StemCell Therapy

Considering the battering that my right eye has taken, it is doing pretty well. I have fairly good long-distance vision. I switch between a contact lens and very thick glasses.

Some of my material as a comedian is based on sight loss. As I found my voice as a comedian, it has developed into all manner of things. Now I just tend to gossip on stage. I always try and justify it by saying that because I have spent a lot of my life in hospital waiting rooms, a good distraction is a little bit of gossip.

My first show, A Poke in the Eye, was about the year I lost my sight when I was 21. It was a complex journey. The show was picking out the most interesting parts of that time. My mum, dad and my brothers were main characters in it.

I thought I would use what was a negative experience and turn it into something positive. It is your unique outlook on the world that people find funny. You need to tap into that as much as you can. Comedy is one of the few things I have found that I am good at. What better way to spend your time than with a group of people having a laugh.

You have to be resilient. You have to put up with tough audiences. But the highs are so great that you put up with the lows. I did an Edinburgh Fringe run of my third show, Eyecon, on a Saturday and it was packed full with a really young, rowdy audience. They were an absolute riot and it just felt like a party.

There are loads of times where shows havent gone well. I will try a new joke or a new subject and it just dies. No one finds it funny. You have to take it all with a pinch of salt. Sometimes they are not the audience for you.

It is your unique outlook on the world that people find funny. You need to tap into that as much as you can

Any comedian who is giving it their all I admire. My idol was always Joan Rivers. She was one of the first female comedians ever. I got compared to her in Edinburgh and there is no greater compliment.

You will always get a little bit nervous. It would be weird if you didnt. Sometimes I am really tired and I have had a long day. Without that adrenalin, I would have been totally flat. You turn that nervousness into energy. As soon as you get your first laughs and things start to flow, youre away.

I decided to support the International Glaucoma Association because there isnt much awareness around young people and glaucoma. It is one of the biggest causes of sight loss and it is a condition that can be controlled. I am very much a believer in prevention rather than cure.

Humour has been my defence and my saving grace. When things have been properly tough, I have found a way to laugh it off. The only alternative is to cry. I know how I want to live my life.

Georgie Morrell is a stand up comedian. She supported the International Glaucoma Associations Glaucomasters campaign during National Eye Health Week 2019. For more details about upcoming gigs visit her website.

Image credit: Steve Ullathorne

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Humour has been my defence and my saving grace - AOP

A study in the journal Frontiers in Neurology, is shedding light on a rare side effect of the erectile dysfunction drug sildenafil. The active ingredient in Viagra, sildenafil can cause the vision in some men to be tinted blue.

The report refers to the cases of 17 men who visited a hospital in Turkey with vision problems 24 hours after taking the drug. They reported blurred vision, sensitivity to light, reduced eyesight and changes to colour perception which included, intensely blue-coloured vision, a side effect medically known as cyanopsia.

Other reports of vision changes included red-green colour blindness (where green and red colours appeared brownish).

According to Science Live, its well known that sildenafil can cause temporary vision changes (like cyanopsia) that can last for a few hours. But persistent vision changes are much more rare. In the case studies examined in the report, researchers say that the mens vision returned to normal after 21 days.

In a statement, study author Dr. Cneyt Karaarslan of the Dnyagz Adana hospital in Turkey, told EurekaAlert that for the vast majority of men, any side effects [of sildenafil] will be temporary and mild. She said that she wanted to highlight that persistent eye and vision problems could be encountered by a small number of users.

One possibility for the blue vision could be that a small number of the population is unable to break sildenafil down and eliminate it from their body efficiently. This would lead to high concentrations of the drug in the bloodstream compared to other users and hence, the blue-tinted vision.

Science Live says that sildenafil works to treat erectile dysfunction by inhibiting an enzyme called phosphodiesterase 5 (PDE5) that helps to regulate blood flow to the penis. But the drug also inhibits a related enzyme thats found in cells at the back of the eye. Its believed that in high doses, this could lead to buildup of a molecule that can be toxic to retinal cells.

For the men in this study, it was their first time taking the erectile dysfunction drug. They began with the highest dose, so starting with a lower dose could have less severe side effects. In a press release, the researchers noted that the high dose was likely because the men were under medical supervision in the study. Otherwise the amount of the drug prescribed would have likely been lower.

While the idea of vision changes is a bit disconcerting, seeing colour as a side effect of taking Viagra is rare. Still, if you are looking to firm things up, its best to consult your doctor to decide on the treatment thats best for you.

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Men with ED seeing blue over rare Viagra side effect - Windsor Star

As William Shakespeare once wrote, the eye is the window to the soul. But if the truth be told, the eyes are actually a porthole to so much more.

In fact, a simple eye test could save your life. Stats show that only one in five people know a routine visit to the optician not only examines your eyesight, but can also assess the general health of your eye and give a clear view of warning signs for a range oflife-threatening illnesses.

So, a visit to the opticians really is more essential than you might think.

Your eye is the one part of the body where we can see blood vessels in their natural habitat without being invasive, Willis Wilkie, lead optometrist at Wilkie & Rider Opticians, said.

And these can be key in spotting a whole host of health conditions.

Sometimes we can spot something so serious that it actually saves someones life.

Willis, who has been a practicing optician for almost 10 years, said its all to do with the mechanics at the back of the eye.

Tiny blood vessels and nerves can hold telltale signs that something is untoward inanother part of the body.

The blood vessels can change when the body is experiencing certain conditions. For example, they can leak, or the optic nerves can be swollen, or there can be a mass at the back of the eye and all these tell us that something is wrong, Willis explained.

Williss career as an eye specialist came after years spent watching his father in the profession.

But even in just one generation, he says there have been significant developments in the techniques and technology used in the industry.

Eye tests these days are much more advanced than they were 40 years ago, Willis said. We still have the old eye chart with the letters, but we also have digital retina photography which ensures detail, accuracy and repeatability.

It gives us a much better view so we can detect any eye health problems, as well as symptoms of other health conditions.

We also have the air puff test and drops we can use in the patients eyes to make the pupils bigger which helps make our job a little easier.

In the past, we couldnt do much about that. Now, we have options.

Having your eyes tested is recommended every two years until the age of 60, then annually.

And Willis says, even if you dont wear glasses or think you might need glasses, its always a good idea to schedule an appointment, just to make sure everything is as it should be.

Most people dont come to us unless they feel there is a problem with their sight, like theyre getting headaches at the computer, or they are struggling to read things at a distance.

But eyes are very important and we should be having them tested to make sure there are no signs of problems, such as glaucoma, cataracts or macular degeneration.

Or, of course, more serious illnesses which can be picked up simply by looking at the back of the eye.

From diabetes, high blood pressure and cardiovascular disease to arthritis and even tumours, theres so much we can see.

So if youre worried about your eyes, its probably wise to see an optician first before calling your GP. Hopefully we can work out what the problem is and spot any other health issues while were there.

Its important to remember that when diabetes is in its early stages, diabetic retinopathy does not usually cause any noticeable symptoms, so you may not even know you have it.

However, an eye test can detect the condition before you notice any changes to your vision.

Diabetes can affect small blood vessels in the eye, damaging the retina, which is vital for sight. And an eye test can pick up tiny leaks from damaged blood vessels.

It is not uncommon for someone to be informed that they may have high blood pressure as a result of observations made by their optician during a routine eye test.

When examining the retina, they can see whether or not the blood vessels are narrowed or are leaking.

Having high cholesterol which can lead to heart problems or a stroke doesnt usually have any symptoms.

However, it can cause blockages in any of the bodys blood vessels, including those in the eyes. Opticians can spot little lumps of cholesterol. These can block blood vessels resulting in short episodes ofvisual loss.

Some people may be aware that eye tests can detect cancers of the eye such as melanomas, but they can also detect signs of brain tumours.

Swelling of the optic nerves can be visible during an eye test, and can indicate a brain tumour is present.

Autoimmune forms of the disease, like rheumatoid arthritis, as well as causing inflammation in your joints, can also cause inflammation in your eyes.

This can commonly cause dry eye, or occasionally more serious conditions such as inflammation of the iris.

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The eyes have it: A trip to the optician - even if you don't wear glasses - can give you early warning of a range of serious illnesses - The Sunday...

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New research reveals the underlying mechanism for a dangerous heart disorder in which low oxygen levels in the heart produce life-threatening arrhythmias.

The discovery, made with human heart muscle cells derived from pluripotent stem cells, offers new targets for therapies aimed at preventing sudden death from heart attack.

Our research shows that within seconds, at low levels of oxygen (hypoxia), a protein called small ubiquitin-like modifier (SUMO) is linked to the inside of the sodium channels which are responsible for starting each heartbeat, says Steve A. N. Goldstein, vice chancellor for health affairs at the University of California, Irvine and professor in the School of Medicine departments of pediatrics and physiology and biophysics.

And, while SUMOylated channels open as they should to start the heartbeat, they re-open when they should be closed. The result is abnormal sodium currents that predispose to dangerous cardiac rhythms.

Every heartbeat begins when sodium channels open and ions to rush into heart cellsthis starts the action potential that causes the heart muscle to contract. When functioning normally, the sodium channels close quickly after opening and stay closed. After that, potassium channels open, ions leave the heart cells, and the action potential ends in a timely fashion, so the muscle can relax in preparation for the next beat.

If sodium channels re-open and produce late sodium currents, as observed in this study with low oxygen levels, the action potential is prolonged and new electrical activity can begin before the heart has recovered risking dangerous, disorganized rhythms.

