputy Prime Minister Heng Swee Keat told media, Even as all of us around the world are dealing with the challenges of COVID-19, we must keep investing in our future. And there is no better investment than in our own personal health.

Singapore has one of the worlds leading healthcare systems, and we are thrilled to be partnering with them to incorporate Apple Watch and LumiHealth into their holistic approach to well-being, said Jeff Williams, Apples chief operating officer. Apple Watch has already helped millions of our customers manage their activity levels to improve their health, and we look forward to applying our expertise here in the same privacy-friendly way that distinguishes all Apple products and services.

LumiHealth is available in the App Store for pre-order now, and the two-year program will be offered from late October 2020.

The city-state was among the first to roll out a contact-tracing app to help combat the coronavirus pandemic this year. It is expanding that effort by distributing tokens that will allow residents to enter selected venues, in an effort that may pave the way for larger gatherings.

Technology is shaping our future and longevity. Click here to read more.

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Singapore and Apple Launch LumiHealth App To Boost Wellness - Longevity LIVE

Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., et al (2012). Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science translational medicine,4(151), 151ra125. https://doi.org/10.1126/scitranslmed.3004006

Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., et al. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. The New England journal of medicine,367(5), 399410. https://doi.org/10.1056/NEJMoa1108524

Mizushima D et al.(2020).Prophylactic effect of PrEP against HBV infection among MSM.Conference on Retroviruses and Opportunistic Infections, abstract 1025.

Spinelli, M. A., Glidden, D. V., Anderson, P. L., Gandhi, M., et al. (2019). Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project. AIDS research and human retroviruses,35(9), 788793. https://doi.org/10.1089/AID.2018.0297

Volk, J., Marcus, J.L., Phengrasamy, T., Blechinger, D., et al. (2015). No New HIV Infections With Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting,Clinical Infectious Diseases, Volume 61, Issue 10, Pages 16011603,https://doi.org/10.1093/cid/civ778

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PrEP: Everything Men Need To Know About Pre-Exposure Prophylaxis - Longevity LIVE

Military officials: Live mortar round found in Carter Co. backyard 'could be anywhere from WWII to the Vietnam War era'News / 23 mins ago

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Military officials: Live mortar round found in Carter Co. backyard 'could be anywhere from WWII to the Vietnam War era' - WJHL-TV News Channel 11

Image credit: Merakist on Unsplash

SEO has become a leading digital marketing strategy

Consider SEO, for instance. Search engine optimisation is all about giving businesses and entrepreneurs alike a way to measure success online through organic growth and rising prominent presents in online search engines around the globe. SEO has been played with its fair share of criticism and controversy over the years, however, for the most part SEO has more than pregnant it's value and today it is one of the leading digital marketing strategies there is. The success and longevity it is measured through SEO marketing is really about approaching SEO from a strong perspective as well as one that is coming hand in hand with a strong and structured stance.

The powerful potential of local SEO strategies

And then there is local SEO. What is local SEO?, you may ask. In short, local SEO is essentially a digital marketing strategy that allows local businesses to become discoverable and search engines on a local basis. This is focused on different SEO factors such as link building and on-page optimisation and the goal is always to get a website to the front page of Google for elephant searches within a local dermographic. Local SEO essentially takes SEO to the next level by giving websites and web pages a chance to move up in the ranks on search engines for keywords that are on a local standard and that genuinely positively impact the overall approach to SEO.

Why local SEO has so much to offer modern businesses

At the end of the day, SEO is incredibly powerful and local SEO is even more so. More than anything else, local SEO now has so much to offer modern businesses because it effectively gives you the momentum and the potential to rise up in search engines and an organic level and in ways that are entirely interpretive and incomprehensible. Local SEO is well and truly on the rise and while SEO itself is a leading digital marketing strategy today, there is no reason at all to think that local SEO is not going to rise to the same global levels of longevity and success in the coming years and beyond.

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Embracing the powerful potential of local SEO - Bizcommunity.com

Consider this stat: through the Lakers 9-2 playoff start, LeBron James has averaged 33.9 minutes per game. That is less than his 19/20 regular-season average (34.6) and far lower than his career 41.7 average postseason minutes per game. So much the Lakers weak supporting cast.

Everyone expected to see the large minutes LeBron had to play to drag Cleveland to the Finals year after year in the East, particularly after getting an unexpected rest due to COVID-19. Above all else, this speaks volumes about Anthony Davis. Throughout the playoffs, and particularly last night, AD has proven he is probably the best teammate LeBron has ever had.

You could try and make the case for Dwyane Wade, but he was beyond his prime when LeBron joined him in South Beach. Davis is entering his prime, and finally in the spotlight after his dramatic exit from New Orleans. Not only that, but AD is positionally a better fit with LeBron. Hell, at this pace, those LeBron and Bronny in the NBA comments dont sound ridiculous anymore.

Such longevity proves LeBron is one of the most intelligent basketball players of all time the way James managed his career, on and off the court, is unprecedented. One of the most impressive arguments for this case is definitely the most underappreciated one. Out of all the greatest ones, LeBron did most on his own.

LeBron James came straight from high school. Do you know who his coach is? He didnt go to college. Hes taken every rookie coach hes had to the NBA Finals. From an educational standpoint, his knowledge base, where did this brain come from? Hes the Einstein of basketball. When you look at myself, a Jordan, a Shaq we had Hall of Fame coaches.

Jordan had Dean Smith, Doug Collins, Phil Jackson, and Tex Winter. Thomas had Chuck Daly. Kobe and Shaq had Phil Jackson. Bird had Red Auerbach, Magic played for Pat Riley. Who did LeBron have? The only Hall of Fame influence in his career was the mentioned Pat Riley, and he wasnt his coach but team president. Erik Spoelstra is a tremendous basketball coach and will end up being one of the best in his era.