Fifteen years ago, the Goldstein group reported SUMO regulation of ion channels at the surface of cells. It was an unexpected finding because the SUMO pathway had been thought to operate solely to control gene expression in the nucleus.

This new research shows how rapid SUMOylation of cell surface cardiac sodium channels causes late sodium current in response to hypoxia, a challenge that confronts many people with heart disease, says Goldstein. Previously, the danger of late sodium current was recognized in patients with rare, inherited mutations of sodium channels that cause cardiac Long QT syndrome, and to result from a common polymorphism in the channel we identified in a subset of babies with sudden infant death syndrome (SIDS).

The information gained through the current study offers new targets for therapeutics to prevent late current and arrhythmia associated with heart attacks, chronic heart failure, and other life-threatening low oxygen cardiac conditions.

The National Institutes of Health funded the study, which appears in Cell Reports.

Source: UC Irvine

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How low oxygen levels in the heart can cause arrhythmias - Futurity: Research News

LOS ALTOS, Calif., Feb. 18, 2020 (GLOBE NEWSWIRE) -- Retrotope announced today that the U.S. Food and Drug Administration (FDA) Office of Orphan Products Development granted orphan drug designation for its chemically-modified polyunsaturated fatty acid drug (RT001) for the treatment of Progressive SupraNuclear Palsy (PSP). Physicians collaborating with Retrotope have previously received approval from the FDAs Division of Neurology Products to test RT001 in Expanded Access trials of three patients having PSP, an orphan neurodegenerative disorder that causes progressive impairment of balance and walking; impaired eye movement, abnormal muscle rigidity; dysarthria; and dysphagia and eventual death.

PSP is a serious neurodegenerative disease that profoundly affects the quality and length of life in adults. Patients are typically severely disabled within 3-5 years of disease onset. It affects an estimated 17,500 adults in the US. In addition to the motor deficits noted above, affected individuals frequently experience personality changes and cognitive impairment. Symptoms typically begin after age 60 but can begin earlier. The exact cause of PSP is unknown, and is often misdiagnosed as Parkinson disease due to the similarity of symptoms in the early stage of disease. The cause of PSP is not known, but it is a form of tauopathy, in which abnormal phosphorylation and accumulation of the protein tau in the mid brain leads to destruction of vital protein filaments in nerve cells, causing their death. Most cases appear to be sporadic as an acquired tauopathy and there is no approved drug therapy. A regionally specific increase in lipid peroxidation has been observed in PSP and mitochondrial structures and functions are compromised, leading to profound oxidation damage.

RT001 is a chemically stabilized fatty acid that confers resistance to lipid peroxidation in mitochondrial and cellular membranes via a novel mechanism. RT001 has been shown to decrease levels of lipid peroxidation in PSP patient mesenchymal stem cells, and restore mitochondrial structure and function to damaged cells. As RT001 is distributed, as an essential fat, throughout tissues in human, it is expected to lower the amount of lipid peroxidation, restore normal mitochondrial function and prevent mitochondrial cell death.

Robert Molinari, Ph.D. CEO of Retrotope commented: We want to sincerely thank the FDAs OOPD for this designation which allows us accelerated review and more flexibility in pursuing this indication. We are also grateful to the researchers, patients and clinicians whose work contributed to the results supporting our filing an investigational new drug (IND) application to FDA in this terrible disease.

Peter Milner, MD, Chief Medical Officer of Retrotope, added, PSP is a disease involving modification and dysfunction of tau protein. RT001s mechanism of action both lowers lipid peroxidation and prevents mitochondrial cell death of neurons which is associated with disease onset and progression. Also RT001 has a synergistic downstream benefit in the pathophysiology of PSP. This orphan designation encourages clinical trials and rapid review of data from trials to treat this intractable disease.

About the Orphan Drug ActThe US FDA Orphan Drug Act (ODA) provides orphan designation for drugs and biological products to treat a rare disease or condition upon request of a sponsor. Orphan drugs are usually defined as those products intended for the safe and effective treatment, diagnosis or prevention of rare diseases/disorders that affect fewer than 200,000 people in the U.S., or that affect more than 200,000 persons but are not expected to recover the costs of developing and marketing a treatment drug. Orphan designation qualifies the sponsor of the drug for various development incentives of the ODA, including tax credits for qualified clinical testing. A marketing application for a prescription drug product that has received orphan designation is not subject to a prescription drug user fee unless the application includes an indication for other than the rare disease or condition for which the drug was designated.

About RT001RT001 is a patented, first-in-class, orally available D-PUFA, a deuterated polyunsaturated fatty acid, that incorporates into mitochondrial and cellular membranes and stabilizes them. Retrotope and others have discovered that lipid peroxidation, the free-radical damage of polyunsaturated fats (PUFAs) in mitochondrial and cellular membranes, may be the primary source of cell death in several degenerative diseases. The presence of D-PUFAs (RT001) can help protect (fireproof) against this attack and potentially restore cellular health.

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About RetrotopeRetrotope, a privately held, clinical-stage pharmaceutical company, is creating a new category of drugs to treat degenerative diseases. Composed of proprietary compounds that are chemically stabilized forms of essential nutrients, these compounds are being studied as disease-modifying therapies for many intractable diseases, such as Parkinsons, Alzheimers, mitochondrial myopathies, and retinopathies. RT001, Retrotopes first lead candidate, is being tested in clinical trials for the treatment of Friedreich's ataxia, a fatal orphan disease; and in a fatal, childhood neurodegenerative disease called Infantile Neuroaxonal Dystrophy, and now in PSP which is also fatal. Expanded Access trials calibrating endpoint effects of RT001 in ALS, PSP, Huntingtons disease, and others are also underway. For more information about Retrotope, please visit http://www.retrotope.com.

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Progressive-Supranuclear-Palsy-Fact-Sheet

SOURCE: Retrotope, Inc. 4300 El Camino Real, Suite 201 Los Altos, CA 94022 650-575-7551

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US FDA Grants Orphan Drug Designation for Retrotope's RT001 in the Treatment of Progressive SupraNuclear Palsy (PSP) - Yahoo Finance

The cell expansion market is expected to grow with a CAGR of 15. 6% from 2019-2027. Driving factors include increasing adoption of regenerative medicines, rising prevalence of cancer. However, the risk contamination during cell expansion is expected to hamper the market during the forecast period.

New York, Feb. 17, 2020 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Cell Expansion Market to 2027 - Global Analysis and Forecasts By Product ; Cell Type ; Application ; End User, and Geography" - https://www.reportlinker.com/p05862085/?utm_source=GNW

Cancer is one of the major cause of human death worldwide.In recent years, the cases of cancer have been increasing tremendously and the trend is anticipated to remain the same in the upcoming years.

According to the World Health Organization in 2018, approximately 9.6 million deaths across the globe were due to cancer. Furthermore, the National Cancer Institute predicted that in 2018, approximately 1,735,350 new cancer cases would be diagnosed in the US.

Changes in lifestyle have resulted in more exposure to oncogenic factors.Cancer can be cured if diagnosed and treated at an initial stage.

Cancer sequencing using next-generation sequencing (NGS) methods provides more information. Additionally, cell expansion related procedures also aids in research, diagnostics and treatment of cancer.Furthermore, Asia Pacific region is also facing the problem of the growing prevalence of cancer.The top 15 countries with Cancer prevalence are Japan, Taiwan, Singapore, South Korea, Malaysia, Thailand, China, Philippines, Sri Lanka, Vietnam, Indonesia, Mongolia, India, Laos, and Cambodia.

According to the National Institute of Cancer Prevention and Research (NICPR), in 2018, in India, total deaths due to cancer were 784,821.

The global Cell Expansion market is segmented by product, cell type, application, end user.Based on product, the cell expansion market is segmented into consumables and instruments.

In 2018, the consumables accounted for the largest market share in the global cell expansion market by product.These consumables are essential components of any laboratory experiment hence they are expected to witness significant growth during the forecast period.

Based on cell type, the cell expansion market has been segmented into human cell and animal cell.Furthermore based on application the cell expansion market has been segmented into Regenerative Medicine And Stem Cell Research, Cancer And Cell-Based Research and Other Applications.

Based in end user market is segmented into Biopharmaceutical And Biotechnology Companies, Research Institutes, cell banks and others.

Some of the essential primary and secondary sources included in the report are the National Institute of Cancer Prevention and Research (NICPR), Association for Management Education and Development, Center for Cancer Research, International Society for Stem Cell Research (ISSCR), American Association of Blood Banks (AABB), National Institute of Cancer Prevention and Research and others.Read the full report: https://www.reportlinker.com/p05862085/?utm_source=GNW

About ReportlinkerReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.

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The global cell expansion market is projected to reach US$ 42,837.11 Mn in 2027 from US$ 11,929.43 Mn in 2018 - Yahoo Finance

The U.S. Food and Drug Administration (FDA) has granted Breakthrough Therapy designation to enfortumab vedotin-ejfv (Padcev; Astellas Pharma and Seattle Genetics) in combination with Mercks (known as MSD outside the United States and Canada) anti-PD-1 therapy pembrolizumab (Keytruda) for the treatment of patients with unresectable locally advanced or metastatic urothelial cancer who are unable to receive cisplatin-based chemotherapy in the first-line setting.