The most important thing Riley and Spoelstra taught LeBron was how to win, they educated him in the Heat way. But you could argue LeBron picked up all the tricks in the first two years with them. Here are LeBrons coaches before he arrived at South beach Dru Joyce, Paul Silas, Brandan Malone, and Mike Brown. After Riley and Spo? David Blatt, Tyrone Lue, Luke Walton, and now Frank Vogel.

You just dont walk in from high school, with no institutional knowledge, and dominate a sport for the years that hes dominated.

There a different side to that coin. LeBron couldve had many more years surrounded with Hall of Fame institutional knowledge if he had stayed in Miami. He didnt like the fact that Riley and Spo didnt bend to superstar desires nearly as much as other franchises do. Lebron chose to leave and run the show somewhere else.

But Zekes point still mostly stands. Not until he was 26 years old did LeBron play under true Hall of Fame leadership. To achieve everything hes done, before and after, particularly develop such a basketball mind on his own is mind-boggling.

LeBron is probably the greatest all-around athlete in professional sports. No one that big should be able to be as strong, as fast, and as agile. But his longevity and the story of his career are a testament that Lebrons strongest brain is the one between his ears.

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HE IS THE EINSTEIN OF BASKETBALL What separates LeBron from every other GOAT candidate - Basketball Network

A new study has revealed psoriatic arthritis may be activated by the same trigger in different patients. Researchers from the University of Oxford and the Wellcome Sanger Institute identified high levels of a specific receptor in immune cells from psoriatic arthritis patients, giving the strongest evidence yet of a single cause for the disease.

Published today (21st September) inNature Communications, this could lead to finding the exact molecular 'trigger' and gives hope for developing a targeted treatment in the future.

A third of patients with the skin condition psoriasis, will develop psoriatic arthritis, which typically causes affected joints to become swollen, stiff and painful. Psoriatic arthritis is a long-term condition that can get progressively worse over time. While some treatments are available there is currently no cure, and in severe disease the joints can become permanently damaged, needing surgery.

It was already known that the disease had a number of genetic predispositions, one of which controls how immune cells called T cells see antigen molecules from disease-causing microorganisms. However, it is not understood exactly what triggers the onset of psoriatic arthritis in patients.

Using cutting edge single cell technology, the researchers analysed thousands of individual immune cells from fluid drained from the knees of patients with psoriatic arthritis. They could see which genes were switched on in each cell and showed these T cells had an activated inflammatory profile. The researchers also amplified and sequenced the RNA from receptor genes, to identify active T cell receptors in each cell. The study showed that many T cells in the joint fluid shared an identical T cell receptor and were therefore clones of each other. These were very likely to have been triggered to reproduce themselves by a particular antigen.

Using machine learning to compare these receptors from different patients, they discovered that the expanded clones of T cells were potentially recognising something in common. These cells also shared other markers, including a receptor called CXCR3, that directed them to the inflammation site.

Dr Hussein Al-Mossawi, Honorary Research Associate at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) at the University of Oxford, said: "Our data suggest that psoriatic arthritis doesn't just appear out of nowhere. Each receptor is like a unique lock that recognises a molecular key and we discovered, that across the patients, they are recognising a common molecule. This gives the first evidence that the T cells are seeing and reacting to the same molecule, which acts as a trigger for the disease. We don't know the exact culprit yet, but this a great step forward in understanding the disease."

The large-scale single cell data from the joints and blood of psoriatic arthritis patients were then used to investigate how the T cells could transfer from the blood to the joint to cause the damage.

Dr Sam Behjati, Group Leader and Wellcome Trust Intermediate Clinical Fellow at the Wellcome Sanger Institute commented: "Our study produced the largest single cell dataset from psoriatic arthritis patients to date. It is helping us to understand the intricate mechanisms behind psoriatic arthritis, including starting to unravel the signals that tell the T cells to cross over into the joint fluid. Imagine the cells as train passengers with a ticket that tells them at which station to get off - the single cell data is allowing us to read that destination for each cell, and understand the signals."

Professor Paul Bowness, Professor of Experimental Rheumatology at NDORMS said: "Our findings indicate that specific T cells are likely to be targeted to enter the joint, where they are triggered to expand, creating inflammation and causing psoriatic arthritis. The next stage of research will be to find the key that is unlocking the disease in patients - from the signals that direct cells to the joint, to what then triggers them to expand. If we can understand these, we could move towards creating therapies that would prevent this, potentially providing a cure."

Reference:Penkava, F, Velasco-Herrera, MDC, Young, MD, et al. Single-cell sequencing reveals a clonal expansion of pro-inflammatory synovial CD8 T cells expressing tissue homing receptors in psoriatic arthritis. Nat Commun 2020; doi:10.1038/s41467-020-18513-6

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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Could Psoriatic Arthritis Be Activated by the Same Receptor in Different Patients? - Technology Networks

Arthritis is the most common joint disorder in the United States, and knees are often the first joints affected by the condition.

One study found that in people above age 60, more than 10 percent of men and 13 percent of women had symptoms of arthritis in their knees.

OTC and prescription pain medication can offer relief, but are frequently associated with side effects. These side effects include kidney damage and heart problems.

Almost 20 percent of Americans report some degree of knee pain, according to figures published in 2006 by the Centers for Disease Control and Prevention (CDC). Pain can range from mild stiffness to levels that are nearly disabling.

Recent studies have found that turmeric, a flavorful spice popular in India, may help relieve joint pain. The spice is popular in Ayurvedic medicine, but is mainly used in food in the United States and not as a medication.

Experts say that there is increasingly clear evidence that the active ingredient in turmeric may have health benefits.

It is widely believed that curcumin, which is the active ingredient in turmeric, has anti-inflammatory and antioxidant properties. And for this reason, its frequently used as a supplement by many people to help with joint symptoms, Dr. Nagendra Gupta, FACP, CPE, an internist at Texas Health Arlington Memorial Hospital, told Healthline.

A study published in the medical journal Trials compared the effectiveness of turmeric to that of an anti-inflammatory drug called diclofenac.