It is estimated that approximately 81,000 people in the U.S. will be diagnosed with bladder cancer in 2020. [1] Urothelial cancer accounts for 90% of all bladder cancers and can also be found in the renal pelvis, ureter, and urethra. [2] Globally, approximately 549,000 people were diagnosed with bladder cancer in 2018, and there were approximately 200,000 deaths worldwide. [3]

The recommended first-line treatment for patients with advanced urothelial cancer is cisplatin-based chemotherapy. For patients who are unable to receive cisplatin, such as people with kidney impairment, a carboplatin-based regimen is recommended. However, fewer than half of patients respond to carboplatin-based regimens and outcomes are typically poorer compared to cisplatin-based regimens. [4]

Conditionally approvedEnfortumab vedotin-ejfv, a first-in-class antibody-drug conjugate (ADC) that is directed against Nectin-4, a protein located on the surface of cells and highly expressed in bladder cancer, was conditionally approved by the FDA in December 2019 based on the Accelerated Approval Program. [5][6]

Antibody-drug Conjugates or ADCs are highly targeted biopharmaceutical drugs that combine monoclonal antibodies specific to surface antigens present on particular tumor cells with highly potent anti-cancer agents linked via a chemical linker.

With seven approved drugs on the market, ADCs have become a powerful class of therapeutic agents in oncology and hematology.

Continued approval for enfortumab vedotin-ejfv in combination with pembrolizumab for the treatment of patients with advanced or metastatic urothelial cancer may be contingent upon verification and description of clinical benefit in confirmatory trials. [5]

The drug is indicated for the treatment of adult patients with locally advanced or metastatic urothelial cancer who have previously received a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor and a platinum-containing chemotherapy before (neoadjuvant) or after (adjuvant) surgery or in a locally advanced or metastatic setting.

Nonclinical data suggest the anticancer activity of enfortumab vedotin is due to its binding to Nectin-4 expressing cells followed by the internalization and release of the anti-tumor agent monomethyl auristatin E (MMAE) into the cell, which result in the cell not reproducing (cell cycle arrest) and in programmed cell death (apoptosis). [5]

Breakthrough therapyThe Breakthrough Therapy process is designed to expedite the development and review of drugs that are intended to treat a serious or life-threatening condition. The designation is based upon preliminary clinical evidence indicating that the drug may demonstrate substantial improvement over available therapies on one or more clinically significant endpoints. In the case of enfortumab vedotin, the designation was based on the initial results from Phase Ib/II EV-103 Clinical Trial.

The FDAs Breakthrough Therapy designation reflects the encouraging preliminary evidence for the combination of enfortumab vedotin and pembrolizumab in previously untreated advanced urothelial cancer to benefit patients who are in need of effective treatment options, said Andrew Krivoshik, M.D., Ph.D., Senior Vice President, and Oncology Therapeutic Area Head, Astellas.

We look forward to continuing our work with the FDA as we progress our clinical development program as quickly as possible.

This is an important step in our investigation of enfortumab vedotin in combination with pembrolizumab as first-line therapy for patients with advanced urothelial cancer who are unable to receive cisplatin-based chemotherapy, said Roger Dansey, M.D., Chief Medical Officer, Seattle Genetics.

Based on encouraging early clinical activity, we recently initiated a phase III trial of this platinum-free combination and look forward to potentially addressing an unmet need for patients.

Clinical trialThe Breakthrough Therapy designation was granted based on results from the dose-escalation cohort and expansion cohort A of the Phase Ib/II trial, EV-103 (NCT03288545), evaluating patients with locally advanced or metastatic urothelial cancer who are unable to receive cisplatin-based chemotherapy-treated in the first-line setting with enfortumab vedotin-ejfv in combination with pembrolizumab.

The initial results from the trial were presented at the European Society of Medical Oncology (ESMO) 2019 Congress, and updated findings at the 2020 Genitourinary Cancers Symposium.

EV-103 is an ongoing, multi-cohort, open-label, multicenter phase Ib/II trial of PADCEV alone or in combination, evaluating the safety, tolerability, and efficacy in muscle-invasive, locally advanced and first- and second-line metastatic urothelial cancer.

Adverse eventsSerious adverse reactions occurred in 46% of patients treated with enfortumab vedotin-ejfv. The most common serious adverse reactions (3%) were urinary tract infection (6%), cellulitis (5%), febrile neutropenia (4%), diarrhea (4%), sepsis (3%), acute kidney injury (3%), dyspnea (3%), and rash (3%). Fatal adverse reactions occurred in 3.2% of patients, including acute respiratory failure, aspiration pneumonia, cardiac disorder, and sepsis (each 0.8%).

Discontinuing treatmentAdverse reactions leading to discontinuation occurred in 16% of patients; the most common adverse reaction leading to discontinuation was peripheral neuropathy (6%). Adverse reactions leading to dose interruption occurred in 64% of patients; the most common adverse reactions leading to dose interruption were peripheral neuropathy (18%), rash (9%) and fatigue (6%). Adverse reactions leading to dose reduction occurred in 34% of patients; the most common adverse reactions leading to dose reduction were peripheral neuropathy (12%), rash (6%) and fatigue (4%).

The most common adverse reactions (20%) were fatigue (56%), peripheral neuropathy (56%), decreased appetite (52%), rash (52%), alopecia (50%), nausea (45%), dysgeusia (42%), diarrhea (42%), dry eye (40%), pruritus (26%) and dry skin (26%). The most common Grade 3 adverse reactions (5%) were rash (13%), diarrhea (6%) and fatigue (6%).

Specific recommendations

HyperglycemiaHyperglycemia occurred in patients treated with enfortumab vedotin-ejfv, including death and diabetic ketoacidosis (DKA), in patients with and without pre-existing diabetes mellitus. The incidence of Grade 3-4 hyperglycemia increased consistently in patients with higher body mass index and in patients with higher baseline A1C. In one clinical trial, 8% of patients developed Grade 3-4 hyperglycemia. Patients with baseline hemoglobin A1C 8% were excluded.

Physicians are recommended to closely monitor blood glucose levels in patients with, or at risk for, diabetes mellitus or hyperglycemia and, if blood glucose is elevated (>250 mg/dL), withhold the drug.

Peripheral neuropathyPeripheral neuropathy (PN), predominantly sensory, occurred in 49% of the 310 patients treated with enfortumab vedotin-ejf in clinical trials. Two percent (2%) of patients experienced Grade 3 reactions. In one clinical trial, peripheral neuropathy occurred in patients treated with enfortumab vedotin-ejf with or without preexisting peripheral neuropathy.

The median time to onset of Grade 2 was 3.8 months (range: 0.6 to 9.2). Neuropathy led to treatment discontinuation in 6% of patients. At the time of their last evaluation, 19% had complete resolution, and 26% had partial improvement.

Physicians should:

Occular disordersOcular disorders occurred in 46% of the 310 patients treated with enfortumab vedotin-ejf. The majority of these events involved the cornea and included keratitis, blurred vision, limbal stem cell deficiency and other events associated with dry eyes. Dry eye symptoms occurred in 36% of patients, and blurred vision occurred in 14% of patients, during treatment with enfortumab vedotin-ejf.

The median time to onset to symptomatic ocular disorder was 1.9 months (range: 0.3 to 6.2).

Physicians should monitor patients for ocular disorders and consider:

Skin reactionsSkin reactions occurred in 54% of the 310 patients treated with enfortumab vedotin-ejf in clinical trials. Twenty-six percent (26%) of patients had a maculopapular rash and 30% had pruritus. Grade 3-4 skin reactions occurred in 10% of patients and included symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), bullous dermatitis, exfoliative dermatitis, and palmar-plantar erythrodysesthesia. In one clinical trial, the median time to onset of severe skin reactions was 0.8 months (range: 0.2 to 5.3).

Of the patients who experienced rash, 65% had complete resolution and 22% had partial improvement.

Physicians should monitor patients for skin reactions, and consider:

Infusion site extravasationSkin and soft tissue reactions secondary to extravasation have been observed after the administration of enfortumab vedotin-ejf. Of the 310 patients, 1.3% of patients experienced skin and soft tissue reactions. Reactions may be delayed.

Erythema, swelling, increased temperature, and pain worsened until 2-7 days after extravasation and resolved within 1-4 weeks of peak. One percent (1%) of patients developed extravasation reactions with secondary cellulitis, bullae, or exfoliation.

Physicians should ensure adequate venous access prior to starting enfortumab vedotin-ejf and monitor for possible extravasation during administration. If extravasation occurs, stop the infusion and monitor for adverse reactions.

Embryo-fetal toxicityEnfortumab vedotin-ejf can cause fetal harm when administered to a pregnant woman.

Physicians should advise patients of the potential risk to the fetus and advise female patients of reproductive potential to use effective contraception during enfortumab vedotin-ejf treatment and for 2 months after the last dose. At the same time, they should advise male patients with female partners of reproductive potential to use effective contraception during treatment with enfortumab vedotin-ejf and for 4 months after the last dose.

Clinical trialA Study of Enfortumab Vedotin Alone or With Other Therapies for Treatment of Urothelial Cancer (EV-103) NCT03288545

References[1] American Cancer Society. Cancer Facts & Figures 2020. Online. Last accessed on January 23, 2020.[2] American Society of Clinical Oncology. Bladder cancer: introduction (10-2017). Online. Last accessed on January 23, 2020.[3] International Agency for Research on Cancer. Cancer Tomorrow: Bladder. Online. Last accessed on January 23, 2020.[4] National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer. Version 4; July 10, 2019. Online. Last accessed on January 23, 2020.[5] Enfortumab vedotin-ejfv (Padcev; Astellas Pharma [package insert]. Northbrook, IL)[6] Challita-Eid P, Satpayev D, Yang P, et al. Enfortumab Vedotin Antibody-Drug Conjugate Targeting Nectin-4 Is a Highly Potent Therapeutic Agent in Multiple Preclinical Cancer Models. Cancer Res 2016;76(10):3003-13.

A version of this article was first published in ADC Review | Journal of Antibody-drug Conjugates.

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Combination Enfortumab Vedotin + Pembrolizumab Granted Breakthrough Therapy in Bladder Cancer - OncoZine

Medical treatment involving stem cells is an ever-growing, billion-dollar industry, so chances are you have heard about it in the news. Here in the U.S. and around the world, stem cells are being used in various therapies to treat a wide variety of health problems and diseases, including dementia, autism, multiple sclerosis, cerebral palsy, osteoarthritis, cancer, heart disease, Parkinsons disease, and spinal cord injury. Treatments for such health issues may sound promising, but the risk is many of those being sold and advertised arent yet proven to be safe and effective. This is why its so important to educate yourself before jumping into any kind of stem cell treatment.

To gain a better understanding of this new age of medical research, one must first understand what stem cells are and how they work. Stem cells are special human cells that can develop into many different types of cells. They can divide and produce more of the same type of stem cells, or they can turn into different functioning cells. There are no other types of cells in the body that have this natural ability to generate new cell types.

So where do stem cells that are used for research and medical treatments come from? The three main types of stem cells are embryonic (or pluripotent) stem cells, adult stem cells, and induced pluripotent stem cells.

Embryonic stem cells come from unused, in vitro fertilized embryos that are three to five days old. The embryos are only donated for research purposes with the informed consent of the donors. Embryonic stem cells are pluripotent, which means they can turn into any cell type in the body.

Adult stem cells are found in small numbers in developed tissues in different parts of the body, such as bone marrow, skin, and the brain. They are specific to a certain kind of tissue in the body and are limited to maintaining and repairing the tissue in which they are found. For example, liver stem cells can only make new liver tissue; they arent able to make new muscle tissue.

Induced pluripotent stem cells are another form of adult stem cells. These are stem cells that have been manipulated in a laboratory and reprogrammed to work like embryotic (or pluripotent) stem cells. While these altered adult stem cells dont appear to be clinically different from embryonic stem cells, research is still being conducted to determine if the effects they have on humans differ from actual embryonic stem cells.

Stem cells can also be found in amniotic fluid and umbilical cord blood. These stem cells have the ability to change into specialized cells like embryonic stem cells. While more research is being conducted to determine the potential of these types of stem cells, researchers already actively use these through amniocentesis procedures. In this procedure, the stem cells drawn from amniotic fluid samples of pregnant women can be screened for developmental abnormalities in a fetus.

The main difference between embryonic and adult stem cells is how they function. Embryonic stem cells are more versatile. Since they can divide into more stem cells or become any type of cell in the body, they can be used to regenerate or repair a variety of diseased tissue and organs. Adult stem cells only generate the types of cells from where they are taken from in the body.

The ability for stem cells to regenerate under the right conditions in the body or in a laboratory is why researchers and doctors have become so interested in studying them. Stem cell research is helping scientists and doctors to better understand how certain diseases occur, how to possibly generate healthy cells to replace diseased cells, and offer ways to test new drugs.

Clearly, stem cell research is showing great potential for understanding and treating a range of diseases and other health issues, but there is still a lot to learn. While there are some diseases that are showing success using stem cell treatments, many others are yet to be proven in clinical trials and should be considered highly experimental.

In our next article, various stem cell treatments, FDA regulations, and other stem cell hot topics will be explored. It will also focus on what to look for when considering stem cell therapies so people arent misled or misinformed about the benefits and risks.

For more information regarding the basics of stem cells visit these sites:

https://stemcells.nih.gov/info/basics/1.htm

https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/in-depth/stem-cells/art-20048117

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The 411 on Stem Cells: What They Are and Why It's Important to Be Educated - Legal Examiner

Past Institute lectures

A lecture for the Von Hugel Institute series Ethics in Public Life, 5th February 2015, given by Claire Foster-Gilbert, Director, Westminster Abbey Institute.

The context of the series of lectures of which this is one is ethics in public life, and I would like to start by taking some time to describe the creation and operation of Westminster Abbey Institute, and use it as a prism for our consideration of bioethics and decision making in the UK. I want to say a little bit about the sacred-secular divide which I do not see. Then the two thorny examples I will use in bioethics, when I come to them, will be embryology and assisted dying.

Westminster Abbey Institute was launched in November 2013 to revitalize moral and spiritual values in public life, working with the public service institutions around Parliament Square, and drawing on its Benedictine resources of spirituality and scholarship.

Westminster Abbey sits on the south side of Parliament Square, with the Judiciary in the form of the Supreme Court on the west side, the Executive in the form of Whitehall on the north side, and the Legislature in the form of the Houses of Parliament on the east side. The Institute is the Abbeys answer to the question: what is it bringing to public service and how can it support those in public office?

We knew, when we started, what we were not: a think tank, part of the commentariat, a campaigning organisation, nor a fawning courtier. Nor were we apologists for religion in the public square. The Abbey is already more integrated than that. There is no sense of a sacred-secular divide, and as I go about my work as Director I feel none between my work and that of the public service institutions around the Square. The similarity is that we are identifying at the heart of the Parliament Square endeavour a sincere wish to support the good, to serve society, to make things better in the world. And in that sincere wish I see spirit moving, hearts opening, minds analysing, bodies acting, as a holistic, responsive flow to the call of public service.

I am not naive: the motivation to serve the public and the vocation to public service are not pure. In amongst the good wheat of service are the tares of motives such as selfish ambition, personal gain, fame, and the needy weakness of human nature to be recognised and rewarded. I see those other motives, but I know them for my own also, so am in no position the Abbey Institute is in no position, lets be clear to judge or condemn them. Like the parable, we leave that till the harvest. And meanwhile, by supporting the good, believing in the motives that are for service, recognising and applauding the rightness in the work around the Square, the murky tares, if I may torture the analogy beyond its capability, melt away. We hope.

I see a wholeness, then, responding to a call to serve. The deeper the response the more effective and lasting it will be and here is a place where our religion makes a specific contribution. The further back into God it reaches, the more effective and lasting and good the call to public service will be. I call it God. Spirit, depth, the swirling deep movement of creativity, the meditation of the soul, the rest before action. The further the archer draws back the bow, the further and truer the arrow will fly. It has been notable just how much of a longing for depth has shown itself in the people and institutions around the Square in the short time the Institute has been operating.

Our method is first to offer a Benedictine context. That is, we offer conversation that locates itself in stability, community and the conversion of manners. We will sit down with a group of, say, senior Civil Servants, or those tasked with offering professional development to MPs, or a group of Peers, and together we will devise a seminar for their department or group which will look at the good that the department or group is trying to do. What is significant and distinctive is that the psychological and philosophical location of the conversation is deep. That depth is also physically expressed by the Jerusalem Chamber where King Henry IV died and V became King, and the King James Version of the Bible was finalised, and so forth, where the seminars happen. Part of the Abbots and then the Deans lodging, a space where spiritual and worldly do not separate.

I was set a great example of how to do depth by Rowan Williams when he was the interlocutor for a series of four public conversations at St Pauls Cathedral, taking in turn global economy, ecology, governance and health, and asking the experts in those fields questions which immediately drew them into a consideration of the philosophical and even theological underlying currents of the subjects. The bishops did a similar thing with genetics experts when they spent a day learning about the subject. They were really good questions, and ones that practitioners, officials, public servants often dont have time to ask, but they are the most important questions because they lead us into our spiritual humanity.

A really lovely example emerged yesterday when we were sitting around the table in the Permanent Secretarys office of a Government Department, discussing a forthcoming seminar for the Department. One of the Civil Servants spoke about how too often officials in the Department will apply formulaic approaches, such as the benefit-cost ratio, in a way that masks or even undermines vital human qualities such as empathy and humility, and we will look at this in the seminar. Importantly, the words and the disposition came from the Civil Servant, not from the Abbey Institute. We are not functioning on the Square to tell others what the Good is. It emerges in the encounter.

So the conversation is located in a Benedictine place (in a way, for a short while, that Permanent Secretarys office became a Benedictine space). First, it is stable, it is safe here, and here is not going to go away, its an historical place where we can feel our own passing, gain a perspective on our place in history. Second, it is a place of community, which means that we are gathered in goodwill together, seeking the good together, united in our efforts and made companions in our purpose, not by any means agreeing with each other but feeling safe with each other. As a community of goodwill we feel it is safe to get things wrong, to take time to form conscience, to work things out. And of course we operate to the Chatham House rule. Third, we are about the conversion of manners. We expect transformation to take place though we dont necessarily know what it will be. Broadly, though, borrowing from Philip Shepherd, we will be looking for moves:

And I dont mind admitting that this transformation is probably only realised after the talking is over and everyone has gone to evensong and then wandered around the Abbey in the semidark and silence of the close of the day and had a glass of wine back in the Jerusalem Chamber!

In agreeing that we are a community of goodwill seeking to articulate the good I have offered an analogy from sailing that works well. A Government Department can be imagined as a sailing boat. At the helm stands the Permanent Secretary, who, like all good helmsmen, seeks never to steer the boat more than five degrees either side of the compass direction upon which the boat is set. Civil Servants in the Department form the crew, from the navigator who must know the course and ensure the helmsman anticipates obstacles, to the scrubber of decks who ensures no one slips up. All play their part in ensuring the boat remains shipshape and able to withstand the waves and the winds in travelling its appointed course.