The randomized trial gave 139 patients with knee pain either a 500-milligram (mg) capsule of curcumin three times a day or a 50-mg diclofenac pill twice daily. Scientists found that both groups experienced significant pain relief.

Curcumin has similar efficacy to diclofenac but demonstrated better tolerance among patients with knee OA. Curcumin can be an alternative treatment option in the patients with knee OA who are intolerant to the side effects of non-steroidal anti-inflammatory drugs, the study authors wrote.

In another study, published this week in the Annals of Internal Medicine, researchers at the University of Australia in Tasmania assigned 70 participants, over age 40, with knee osteoarthritis (OA) and swelling diagnosed by ultrasound, to receive either 1000 mg per day of turmeric or a placebo.

After 12 weeks, the randomly controlled placebo trial found that an extract of turmeric was more effective than a placebo in reducing knee pain in people with knee osteoarthritis.

Those taking turmeric reported significantly less knee pain at the end of the study, according to the standardized questionnaire.

Researchers emphasized that more research is needed, and the only limiting factor of their study was the small number of participants.

This research also received funding from Natural Remedies PVT Ltd, a company that offers Ayurvedic medicines and herbs.

While this may indicate a conflict of interest, previous research also supports this spices effectiveness for pain relief.

Turmeric (Curcuma Longa) is a frequently used spice in South Asian foods like curries, and it can add a warm orange or yellow color to meats and rice dishes. It also has a long history of use in Ayurvedic medicine.

The active ingredient in turmeric is curcumin, and research finds that it has a surprisingly wide range of beneficial properties.

Curcumin, unlike some NSAIDs, has also been determined to be nontoxic. NSAIDs, such as ibuprofen, taken in excess can cause symptoms that include convulsions, coma, and acute renal (kidney) failure.

Experts say that given turmerics known health benefits, including it in meals is best.

Eating turmeric with fats or oils can improve absorption.

Turmeric however, specifically the phytonutrient curcumin, has so many health benefits, so definitely incorporating turmeric into meals would be ideal as part of an overall healthy lifestyle plan, said Reema Kanda, RD, a clinical dietitian at Hoag Orthopedic Institute.

Incorporating turmeric into meals that contain fats and oils or black pepper will enhance absorption.

Kanda emphasized that the quality of the turmeric powder can also affect bioavailability. She also said, You want to be sure the turmeric powder is free of contaminants that are often found when making powders.

She added that many studies have utilized turmeric extracts over turmeric powder, which has higher amounts of curcumin. Because of that, the studies recommended extracts for therapeutic use for health benefits such as improving in joint pain.

Theres strong evidence that eating the Mediterranean diet may provide significant knee pain relief in people with OA.

Researchers reviewing three different studies found that people with symptoms of arthritis had an improved quality of life after starting the Mediterranean diet.

According to the study, the Mediterranean diet may benefit OA because of its anti-inflammatory properties, tendency to reverse metabolic syndrome (a risk factor of diabetes), and reduce obesity.

Researchers say the diet is also rich in polyphenols (plant compounds), which can prevent inflammation and cartilage destruction, and this could also be why it shows benefit.

While there is no specific diet that works as a cure for arthritis, various studies have shown that a Mediterranean diet can help fight the inflammation associated with arthritis and slow the disease progression, said Gupta.

As always, getting the right dosage is key to staying healthy. While turmeric may help joint pain, more is not always better.

Consuming large amounts of turmeric can have side effects.

Subjects in a 2006 small dose-response study reported a range of adverse reactions from using 500 mg to 12,000 mg of curcumin daily, although the researchers found overall participants tolerated the high levels of the spice.

Of 24 participants, seven reported side effects that included headache, diarrhea, and skin rash. All but one of the people with side effects were taking over 4,000 mg of turmeric.

Turmeric is also high in oxalate, a chemical that in large doses can combine with calcium to create kidney stones.

According to the Food and Drug Administration (FDA), curcumin, the active ingredient in turmeric, is generally recognized as safe. However, the FDA has previously warned that turmeric from Bangladesh contained excessive levels of lead, which can adversely affect health.

Studies have shown that turmeric can have strong anticoagulant effects, which could affect how blood-thinning drugs work in the body.

If you want to try using turmeric to treat joint pain, its always a good idea to speak with your doctor first to make sure it wont interact with medications youre already taking.

Joint pain, especially in the knee, due to arthritis affects about 1 in 10 older Americans.

Research finds that an ingredient in the spice turmeric can significantly reduce knee pain in people with osteoarthritis but it wont improve swelling or change cartilage.

Although considered safe by the FDA, there is strong evidence that turmeric can interact with blood-thinning drugs, and the agency has warned that turmeric imported from Bangladesh has shown high levels of lead.

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Want to Take Turmeric for Arthritis Pain? Here's What to Know - Healthline

Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue.

Osteoarthritis, on the other hand, is usually the result of external lifestyle factors, such as injury and obesity.

Although, as the NHS points out, osteoarthritis can be associated with the joints severely damaged by rheumatoid arthritis.

Unfortunately, there is no cure for both forms of arthritis but making healthy lifestyle changes has been shown to provide some symptom relief.

READ MORE:Arthritis pain - the best vegetable to lower your risk of joint pain and inflammation

Further research supports the effective anti-inflammatory and immune-balancing properties.

Boswellias ability to alleviate osteoarthritis pain and inflammation appears to be even more promising.

One study published in the journal Phytomedicine found that all 30 people with osteoarthritis knee pain who received boswellia reported a decrease in knee pain.

They also reported an increase in knee flexion and how far they could walk.

If you have arthritis, it is vital that you take steps to lose weight if you are overweight.

Why? "Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems," explains the NHS.

As the health body points out, exercise may seem counterintuitive if you are in pain but it can aid weight loss while bringing direct benefits for managing arthritis.