The waves are the events of the nation and the world. They may be relatively calm or they may rise into steep and stormy mountains of water, threatening the stability of the boat.

The winds are public opinion, which can fill the sails of the boat and send it scudding on its chosen course. They can gust and buffet, interrupting the boats smooth journey. Or they can blow adversely, threatening to push the boat off course altogether.

Hence, the helmsman cannot simply hold the tiller fixedly. He or she must constantly respond and adjust to the wind and the waves, aiming to keep within five degrees either side of the compass direction or risk increasingly over-compensatory swings away from the course of travel.

The compass point towards which the boat is sailing is The Good. As such, it is not a destination; the journey is the thing, the direction of travel the concern, not the arrival.

By whom is The Good defined? It is true that the Government Minister is granted that responsibility and privilege by virtue of having been elected by universal franchise. But in defining The Good, Ministers have to have their Partys support. And of course the strength of the prevailing wind, public opinion, may be such as to determine a change of compass direction altogether. For the politician, public opinion will set parameters on what he or she can achieve. The great political leader will have a vision of the Good that transcends narrowminded concerns but retains Party support, and respects the parameters set by the prevailing wind of public opinion. The visionary and skilled politician will learn, quite possibly from his or her Civil Servants, about the art of tacking.

Because of course it is the helmsman and the crew who execute the tack, and any other sailing manoeuvres required. The Civil Service crew, having gathered the evidence sniffed the wind, watched the waves will need to be able to tell Ministers when their proposed direction of travel will not work: when, whatever the Ministers might want to think, their proposed direction is possibly not towards The Good. Thus the Good is sought by all.

And in passing, if one imagines Whitehall as a fleet of boats, those, too, will need to be taken into account by the helmsman. But and it is a wonderful sight sailing boats, journeying as a fleet in the same direction across the waves, subject to the same wind, stay uniform distances apart.

Having established a common concern with identifying the Good, seated in our Benedictine space, we then spend time as moral philosophers, looking at the specifics of the policy drivers for a given Government Department. Our analysis is rigorous, using the method I developed in the Centre of Medical Law and Ethics at Kings College, London, under Ian Kennedy, in the 1990s.

We use the three broad approaches that moral philosophers have taken over the centuries as they have sought to determine what is good. These we have called goal-based, duty-based and right-based, following Dworkinii, Botrosiii and Fosteriv. Very briefly and broadly, a goal-based thinker will see the good of an action in its consequences rather than in the content of the action itself; a duty-based thinker will look at the action and judge it according to preexisting moral rules; and a right-based thinker will judge the action according to the views of those most affected by it. The goal-based approach is valid insofar as it is the case that we rarely act without some end in view and it is right to consider whether that end is a good one. The goal-based approach is limited in that even very desirable goals should not justify actions which in themselves are intrinsically nasty. The ends are important moral considerations but they dont justify the means. Morality is not a mathematical exercise. The duty-based approach is valid in that it makes us think hard about what we are doing rather than merely why we are doing it, recalibrating the needle of our moral compass, making us morally sensitive rather than mathematically certain. The duty-based approach is limited because it can blind us to important consequences (Kant would have us truthfully respond to a murderer seeking her prey); and it is limited because it can make us arrogant: concerned only with our own place in heaven earned by doing the right thing, regardless of its effect or the views of others (the poor soul who will be murdered because Kant refused to tell a lie, or the patient who wants his life support switched off and we refuse to take a life). The right-based approach is valid because it requires us to listen to others, it makes us community-minded instead of purist. It is limited because on its own it would make someones request, for example, to take their life, right with no other consideration except that it is their wish.

All three approaches are needed. They conflict, they make us think, they require sensitive responses, honest appraisal, self-awareness because we will temperamentally favour one approach over the others, but taken together they form a three-legged stool that stands firm, if the legs are all of the same length, even on rocky ground.

And then comes the real challenge of bioethics. The Department of Health wants us all to live better for longer. But when does life begin and when does it end? I want in this third and final part of my lecture to explore the contemporary challenge of these questions by looking at two issues embryology and assisted dying that have been working their way around Parliament Square, with cases in the Supreme Court, policy development in Whitehall, and legislation or attempts at legislation in the Houses of Parliament.

Human fertilisation and embryology are scientifically complex and they are also, at every stage, morally sensitive. The challenge to Government and Parliament has been whether and how to draw these extraordinary scientific developments within a regulatory framework in a way that respects the science and does not ride roughshod over the sensitive moral questions, or ban the research and practice altogether. Having chosen the former course of action, what principles needed to underlie the regulatory framework?

Let us take a step back in time and thought. Let us bring the issue into our safe Benedictine space. Here we are allowed to think out aloud. We do not have to have a pre-determined position, but if we do, we wont be shouted down or assumed to be on the side of the devil.None need feel defensive. In this Benedictine space we are seeking the Good, aware that many have tried before us and God willing there will be many afterwards, all calibrating their moral compass and seeking to steer the boat no more than five degrees either side of the compass point, but having to allow, because of the wind of public opinion and the waves of ever changing events, that much leeway either side. We know we will not find perfect answers.

And now for the three-legged framework. From a goal-based perspective, we ask what embryology is for, and why it matters. Embryology is important as a cure for infertility, as a therapeutic response to currently incurable diseases using cell transplantation and, very recently proposed, eliminating mitochondrial disease altogether. Its goals, then, are for life: new life, and curing diseased life. No one, really, could argue with the goals of embryology. We would want the research and practice to be done excellently, so as to ensure these good goals were reached, but from a goal-based perspective, taken on its own, there can be no quarrel with it.

From a duty-based perspective, what does embryology involve? Here the moral questions start to bite. The first question must be about the status of the embryo itself. Because if the embryo has the same status as a human life, no matter how wonderful the goals are, no one would countenance destroying a human life to reach them, and embryology (which always involves destroying embryos) would fall at this moral fence.

The reasons you might regard the embryo as a human life are as follows: the embryo is formed from the fertilisation of an egg by a sperm forming a unique genome no one (if it is a person) was ever like it before, and no one will be ever again. We, each of us diverse people, were all embryos once. If we are to choose a point when life begins, the formation of the fertilised egg is certainly a definite stage one could choose.

The reasons you might not regard the embryo as human life are: the place of fertilisation is not the womb or the field in which the embryo is implanted, but at the base of the fallopian tubes. The embryo still has a journey to make to reach the womb and implant. (Some Shia teaching on this argues that life cannot be said to have begun until the seed, egg and field are all in place, ie at implantation.) During that journey, in the normal course of events, 70% of embryos do not reach the womb. It is during that journey that the all-important stem cells start to proliferate, hence the interest in the early, pre-implanted embryo, not the fetus in the womb. During that journey, the embryo may divide and become more than one fetus, hence genetically identical twins. These reasons may persuade you that it would be acceptable to see the early embryo not as human life but as potential life, and that its use therapeutically is acceptable. You may feel the goal-based tug: the status of the early embryo is in question, and the use of them therapeutically is so full of promise Should the duty-based consideration, that the embryo has independent moral status like that of a human being, give way?

What is important to recognise is that we do not say that the embryo has no status. The legislation has recognised its moral importance by regulating its use. But the law has accepted that the embryo is not the same as a human life.

From a right-based perspective, you cannot really make a judgement. The embryo cannot speak for itself. Is it fanciful to conduct a thought-and-feeling experiment predicated on the fact that we were all embryos once. Would we be happy to have been destroyed even before reaching the womb, to save another life or lives, or to create a new life? ??

The other right-based question relates to those who might benefit from stem cell or mitochondrial therapy: if they think of the embryo as having human status they may not want to benefit from such treatment. Healthcare practitioners may seek to be conscientious objectors.

The challenge to UK decision-making of embryology has been profound and I think, myself, that we have not done badly at it. Prior to this last development on mitochondrial DNA, the debates have been long and thoughtful, no speedy legislation was drawn up (except to prevent cloning), and the regulation is careful. In the UK, embryo research can take place but it is all regulated. (In the US, embryo research may not take place if it is federally funded; if you can pay for it yourself, you can do what you like!)

However, courts continue to be referred to as no legislation could possibly anticipate the science. It has turned out that the most fruitful source of embryonic stem cells has not come from embryos but from de-differentiated adult cells. Since however these de-differentiated cells, if placed in a womb, could theoretically grow into a clone of the person whose cell it was, this has had to be specifically outlawed and, much more recently, and potentially worryingly, a court has ruled that: The mere fact that a parthenogenetically activated human ovum commences a process of development is not sufficient for it to be regarded as a human embryo. This judgement opens the way to patenting the process of creating stem cells. It is potentially worrying since it arguably robs the embryo of its moral status. However, what is the status of a de-differentiated cell, which could originate from any one of the bodies in this room just by scraping our skin?

Is the very recent decision of the Commons to allow the process that removes diseased mitochondrial DNA from the offspring of mothers with the disease a case of slipping down a slippery slope into unethical waters? Is it the first step towards eugenics, since it eliminates the disease from the germ line permanently? Or is it an intelligent use of skills and techniques we have developed through carefully regulated embryo research, that will allow the cure of a vile disease?

Assisted dying, unlike embryo research, has not been made legal and given a set of regulations by which to abide. Despite its repeated return to Parliament and the apparent public support for a change in the law, none has happened, as yet. In practice, cases have been decided by the Courts and the number of cases coming to the Courts is only increasing. It is something of a sore point for the judges: they cannot turn cases away. All the time, as they see it, Parliament refuses to take the bull by the horn and create legislation, they are obliged to give judgements on a case by case basis that creepingly changes the law, and it is changed by lawyers not by democratically elected representatives of the public debating in public.