Regular exercise can also:

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Rheumatoid arthritis treatment: The herbal extract shown to reduce joint swelling - Express

While the short-term risks of hydroxychloroquine treatment were minimal, long-term use was associated with excess cardiovascular mortality in rheumatoid arthritis (RA), according to study results published in Lancet Rheumatology. Researchers noted that combining hydroxychloroquine with azithromycin further increased risk for heart failure and cardiovascular mortality, even in the short term.

Hydroxychloroquine is frequently used as a first-line treatment agent in patients with autoimmune conditions, including RA. The potential efficacy of hydroxychloroquine as an antiviral agent against coronavirus disease 2019 (COVID-19) has led to widespread publicity, much of which focuses heavily on its side effects. The present study assessed the safety profile of hydroxychloroquine alone and in combination with azithromycin in patients with RA.

The multinational, retrospective cohort study enrolled adult patients with RA who were new users of hydroxychloroquine or sulfasalazine. Health records and claims data were obtained from 14 databases in Germany, Japan, the Netherlands, Spain, the United Kingdom, and the United States. The study period was from 2000 to 2020.

Study participants were followed up for the development of 16 severe adverse events of interest over the short (30 days) and long term (>30 days). Patients being initiated with hydroxychloroquine were compared with those being initiated with sulfasalazine. A self-controlled case series was also conducted to assess the safety of hydroxychloroquine in the general population, including patients without RA. Case series participants were identified from the same 14 databases. Finally, severe adverse events were assessed in patients receiving hydroxychloroquine plus azithromycin vs those receiving hydroxychloroquine plus amoxicillin. Propensity score matching and calibration were performed in all patient-to-patient comparisons to minimize confounding. Cox proportional hazard models were used to estimate the hazard ratios (HRs) for severe adverse outcomes among patients receiving hydroxychloroquine vs comparator drugs.

The study cohort included 956,374 patients receiving hydroxychloroquine, 310,350 receiving sulfasalazine, 323,122 receiving hydroxychloroquine plus azithromycin, and 351,956 receiving hydroxychloroquine plus amoxicillin. No excess risk for any of the 16 adverse events was observed with hydroxychloroquine vs sulfasalazine over 30 days of follow-up. The same trends were observed in the self-controlled case series. However, longer use of hydroxychloroquine vs sulfasalazine was associated with increased cardiovascular mortality (HR, 1.65; 95% CI, 1.12-2.44).

Compared to hydroxychloroquine plus amoxicillin, hydroxychloroquine plus azithromycin was associated with significantly increased risk for cardiovascular mortality (HR, 2.19; 95% CI, 1.22-3.95), chest pain or angina (HR, 1.15; 95% CI, 1.05-1.26), and heart failure (HR, 1.22; 95% CI, 1.02-1.45) in the short term.

While hydroxychloroquine presented no significantly increased risk for severe adverse events with short-term use, long-term use was associated with excess cardiovascular mortality. The addition of azithromycin appeared to increase the risk for heart failure and cardiovascular mortality, even in the short term.

We call for careful consideration of the benefit-risk trade-off when counselling those on hydroxychloroquine treatment, the researchers concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Lane JCE, Weaver J, Kostka K, et al. Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study. Published online August 21, 2020. Lancet Rheumatol. doi:10.1016/S2665-9913(20)30276-9

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Treatment With Hydroxychloroquine Plus Azithromycin Linked to Cardiovascular Mortality in Rheumatoid Arthritis - Rheumatology Advisor

There is some renewed hope for rheumatoid arthritis drugs, like Eli Lilly & Co.s and Incyte Corp.s Olumiant and Roche Holding AGs Actemra, as possible COVID-19 treatments after a series of clinical setbacks this summer seemed to close the door on the categorys potential.

Lillys LLY, -1.93% stock was up 1.1%, shares of Incyte INCY, -1.61% were down 4.2%, and Roches ROG, -1.48% stock had gained 1.8% in trading on Friday afternoon.

The industry has done what it should, to really test those [hypotheses], said Patrik Jonsson, president of Lilly Bio-Medicines. You never know what the outcome will be...I think that will probably continue to be the progress made and also sometimes disappointment.

Lilly and Incyte said Monday that giving Olumiant to hospitalized COVID-19 patients in combination with Gilead Sciences Inc.s GILD, -1.29% remdesivir helped them recover faster. The Food and Drug Administration in May granted an emergency use authorization to remdesivir as a treatment for COVID-19 during the pandemic.

Then, on Friday, Roche said a late-stage trial that primarily enrolled people of color found that hospitalized COVID-19 patients who took Actemra were less likely to go on ventilators than those receiving placebo an intriguing finding given that Black and Hispanic Americans are disproportionately more likely to contract and die from COVID-19.

We wanted to start a clinical trial with Actemra because it was being investigated in a general population for the treatment of COVID-19 pneumonia, said Dr. Jamie Freedman, head of U.S. medical affairs for Roches Genentech business. We decided we should [enroll a] trial with African-Americans and other minority patients.

The interest in testing rheumatoid arthritis drugs as COVID-19 treatments began back in February, when The Lancet published a list of already approved drugs that could benefit COVID-19 patients, including Olumiant. In March, researchers in China shared findings from a single-arm study that tested Actemra as a treatment for 21 severely ill COVID-19 patients.

One of the non-arthritis indications for Actemra is for cytokine release syndrome in leukemia patients undergoing gene therapy. Cytokine release is a type of an immune response seen in some severely ill COVID-19 patients. Given the lack of proven treatment options during the pandemic, doctors began to prescribe Actemra to their COVID-19 patients extensively off-label, Freedman said.

All of these factors set off a flurry of global trials, initiated by the drug makers, governments, and public health bodies, evaluating Actemra, Kevzara, and Olumiant as coronavirus therapies.

But then this summer, Actemra and Kevzara, another FDA-approved rheumatoid arthritis treatment, both failed Phase 3 clinical trials testing the therapies in severely ill COVID-19 patients. Roche said in July that there was no difference in the number of patients who died by week four among those taking Actemra or placebo, while Sanofi SNY, -3.03% and Regeneron Pharmaceuticals Inc. REGN, +0.08%, which market Kevzara, said Sept. 1 they would no longer pursue coronavirus-related clinical development for the drug.

The snapshot of data that Lilly released this week about Olumiant is the first finding that the company has released about using the drug as a treatment for COVID-19 treatment. This data may also indicate that rheumatoid arthritis drugs like Olumiant and Actemra, which are also being tested with remdesivr, with data expected to be shared sometime this year, may work better in combination than as standalone therapies for COVID-19 patients.

Olumiant could serve as an important additional treatment option as the medical community continues to learn how to best manage patients hospitalized with COVID-19, Mizuho Groups Vamil Divan told investors in a Sept. 14 note.

Lilly and Roche separately said they both expect to publish this weeks findings in peer-reviewed medical journals.

So far this year, Lillys stock has rallied 16.6%, shares of Incyte are down 1.4%, and Roches stock is up 16.4%. The S&P 500 x SPX, -1.15% is up 3.9% year-to-date.

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Initial data from a pair of clinical trials may revive interest in arthritis drugs as COVID-19 treatments - MarketWatch

VIENNA, Va.--(BUSINESS WIRE)--CEL-SCI Corporation (NYSE American: CVM) today announced that the European Patent Office has issued CEL-SCI patent: European Patent 2989121 to be published on October 7, 2020, and titled Method of Preparation and Composition of Peptide Constructs for Treatment of Rheumatoid Arthritis for the Companys LEAPS platform technology. CEL-SCIs LEAPS technology relates to peptide constructs which may be useful in the treatment or prevention of autoimmune diseases, particularly rheumatoid arthritis, asthma, allergies, and host versus graft (or graft versus host) rejection.

The basic goal of this technology is to 'modulate' the immune system of a patient with Rheumatoid Arthritis, and other autoimmune diseases, away from the body attacking itself to a more normal immune response where the body does not attack itself. This should result in a decrease or elimination of the symptoms of the disease. We are in the process of completing pre-IND studies for CEL-4000, being developed against Rheumatoid Arthritis, and hope to start human studies with CEL-4000 next year. LEAPS is also currently being tested at the University of Georgia vaccine center against COVID-19, said Dr. Daniel Zimmerman, Senior Vice President of Research, Cellular Immunology.

The LEAPS platform technology is being developed as a potential therapeutic vaccine for rheumatoid arthritis under phase I and phase II SBIR grants of over $1.7 million from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the U.S. National Institutes of Health (NIH) which was used in part to fund IND enabling studies in non-human primates.

In animal challenge tests conducted in arthritic diseased animals using CEL-4000 as a therapeutic treatment in collaboration with our Rush Universities Medical center collaborators and co-inventors on this patent, LEAPS platform technology has been shown to direct the immune response preferentially to a cellular (e.g. T-cell) response, reducing pro inflammatory cytokines (IFN and IL17A) and enhancing production of anti-inflammatory cytokines (IL4 and IL10). Additional studies in other disease models have shown either cellular, humoral (antibody) or mixed pathway immune responses depending on the disease model and the desired type of protection.

LEAPS is a patented, T-cell modulation, peptide epitope delivery technology that enables CEL-SCI to design and synthesize proprietary peptide immunogens. LEAPS compounds consist of a small T-cell binding peptide ligand linked with a disease-associated peptide antigen. Usually given after the disease process is initiated and underway. That is not being used as a preventative agent or conventional preventative vaccine.

The LEAPS conjugates can potentially be utilized to treat diseases for which antigenic epitope sequences have already been identified, such as: a number of infectious diseases, some cancers, autoimmune diseases (e.g., rheumatoid arthritis), allergic asthma and allergy, and select CNS diseases (e.g., Alzheimer's).

About CEL-SCI Corporation

CEL-SCI believes that boosting a patients immune system while it is still intact should provide the greatest possible impact on survival. Therefore, in the Phase 3 study CEL-SCI treated patients who are newly diagnosed with advanced primary squamous cell carcinoma of the head and neck with the investigational product Multikine* first, BEFORE they received surgery, radiation and/or chemotherapy. This approach is unique. Most other cancer immunotherapies are administered only after conventional therapies have been tried and/or failed. Multikine (Leukocyte Interleukin, Injection), has received Orphan Drug designation from the FDA for neoadjuvant therapy in patients with squamous cell carcinoma (cancer) of the head and neck.

CEL-SCI believes that this Phase 3 study is the largest Phase 3 study in the world for the treatment of head and neck cancer. Per the studys protocol, newly diagnosed patients with advanced primary squamous cell carcinoma of the head and neck were treated with the Multikine treatment regimen first - for 3 weeks prior to receiving the Standard of Care (SOC), which involves surgery, radiation or concurrent radiochemotherapy. Multikine is designed to help the immune system see the tumor at a time when the immune system is still relatively intact and thereby thought to better be able to mount an attack on the tumor. The aim of treatment with Multikine is to boost the bodys immune system prior to SOC to attack the cancer. The Phase 3 study is fully enrolled with 928 patients and the last patient was treated in September 2016. To prove an overall survival benefit, the study requires CEL-SCI to wait until 298 events have occurred among the two main comparator groups. This study milestone occurred in late April 2020. The study is currently in the database lock and analysis phase.

The Companys LEAPS technology is being developed for rheumatoid arthritis and as a potential treatment of COVID-19 in hospitalized and at-high-risk patients. The Company has operations in Vienna, Virginia, and near/in Baltimore, Maryland.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, including statements with respect to Multikine and the Phase 3 clinical trial of Multikine in patients with advanced primary squamous cell carcinoma of the head and neck. When used in this press release, the words "intends," "believes," "anticipated," "plans" and "expects," and similar expressions, are intended to identify forward-looking statements. Such statements are subject to risks and uncertainties that could cause actual results to differ materially from those projected. Factors that could cause or contribute to such differences include an inability to duplicate the clinical results demonstrated in clinical trials or nonclinical studies, timely development of any potential products that can be shown to be safe and effective, receiving necessary regulatory approvals, difficulties in manufacturing any of the Company's potential products, inability to raise the necessary capital and the risk factors set forth from time to time in CEL-SCIs filings with the Securities and Exchange Commission, including but not limited to its amended report on Form 10-K/A for the year ended September 30, 2019. The Company undertakes no obligation to publicly release the result of any revision to these forward-looking statements which may be made to reflect the events or circumstances after the date hereof or to reflect the occurrence of unanticipated events.