Before reflecting on the challenge to law and policy-makers that assisted dying has posed, let us once again step back into our Benedictine space, and we should pause here for a moment and recollect that the primary quality of that space is listening

And now conduct our analysis. Assisted dying is the act of making available to a person, who has expressly and competently asked for it, the means to take his or her life by their own hand.

From a goal-based perspective, one goal of assisted dying is to alleviate suffering. Another is torespect the autonomy of individuals. Another may be put more boldly: to end life deliberately.

From a duty-based perspective, principles of the sanctity of life and of respecting autonomy both raise their concerns, and conflict. How are they resolved?

From a right-based perspective, the principle of respect for autonomy trumps any duty of other individuals to save, sustain or end life. It is, simply, up to the individual. When polls are taken on the subject of assisted dying and euthanasia the vast majority of responses are in favour of it, on the grounds, though, that it is my life to do with as I please and who is any doctor to prevent me. But a law that permitted a solely right-based approach that the request should be granted simply because it had been made would be impossible to apply. It would be impossible to know if the person had actually asked for death, because they would be dead. Additional safeguards have to be included in any legislation, and these require that certain relevant professionals are satisfied that the conditions allowing assisted dying are met. This is not, then, a purely rights-based activity any more. Similar difficulties arise in seeking abortion - it is not, in the legislations, simply up to the mother whether or not the abortion takes place. She has to satisfy two doctors that she fulfils the criteria set by the law. The fact that doctors will very often sign the forms without questioning the mother, because they take a right-based approach in profoundly believing in her right to choose, is symptomatic of the challenge of lawmaking in areas of bioethics.

If the dying in question is assisted only, ie the person has to take the lethal substance themselves, this right-based problem is allayed. That is to say, we may be fairly sure that if the pink drink given by organisations such as Dignitas is drunk without assistance once it is put in the hands of the one seeking assisted dying, then he or she most definitely did want to die.

We cannot know what passes in their hearts however, and Mary Warnock has been worryingly at ease with the idea that it would be perfectly all right to seek euthanasia on the grounds that one felt a burden to ones family and friends. The wishes and needs of the community of that individual: family, loved ones, society are all included in the right-based approach, and what of these? Chaplains ministering to those receiving euthanasia in Holland speak of the devastation of families, resonant of the desolation of the families of suicides.

The most recent case that came to the Supreme Court was that of Nicklinson, Lamb and the Director of Public Prosecutionv. Nicklinson and Lamb were both almost entirely paralysed; Nicklinson from a stroke which left him able to blink only and Lamb from an accident that meant he could only move his right hand. Hence neither would be able to take the pink drink unaided, so both wished to be assisted to die without fear of prosecution of those who helped. The Director of Public Prosecution sought the freedom to decide on the matter of assisting suicide on a case by case basis.

In the Supreme Court, all the Law Lords agreed that Article 8 of the Human Rights Act (which is the right to a private life, to be overridden only in the case of threats to public safety or criminal acts) is relevant to the issue of assisting someone to die if it is their express wish. That is to say, domestic rulings can be made by way of interpretation of the Article in relation to assisted suicide. But while some Law Lords believed that it was a right for a person to be assisted to die if it was their express wish, according to Article 8, others did not. It was recognised that there was a fundamental incompatibility between the sanctity of life and autonomy. Several Law Lords argued strongly that the debate should be held in Parliament as the representative body of society, not judged upon by appointed Justices. And indeed there is yet another bill to allow assisted dying making its way through the House of Lords now. It has reached the stage where the Lords are working through more than 100 amendments, some of which are clearly intended to wreck the bill, whilst others provide clarification and strengthening of safeguards. And arguably the intellectual purity of the moral reasoning of the judges is a better place to turn to than the mess of Parliamentary debate. What a strange way for law on such a sensitive and controversial issue as the management of the dying process to be written: by the tug of war of differing factions and the compromise that will inevitably be reached if the bill is to succeed.

And yet, how are we to decide these matters that affect us all? I should like to finish, provocatively, with a lengthy quotation from a recent lecture delivered by one of the Justices of the Supreme Court, Lord Sumption.

To sum up, then. We have considered challenging and complex bioethical issues using the Westminster Abbey Institute approach of first, creating a Benedictine space of safety and stability, second, subjecting the matter to rigorous moral analysis and third, coming to a decision, which decisionmaking is the responsibility of the lawmakers and the policymakers. What I have not done is to offer absolute rules or principles which trump every other consideration. It is far better to be morally sensitive than to be morally certain. And so I am agreeing with Lord Sumption that, however fallible it may be, Parliament is the place to fashion legislation on these matters. We do well to attend to whom we put there.

(i) Philip Shepherd, New Self, New World: recovering our senses in the twenty-first century, (Berkeley: North Atlantic Books), 2010 (p 282)(ii) Ronald Dworkin, Taking Rights Seriously, 1977 (Harvard: Harvard University Press)(iii) Sophie Botros and Claire Foster, The moral responsibilities of research ethics committees, in Dispatches, 3:3, Summer 1993(iv) Claire Foster, The Ethics of Medical Research on Humans, (Cambridge: Cambridge University Press) 2001(v)R (on the application of Nicklinson and another) (Appellants) v Ministry of Justice (Respondent); R (on the application of AM) (AP) (Respondent) v The Director of Public Prosecutions (Appellant); R (on the application of AM) (AP) (Respondent) v The Director of Public Prosecutions (Appellant) 25 June 2014(vi) Lord Sumption, The Limits of Law, 27th Sultan Azlan Shah Lecture, Kuala Lumpur, 20 November 2013

Download a transcript of this lecture (PDF, 238KB)

Original post:
The Challenge of Bioethics to Decision-Making in the UK - Westminster Abbey

Four University of Pennsylvania seniors and three recent alumni have won a Thouron Award to pursue graduate studies in the United Kingdom. Each scholarship winner receives tuition for as long as two years, as well as travel and living stipends, to earn a graduate degree there.

Established in 1960 and supported with gifts by the late John Thouron and his wife, Esther du Pont Thouron, the Thouron Award is a graduate exchange program between Penn and U.K. universities that aims to improve understanding and relations between the two countries.

Penns seven 2020 Thouron Scholars are:

Daniel Brennan

Senior Daniel Brennan, of Miami, is a varsity oarsmen for Penns lightweight crew team majoring in history and political science, with concentrations in military history and political theory in the School of Arts and Sciences. As a United States Marine and past moderator of the Universitys Philomathean Society, he is an advocate for greater civil-military awareness. Brennan works on national security policy as a Student Fellow at the Perry World House and is writing his honors thesis on the development of counterinsurgency strategy during the Cuban War of Independence. He is a Benjamin Franklin Scholar and has worked on anti-hunger issues both as a Fox Leadership Fellow with the Catholic Archdiocese of Philadelphia and by organizing his crew teams meal-packing events. In the U.K., he plans to pursue a masters degree in military history.

Braden Cordivari

Braden Cordivari, of Elverson, Pennsylvania, is a 2018 graduate of the College of Arts and Sciences. He received his bachelors degree in classical studies and anthropology with a minor in archaeological science. Since 2015, he has continued to work at Penns excavations at the ancient Iron Age city of Gordion in Turkey. He spent the 2018-19 academic year as a John Williams White Fellow at the American School of Classical Studies at Athens completing a program of intensive study of Greek archaeology and history. His research interests include human/environment relationships in the past and the study of craft production through science-based methods. Cordivari plans to pursue a masters degree in archaeological science at the University of Cambridge.

Gregory Forkin

Gregory Forkin, of Philadelphia, is a 2019 graduate with a bachelors degree in mathematics, physics, and biology and a minor in chemistry. He was a University Scholar and a member of Phi Beta Kappa. Currently, he is conducting research in neuroscience under Professor Vijay Balasubramanian and is a teaching assistant in the Math Department in the School of Arts and Sciences. Forkin plans to pursue a masters degree in pure mathematics at the University of Cambridge.

Natasha Menon

Senior Natasha Menon, of Scottsdale, Arizona, is pursuing a major in philosophy, politics, and economics with a concentration in distributive justice and a minor in legal studies and history in the School of Arts and Sciences. Menon serves as president of the Undergraduate Assembly, through which she works to elevate the voices of marginalized communities on campus to effect change. She is also a Civic Scholar, and has volunteered at Moder Patshala, a Bangladeshi immigrant services center in Philadelphia, for three years. Menon plans to pursue a masters degree in international migration and public policy at the London School of Economics. Upon returning to the U.S., she hopes to pursue a law degree and engage in public service in Arizona.

Robert Subtirelu

Senior Robert Subtirelu, from Ronkonkoma, New York, is majoring in the biological basis of behavior and minoring in chemistry in the School of Arts and Sciences. A recipient of the 2019 Clinical and Translational Research Award, he has conducted research with the Perelman School of Medicines Department of Neurosurgery to investigate post-traumatic epilepsy. He works as a teaching assistant, volunteers with Wissahickon Hospice, and remains an active member of Penns Medical Emergency Response Team. He also founded and coordinated the activities of a not-for-profit organization that has established educational and nutritional programs internationally. Subtirelu plans to pursue a masters degree in clinical and therapeutic neuroscience at the University of Oxford.