* Multikine (Leukocyte Interleukin, Injection) is the trademark that CEL-SCI has registered for this investigational therapy, and this proprietary name is subject to FDA review in connection with the Company's future anticipated regulatory submission for approval. Multikine has not been licensed or approved for sale, barter or exchange by the FDA or any other regulatory agency. Similarly, its safety or efficacy has not been established for any use. Moreover, no definitive conclusions can be drawn from the early-phase, clinical-trials data involving the investigational therapy Multikine. Further research is required, and early-phase clinical trial results must be confirmed in the Phase 3 clinical trial of this investigational therapy that is in progress.

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CEL-SCI Awarded European Patent for LEAPS Vaccine in Treatment of Rheumatoid Arthritis - Business Wire

Biting into my first apple after so many years was brilliant.

To eat something so crunchy without experiencing the unfathomable pain I had previously is something most people take for granted.

Just over a year earlier Id had a complete jaw replacement after several years of suffering from arthritis. Contrary to popular belief, it is not simply an old persons disease.

I was eight years old when I first remember waking up with stiffness, but I didnt understand why. My parents and I thought these were simply growing pains, but by the age of 10, I was struggling to function and my fingers rapidly became more inflamed and swollen.

Only just into double digits, and I was diagnosed with Juvenile Polyarticular Rheumatoid Arthritis (JPRA). I went from this bubbly, confident girl to one who had to learn to cope with all this change.

My condition is characterised by chronic inflammation to the joints caused by the immune system mistakenly attacking the cells lining them when you are still growing up.

My JPRA was particularly aggressive when I was young, and it caused lots of damage to my joints. I had to wear a neck brace and sleep in custom-made leg and arm splints.

I ended up missing quite a bit of school, which hugely impacted my confidence and my academic performance. My life became more about getting through each day instead of playing outside and being carefree like all the other children.

I had to stop all the hobbies I enjoyed: gymnastics, ballet, athletics, competitive swimming. I wasnt allowed to do PE; I had to sit and watch the others,which was devastating.

My whole world changed overnight. I felt quite alone and confused as I really didnt understand the fight that was going on in my body. Because I wasnt visibly ill, some of the children in my year started to bully, tease and make fun of me.

As I got older, my joints could not deal with the normal stresses and strains of life and eventually it became clear that Id have to undergo surgery. I really wanted to continue with life as normal, so I put on a brave face and didnt divulge much information with my friends; nothing about my finger operations at 15, wrist replacement at 17, or wrist fusions in my early 20s.

When I left schoolat 18, I started training to become a nursery nurse. I figured that if I worked the way normal people did then my illness could stay hidden. I did this for more than 30 years.

I really was the master of disguise, playing down every surgery and telling very few people about them. At times I wonder how I managed at all. But having my two sons in my early 20s gave me all the strength I needed. Being a mum was all I ever wanted in life.

Then 2018 came and the jaw pain Id been experiencing suddenly got very intense to the point where I could no longer eat or sleep.For a year I endured the worst agony Ive ever felt in my entire life.

I was on 3,600mg of painkillers every day and woke up each morning with dread at what I would have to face.

I waited for a gruelling year for surgery to completely replace my jaw, which is unfortunately common.

In the months leading up to my operation, my jaw had basically collapsed due to the deterioration of my joints, so I had to have a series of steroid injections as well as surgical wash outs to get rid of some of the bone debris.

I also had to have a muscle graft from my stomach to my jaw joint at one side to hold it up and screws into the other collapsing side to allow me to open my mouthenough for liquids and purees.

Talking was difficult due to the severe pain.

The operation was 8.5 hours long. Doctors replaced my jaw joint with a 3D printed model made ofsurgical steel and plastic, and 25 screws were drilled into my face.

I was in floods of tears when I came round tears of relief and of hope for the future. I knew it was a turning point in my life. The pain immediately afterwards was different and, although I had to get through the long recovery of 18 months, I could feel that things were going to improve and I was starting to see the light at the end of the tunnel.

My recovery is still ongoing and I still get a burning sensation every time I chew, as well as intermittent nerve pain but its like night and day compared to what it was before the operation. I feel like smiling again.

Im 41 years old now and,unfortunately, I know that more surgery will be inevitable as my underdeveloped joints just dont stand everyday life like other peoples do. But it doesnt scare or worry me.

Surgery is tough but I accepted it as an inherent part of my life a long time ago. Instead, what really scares me is not being able to do simple things the other day I was trying to cut some vegetables, but my fingers ached too much. I just broke down in tears because all I wanted to do was make dinner for my sons and I hated having to ask for help.

Arthritis is a lifelong illness and you never get away from the pain and the challenges it throws at you.

As Covid-19 impacts hundreds of operations, those with arthritis need clear communication about when they will be treated.

I know what its like to live with chronic pain for so long, nows the time to finally give arthritis the attention it deserves.

Joanna is supporting Versus ArthritisImpossible to Ignore campaign.

My Life Through a Lens is an exciting series on Metro.co.uk that looks at one incredible photo, and shares the story that lies behind it. If you have an experience you would like to share, please email kathryn.snowdon@metro.co.uk with MLTAL as the subject.

MORE: I abseiled into a 400C flaming pit otherwise known as the Door to Hell

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I had a whole jaw replacement because of arthritis - Metro.co.uk

Eli Lilly and Co. has played a key role in developing important medicines since its founding in 1876. Some of those drugs include penicillin, Prozac, Zyprexa and Humulin. Wochit

Eli Lilly and Company officials are asking the federal government to grant emergency approval to use a drug approved for rheumatoid arthritis to treat COVID-19, after a study showed it hastened recovery when used with another therapy.