Zachary Whitlock

Senior Zachary Whitlock, of Washington, D.C., is in the Vagelos Integrated Program in Energy Researchjoint-degree program, majoring in materials science and engineering in the School of Engineering and Applied Science and in earth science in the School of Arts and Sciences. Whitlock has workedon biomimetic functional materialswith Penn Engineerings Shu Yang Laboratory and internationally at the French Alternative Energies and Atomic Energy Commission. More recently, he worked at the intersection of industrial materials and environmental impact on the Kleinman Center for Energy Policy-funded project Fossil Fuels, the Building Industry, and Human Health. He is a 2020 Kleinman Undergraduate Fellow and Supported Student at the Water Center at Penn. He is planning to pursue a masters degree in environmental systems engineering at University College London and ultimately hopes to contribute to the sustainability and impact mitigation of projects reliant on ecosystem services.

Maia Yoshida

Maia Yoshida, of Madison, New Jersey, received her bachelors degree in 2018 in molecular and cell biology with a minor in fine arts. She is now a researcher in a bioengineering lab, engineering immune cells to better fight cancers. While at Penn, she researched the molecular mechanisms involved in neurodegenerative diseases and was a teaching assistant for a fine arts course on biological design. She also taught elementary school science at the Penn Alexander School in West Philadelphia. As the president of Global Brigades at Penn, she led fundraising efforts for sustainable development projects in Honduras. Yoshida plans to pursue a masters degree in STEM Education at Kings College London.

TheCenter for Undergraduate Research and Fellowshipsserves as Penns primary information hub and support office for students and alumni applying for major grants and fellowships, including the Thouron Award.

Here is the original post:
Penn announces seven 2020 Thouron Award winners - Penn: Office of University Communications

Last November, at the start of the American Heart Association 2019 Scientific Sessions in Philadelphia, cardiologist and current AHA presidentRobert Harrington, MD, sent out atweetto his 14,200 followers: No MANELS! There are no all-male panels at #AHA2019.

Within an hour, the post had amassed hundreds of likes and retweets, as scientists and physicians from all over the country chimed in to express their support. Outstanding! Lets continue to support our young women in STEM and to increase the number of #WomeninMedicine, replied a preventative cardiologist from USC. The best part? This wasnt hard for @AHAMeetings to accomplish. Because #WeAreEverywhere, a cardiologist who specializes in myocardial infraction also tweeted in response.

Harrington, the Arthur L. Bloomfield Professor in Medicine and chair of the Department of Medicine at Stanford, has shown a commitment to amplifying diverse voices and leveraging innovative technologies and policies to improve health equity. And its these values that drive his work at Stanford and the AHA. Recently, Lindsey Baker, communications manager in the Department of Medicine, spoke with Harrington about his views on technology and diversity in medicine.

1. Youve taken up several initiatives during your tenure as AHA president including health equity and diversity, and research. How did you choose these topics, and why were they important to you?

Harrington:One of the great things about being the AHA president is that you realize you have a big public platform. It provides an opportunity to think about the things that matter to you.

Im a clinician and a clinical researcher, so one of the key themes of my 2019 AHApresidential addresswas the idea that evidence matters that its really important to have an evidence base to guide what we do in clinical medicine, and in order to generate that evidence base we need to support research. And in order to support research, we have to think about health equity: How do we make research more approachable for people in communities where theyve been understudied and underserved?

We now include the word equitable in all of our goal statements. And we just recently announced our2030 impact goals, which emphasize how we improve overall whole person health in the U.S. and globally.

Were also committed to supporting young investigators. Right now, over 70% of all of our new research awards go to early career investigators. Ive mentored residents and fellows for a long time now, so theres overlap with my day job. Im also a first-generation college student, and were passionately committed to supporting that group as well.

2. Fewer than 15% of cardiologists are women. How are you closing the gender gap?

Harrington:I was raised by a single mother. I have one sister, I have a wife, I have four daughters. Im surrounded by women. And yet cardiology as a field is not known for being women-friendly.

So, I decided that I was going to make it part of my AHA presidency. We now have a lot of initiatives to address this: Weve created a new group calledResearch Goes Red, which builds on our Go Red for Women campaign, which is focused on understanding heart disease in women. Weve also created a womens research working group designed to make sure that were reviewing submitted grants in a gender-equitable way, and that were including more women as part of all of our science committees. Right now, our committees are roughly 42% women, and weve made a public commitment to get to 50% in the next few years.

And in 2019, we made the official decision to stop hosting manels, which are scientific panels comprised solely of men. When we were planning the 2019 scientific sessions, I told colleagues that I will no longer serve on a panel that only contains men, and I asked them to stop hosting panels at the AHA scientific sessions that only include men.

3. Youre involved in theApple Heart Study, which saw record participant enrollment and the widespread introduction of digital technology into clinical research. What in your opinion makes this study so groundbreaking? What have been some takeaways?

Harrington:All credit for Apple Heart goes to others toMintu Turakhia,Marco Perez,Ken Mahaffey,Manisha Desaiand their teams. My role has been supportive.

Here are the real takeaways for me: Apple Heart was intended to be a technical feasibility study: Might the watch be able to detect atrial fibrillation using the sensors in the watch and algorithms? Because its not actually detecting a-fib; its detecting an irregularity that has a probability of being a-fib based on a variety of characteristics. And I think the group achieved that.

The second takeaway, and to me the most interesting part of the study, is that in only eight months we convinced 400,000 people to give us informed consent to collect their health data. Thats the power of the technology. If we can engage almost a half-million people in research the way we did the Apple Heart Study, that could change the paradigm of how we do research. These are extraordinary tools that can allow us to have reach into numbers that we just cant do in conventional research.

4. Studies like this make it clear: Technology in research is here to stay. How can we use it in ways that are more supportive and democratic, and less intrusive?

Harrington:The biggest thing that Ive been talking about recently is how do we use the watch, the phone and the web to collect data that can be used for research purposes. And if you dont have to go to the doctors office and see your clinicians or the study coordinators, wouldnt that help to democratize research so that research could reach more people?

Right now, to be involved in research youve got to be willing to come to campus or go to a clinic. What if we could do a lot of it remotely? Might we be able to engage a group of people thats more representative of the population? That to me would be a really important step.

5. Youre very active on social media particularly Twitter. What appeals to you about this platform?

Harrington:Im a big consumer of information. And I largely use Twitter as my social media conduit. I use it to engage in conversations about things I find interesting in cardiovascular medicine, and to keep up with whats going on in the field. I now track all of my academic journals through Twitter thats how I stay current.

I really enjoy the conversations around science, and Twitter makes me read things I might not otherwise read in journals that I havent subscribed to. I think that the crowdsourcing of ideas is really helpful and informative people throw stuff out and ask what you think about it. And all of the sudden you have 50, 100, 200 different voices weighing in.

Twitter democratizes medicine you dont have to be a professor to have an opinion. In fact, some of our early-career investigators are much more facile than established professors on Twitter. Now when I travel around the country to different places for conferences and meetings, I always meet some young person I know from Twitter. Ive met new people, made new friendships and encountered new ideas.

I just tell people to decide how they want to use it. I use it professionally, and there are a few things I do regularly that people know about. For example, Im always showing pictures of my socks, particularly during heart month. I wear a lot of red socks! And everyone knows I love the Boston Red Sox because I tweet about them.

In a new 1:2:1 podcast, Harrington discusses the latest advances in cardiovascular medicine, as well as efforts to address gender inequities in the field of cardiology, with Paul Costello, the School of Medicine's senior communications strategist and adviser.

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5 Questions: Robert Harrington on research, health equity and the gender gap in cardiology - Stanford Medical Center Report

Arts and Healing Across the Lifespan serves as the theme of the 4th annual Creative Age symposium organized by the Arts Council of Washington County.

Jeremy Nobel, M.D., founder of the Foundation for Art & Healing (FAH), is Board Certified in both Internal Medicine and Preventative Medicine, with masters degrees in Epidemiology and Health Policy from Harvard School of Public Health, where he serves on the adjunct faculty.(Photo: Arts Council of Washington County)

We have brought together some of the best thinkers in arts therapy for this one-day, intensive symposium, said Paula Bell, chair of the event. So much exciting research shows the proven benefits, regardless of age, of participating in the arts for longevity, mobility, cognitive ability and quality of life for all.

The symposium features two inspiring keynote speakers and 14 breakout sessions, with entertainment from a concert pianist. Bell suggests the symposium is targeted to parents and teachers; psychologists; counselors; doctors; caregivers; arts, music and drama therapists; those working with patients with dementia, Alzheimers and Parkinsons; and those aspiring to understand the loneliness epidemic.

Jeremy Nobel, M.D., founder of the Foundation for Art & Healing (FAH), embodies in a most personal way the effort to enlist art and science in the relief of human suffering. Nobel, who is Board Certified in both Internal Medicine and Preventative Medicine, with masters degrees in Epidemiology and Health Policy from Harvard School of Public Health, where he serves on the adjunct faculty, is also a poet, a photographer, and a teacher a practitioner of the humanities. He is scheduled to attempt to answer the question, Can creative expression be medicine?

Nobel will help participants discover how creative expression reduces the physical and emotional burden associated with various types of health conditions and life circumstances," said Ken Crossley, co-chair of the event.

Nobels Unlonely Project is the signature initiative of FAH, a project whose mission is to broaden public awareness of the negative physical and mental health consequences of loneliness, while promoting creative arts-based interventions to reduce its burden. The project has garnered national visibility, including being featured on the Today Show, The New York Times and Psychology Today. Nobel will present a breakout session, Deep Dive with Jeremy Nobel.