The trial looked at the impact of adding baricitinib, marketed as Olumiant, to treatment with remdesivir, an antiviral. Patients who received both drugs recovered one day sooner than those who received remdesivir alone, the study of more than 1,000 hospitalized patients found.

Its quite a big outcome, said Patrik Jonsson, Lilly senior vice president and president of Lilly Bio-Medicines.

Those who received baricitinib along with remdesivir also required less clinical support while they were in the hospital and had better outcomes overall, Jonsson said.

While 24 hours may not seem like a dramatic difference, if hospitals are experiencing a surge in patients it can ease the strain on resources.

Eli Lilly officials said that while the results from the trial have not yet been peer-reviewed, they will be doing further analyses and expect to have more results soon.

Unlike remdesivir, which is an infusion, baricitinib is taken by mouth. Currently it is approved to treat rheumatoid arthritis. Jonsson said that if it was also approved for use in COVID-19, Lilly would be able to produce sufficient amounts for both conditions.

We are very confident that we are in a good position when it comes to supply, he said.

Rheumatoid arthritis patients take a 2-mg dose. Lilly plans to ask the FDA to approve a 4-mg dose for COVID-19. The drug currently comes with warnings about a risk of developing blood clots or infections.

Baricitinib is thought to help coronavirus patients by acting as an anti-inflammatory, Jonsson said. It is thought that the drug may lessen the effects of the so-called cytokine storm that the bodys own immune system may produce in response to the virus. It may also interfere with the viruss ability to reproduce, lowering the viral load.

Contact IndyStar reporter Shari Rudavsky at shari.rudavsky@indystar.com. Follow her on Facebook and on Twitter: @srudavsky.

Read or Share this story: https://www.indystar.com/story/news/health/2020/09/16/lilly-study-shows-rheumatoid-arthritis-drug-helps-treat-coronavirus/5803136002/

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Lilly study shows its drug for rheumatoid arthritis helps in coronavirus treatment - IndyStar

Dr Shashank Akerkar, consultant, rheumatology clarifies several doubts and misconceptions pertaining to hydroxychloroquine (HCQ) and highlights the safety and efficacy profile of HCQ. He mentions that in general, practicing rheumatologists prescribe HCQ without ordering a baseline ECG unless the patient has a history of cardiac disease. If the right dosage of HCQ is used for the right patient with no prior cardiac complication, it is not likely to cause cardiac adverse effects.

What is the role of HCQ in the management of COVID-19? Can it in any way cure the disease?

COVID-19 has multiple pathological features and therefore its management requires multiple drug therapies. Hydroxychloroquine (HCQ) alone cannot cure COVID-19 but it has been used in combination with other drugs for this purpose.

However, HCQ is not approved by the Drugs Controller General of India (DCGI) for the management of COVID-19. The Indian Council of Medical Research (ICMR), has recommended it as a prophylaxis (prevention) for COVID-19 (March 23, 2020) and for the treatment of mild and moderate cases of COVID-19 (June 13, 2020 ICMR management protocol).

In many studies, it has been found to decrease morbidity and mortality in COVID-19 patients. For example, in one retrospective observational study that included 3,451 patients from 33 hospitals in Italy, use of HCQ was associated with a 30 per cent lower risk of death in COVID-19 hospitalised patients.

In India, HCQ has shown promising outcomes as a prophylaxis for COVID-19 amongst healthcare workers. In a nation-wide case-control ICMR study with 751 health care workers, the intake of six or more doses of HCQ was linked to a >80 per cent reduction in the risk of COVID-19 infection.

For the last five decades, HCQ has been widely used for the management of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). In in-vitro studies, HCQ has been found to possess antiviral activity against many viruses such as the rabies virus, poliovirus, HIV, hepatitis A virus, chikungunya virus, dengue virus, Zika virus and even SARS-CoV-2.

What are some of the common misconceptions about HCQ that have emerged since the COVID-19 pandemic?

During the pandemic, the use of HCQ has been linked to excessive cardiovascular adverse effects like QTc prolongation, arrhythmia and cardiovascular (CV) mortality. None of this has been conclusively proven through research.

In fact, for decades HCQ has been prescribed for those with RA and SLE, and CV adverse effects have been rare in these patients. A study with 1,537 RA patients on HCQ therapy, found no significant correlation between HCQ use and QT interval prolongation.

QTc prolongation is rarely seen with HCQ use and it is often a self-limiting event. QTc prolongation mostly occurs in the presence of several risk factors, such as high drug concentration and simultaneous exposure to QTc-prolonging drugs like azithromycin. It is possible that the QTc prolongation and arrhythmia observed in COVID-19 patients are cardiac manifestations of COVID-19 disease. Clinical evidence shows that patients with a severe case of COVID-19 are in an arrhythmogenic state with myocardial injury, hypoxia, renal insufficiency, and electrolyte disturbance. Use of antiviral drugs and azithromycin in COVID-19 patients has also been also linked to QTc prolongation.

In general, practicing rheumatologists prescribe HCQ without ordering a baseline ECG unless the patient has a history of cardiac disease. If the right dosage of HCQ is used for the right patient with no prior cardiac complication, it is not likely to cause cardiac adverse effects. However, an ECG (with estimation of QT interval) may be done before prescribing HCQ. The Indian Heart Rhythm Society recommends a baseline ECG to estimate the QTc interval in individuals receiving HCQ treatment. Thus, the rare CV risk linked to HCQ can be assessed proactively, which is why I believe the overall fear about serious CV adverse effects is unfounded and often exaggerated.

Of late, have you encountered any constraints when prescribing HCQ to patients?

There are no constraints in prescribing HCQ for patients with RA, SLE and type-2 diabetes. It has been approved by regulatory authorities such as the DCGI and US FDA for RA and SLE, and in addition to these indications, DCGI has approved it for the management of type 2 diabetes. HCQ has been used in these patients for a long period of time and it has a favourable safety profile.

Why do you believe that the controversy over HCQ is a myth?

Early in March, the WHO initiated a multinational trial of four untested drugs for COVID-19. HCQ was also a part of the trial. Then in May, Mehra et al published one multinational real-world analysis in The Lancet, in which they reported that HCQ treatment (alone or in combination with a macrolide) had no benefit on the in-hospital outcomes in patients with COVID-19. Instead, they concluded that HCQS increases mortality in patients with COVID-19, which led to the stopping of the WHO trial mentioned earlier.

Later on, Australian researchers found discrepancies in the mortality data for HCQ users. In response to this, The Lancet t published an expression of concern and retracted the article that had halted the HCQ trial. The members of the WHO trial committee recommend that there was no reason to modify the trial based on available mortality data. And on June 3, the WHO resumed the trial including the HCQs arm in patients with COVID-19. Most of the HCQS trials which were stopped earlier were also restarted.

What will be the consequences if HCQ is banned for use in COVID-19?

The COVID-19 pandemic is unprecedented and such a health crisis arises once in a century. The morbidity and mortality of COVID-19 is comparatively high. To control a viral pandemic of this kind, the following measures are generally required.

1) preventive healthcare measures e.g. social distancing, hand hygiene and wearing masks etc.

2) vaccination of the general population, when a vaccine is available

3) use of antiviral drugs

4) use of immunomodulatory drugs

5) repurposing of existing drugs when specific treatment is not available.

A vaccine that prevents COVID-19 would ideally have been the best measure. But it takes a long time to develop and test effective vaccines against RNA viruses with rapidly mutating strains. Similarly, it is extremely difficult to develop a specific antiviral drug in a short period of time.

Considering the high morbidity and mortality of COVID-19, newer antiviral drugs such as remdesivir, lopinavir/ritonavir have been repurposed to manage COVID-19 and existing drugs such as HCQ, azithromycin, other antiviral drugs, and dexamethasone have also been repurposed for the treatment of COVID-19. HCQ has been found effective for the treatment and prevention of COVID-19 disease.

No serious untoward effects have been observed with HCQ use for the last five decades that can cause the regulatory authorities to think about banning HCQ. Such a possibility is extremely remote as millions of RA and SLE patients are being successfully treated with HCQ without serious safety concerns.

(Note: These are not recommendations, to be considered as an opinion.)

Read more from the original source:
FAQs on HCQ use in rheumatoid arthritis and other conditions - Express Healthcare

One-and-a-half million people in the United States suffer from rheumatoid arthritis (RA). In fact, The Arthritis Foundation estimates that three times as many women as men have the disease and it affects individuals of all ages, but primarily women ages 30 to 60.

Commonly affecting the hands and feet of the body, RA is considered an autoimmune disease, where the body attacks joints, leading to inflammation and pain as well as a loss of motion. With a diagnosis comes a rapidly-changing lifestyle, often causing activities and hobbies that were once loved and now off-limits.

Through stories on the National Rheumatoid Arthritis Society website, many individuals have shared that arthritis has caused a dramatic lifestyle change thats often accompanied by depression and anxiety. But that doesnt have to be the case.

With patients young and old experiencing the debilitating effects of rheumatoid arthritis, individuals like Pearl Schomburg are advocating for doctors to mention the effects of cannabis in office. Pearl explained to Newshub, Cannabis balm was the first thing I discovered and was shocked by how well it worked.

RELATED: Theres No Known Cure For Arthritis, But Marijuana Works Wonders

The Arthritis Foundation recently shared information about CBD and marijuana on their website to educate patients around its use. Recognizing the potential to treat both inflammation and pain, they advise to always discuss CBD and cannabis with your care team and make sure to contact the manufacturer to see proof of a third-party analysis for purity.

Photo by rawpixel.com

In a 2018 study published in the journal CannabisandCannabinoid Research, researchers found that terpenoids, which exist in cannabis, offer anti-inflammatory properties, but didnt offer as much relief as purified CBD. Often used in chronic inflammation and for pain, purified CBD offered better relief in the study over other mixtures, including CBD.

Psoriasis, a condition where cells build on top of the skin and cause pain and redness, is often coupled with RA and offers treatment that can be very expensive. John S. from Minneapolis explained that his medicine came in the form of a shot billed to insurance at $60,000 each year creating a debilitating pattern of relying on pharmaceutical medicine that is often inaccessible. Would he explore CBD and cannabis? He explained, Its been on my mind; a year ago, I wouldnt have even thought about integrating CBD, now Im looking at reviews online. In fact, MedicalNewsToday cited 2016 research that suggested that cannabinoids offered benefits to individuals with psoriasis.

With the market ever-changing, not only are tinctures available, but patches as well. In 2016, a study found that placing CBD on the body in a topical fashion offered some relief for pain and inflammation over other methods. CBD comes in many forms, including:

As the cost of medicine continues to rise, CBD and cannabis offer a more affordable solution to many experiencing the effects of RA, inflammation and psoriasis.

RELATED: Young People Experience Arthritis Too And Cannabis Can Help

House of Cannabis, a new pot shop in Twisp, WA, is seeing a steady increase (about 52%) of customers coming in aged 50 and older. Mainly focused on pain relief, House of Cannabis has been both startled and empowered by the number of older adults coming in for the first time.

Arthritis is probably the most common issue people are dealing with in their hands, back and legs, shared Cindy Knutson, the retailers general manager and state-certified medical cannabis consultant. Were seeing a shift in mindsets and the market, Knutson continued, notating that adults who typically wouldnt have spoken about cannabis or CBD are now sharing with their friends.

Original post:
Whats Next For Rheumatoid Arthritis And Cannabis? - The Fresh Toast

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Psoriatic Arthritis Treatment Market revenue to expand at significant CAGR through 2027 - The Daily Chronicle