Erica Curtis, certified marriage and family therapist, as well as author, speaker and instructor at UCLArts & Healing, co-authored with Ping Ho, the award-winning book, The Innovative Parent: Raising Connected, Happy, Successful Kids through Art.(Photo: Katie Lubbers)

Erica Curtis, certified marriage and family therapist, as well as author, speaker and instructor at UCLArts & Healing, co-authored with Ping Ho, the award-winning book, The Innovative Parent: Raising Connected, Happy, Successful Kids through Art. As a keynote speaker, Curtis is scheduled to address how art may help parents temper storms of emotion, defuse sibling conflicts, get teeth brushed, and raise happy, successful kids. Her approach has been described as simple, doable and fun.

She believes talking to kids often is not effective, especially when it comes to calming emotions. In her hands-on keynote, Curtis will share art therapy trade secrets to address the countless challenges faced by children and teens when words are inadequate or inaccessible. From anger to anxiety and daily struggles, this session equips the participant with practical tools for calming kids, and is geared toward parents, grandparents, and professionals alike.

Dr. Massimiliano Frani, concert pianist and founder of Genote Health Music, is scheduled to provide entertainment at the Creative Age symposium and will also lead a breakout discussion focused on providing tools to better understand the effects of health music on aging and recovery processes.(Photo: Arts Council of Washington County)

Dr. Massimiliano Frani, concert pianist and founder of Genote Health Music, will provide entertainment on Saturday morning after breakfast and will also lead a breakout discussion focused on providing tools to better understand the effects of health music on aging and recovery processes. Participants may assess health music applications as a non-pharmacological intervention. As master pedagogue, he performs and lectures worldwide about music as medicine and its effects in physical and mental health, education and sports. He has presented Health Music papers, training sessions and conferences worldwide and is the recipient of the Melvin Jones Humanitarian Award.

Other presenters include Vicky Morgan, Victoria Petro-Eschler, Debra Eve, Joni Wilson, Chara Huckins, Dr. Brandt Wadsworth, Barbara Lewis, Nicholas Cendese, Karen Carter, Dr. David Tate, Sharon Daurelle, Emily Christensen, Alex Mack, Saundra Shanti and Rev. Claudia Giacoma.

Bell says the event should havesomething engaging for everyone, including music, dance, art, theater, singing and spiritual care.

This symposium and these workshops are topnotch," Crossley said.

The symposium is slated for Saturday, February 29, 2020, at the Eccles Fine Arts Center on the campus of Dixie State University from 8 a.m. to 5 p.m., with an opening reception in downtown St. George Friday evening from 6 p.m. to 8p.m. at ART Provides Gallery, 35 N.Main Street.

Registration and a light breakfast begin at 7:30 a.m. on Saturday, with lunch at noon, and speakers and workshops continuing until 5p.m. Both meals and symposium materials are included in a registration fee of $50, with seniors and students charged $35. To register for the event, go to http://www.artswashco.com and click on the ticket link.

For a list of hotels and lodging opportunities, additional information and questions, please call 435-238-4948 or email info@engageutah.org.

In addition, participants may earn CEU credits in physical therapy, occupational therapy, recreational therapy, social work and arts and music therapy, with up to seven credits available. Applications are available at the registration desk. CEU credits are available for a $15processing fee, which may be prepaid online or with registration at the door.

JJ Abernathy is an arts advocate and musician, and may be contacted at musictimes05@gmail.com.

Read or Share this story: https://www.thespectrum.com/story/news/2020/02/17/st-george-plays-host-creative-age-symposium-dixie-state/4789142002/

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County arts council announces 'Creative Age' symposium - The Spectrum

Artificial intelligence (AI) is becoming increasingly sophisticated at completing tasks that humans usually do, but more efficiently, quickly and at a lower cost. This offers huge potential across all industries. In healthcare, it holds particular value as it impacts patient care and wellbeing as well as the bottom-line.

The growing role of AI

Indeed, forecasts predict that medical uses of AI will be present in 90% of hospitals in the near future and replace as much as 80% of doctors roles. Investor Tej Kohli expects to see AI applications in healthcare contribute three to four times more global output than the Internet. This currently accounts for $50 trillion of the global economy.

There is clear, untapped potential in using AI. But for it to be fully utilised, the people in charge and implementing it must have a decent grasp of the opportunities and limitations. That means that doctors, nurses, and other healthcare professionals must get-to-grips with AI and its many subsets.

Many uses for AI

The uses of AI in healthcare are seemingly endless. They span the full spectrum of patient care and treatment, from drug discovery and repurposing to clinical trials, treatment adherence and remote monitoring. AIs particular strength lies in highly computerised, manual work that can be easily automated. With it doing the legwork, this frees up practitioners to focus on human tasks like speaking with patients.

Matching donors and patients

Some notable examples of AIs potential include organ donation. Matching patients with donors can be a time-consuming and inaccurate process. Through AI, more matches can be carried out in a short timeframe, compared to when a human has to manually scour the donor and patient database or find a suitable family member donor. Plus, patients can procure donors from a wide range of possible contacts, those who arent a biological fit, because AI can quickly link donors to patients based on a wide range of factors beyond blood type and relation.

Preventative care

Another huge benefit comes in preventative care. Consumer health applications and the Internet of Things (IoT) are helping people track their lifestyle and fitness activities. This encourages them toward healthier behaviour and proactive health management. Additionally putting them in control of their own health and wellbeing.

Better data

IoT devices like the Apple Watch can also, in theory, provide healthcare professionals with timely and accurate data. Blood pressure information, for example, can be tracked throughout the day without the potential of white coat syndrome skewing the results. In getting this data and having AI analyse it, professionals can provide more tailored care and advice, feedback and guidance on treatments and understanding what medicines are working.

Working together across disciplines

Of course, this is but a snapshot of what AI is achieving in medical science and so much more can be done when researchers, doctors, data scientists and other frontline health workers collaborate on problems and solutions. Because, ultimately, no data scientist can fully understand the unique environment of a hospital or doctors surgery. Vice versa, healthcare professionals arent going to be able to know all the ins-and-outs of algorithms and machine learning.

Thats not to say that healthcare professionals having a general understanding of AI isnt important. To work effectively with data science teams, there must be a baseline understanding within the healthcare sector, of the key concepts and trends in AI.

The benefits of understanding AI

There are additional benefits to knowing a bit about AI. First, healthcare leaders can make more informed decisions about AI investments and the infrastructure required. This can help projects align with the organisations wider goals and also ensure that costs dont spiral.

If doctors understand the abilities of a particular AI tool, they can also use it effectively in making decisions, diagnoses and prioritising tasks. They can use a tool to identify patients at risk of developing a specific condition, for example.

Changing culture and steering the direction

Additionally, having more of a grasp of AI can change the culture around adopting such technology. Typically, the sector has lagged behind in accepting emerging technology as was the case with electronic health records. But embracing it early can push innovation and progress further. Shaping it in a way that suits healthcare professionals, patients and the sector as a whole.

As MIT economists Andrew McAfee and Erik Brynjolfsson state, So we should ask not What will technology do to us? but rather What do we want to do with technology? More than ever before, what matters is thinking deeply about what we want. Having more power and more choices means that our values are more important than ever.

Patient communication

It can also help to reassure patients. Machine learning tools are increasingly being used in clinical settings and having a doctor with an understanding of such tools will lead to more thorough discussions. Some patients may wish to know how an AI has come to a specific decision. Doctors will have to communicate the training a machine has undertaken, the data it has been trained with and the algorithms powering its decision-making.

In any case, most patients still prefer human-to-human interactions when talking about their symptoms, test results and prognosis. AI is still mistrusted by many people, partly because they dont understand how it works and whether it is accurate or not. They also feel that an AI doesnt take in their uniqueness and experience of a disease. With a well-informed doctor explaining these things, their fears will be put to rest and they can move onto to their treatment and care.

As vital as medical knowledge

As AI becomes mainstream in the healthcare setting, the onus is on healthcare professionals to invest in their AI education. Failing to understand AI is falling short of patient expectations, People cannot be treated effectively if their physician doesnt know how their AI-powered tool works. In the future, understanding AI and medical knowledge will hold the same importance for practitioners.

So its worth learning about it now and keeping up with AI trends in the industry. For the good of your career as well as your patients.

Link:
Why healthcare professionals need to understand AI - ZME Science

Dataintelo.com, has added the latest research on Medical Wellness Market, which offers a concise outline of the market valuation, industry size, SWOT analysis, revenue approximation, and the regional outlook of this business vertical. The report precisely features the key opportunities and challenges faced by contenders of this industry and presents the existing competitive setting and corporate strategies enforced by the Medical Wellness Market players.

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Medical Wellness Market Strategies and Insight Driven Transformation 2019-2025 - News Parents

Aker Ink bolsters team

Having embraced marketing and digital strategies over the last decade while cementing a reputation for excellence in serving B2B clients, boutique agency Aker PR & Marketing has expanded by hiring Valliere Jones as director of public relations and Tim Gallen as account executive.

Aker Ink serves clients in highly technical or specialized industriesfinding professionals who can turn difficult concepts into easily understood, relatable materials is a challenge, said Aker Ink President Andrea Aker. These seasoned practitioners are adept at telling our clients stories in a compelling way to position themand Aker Inkfor growth.

Jones, a public relations agency veteran with more than 25 years of experience at global, regional and local firms, will plan and execute public relations campaigns that integrate with companys marketing capabilities while supervising and mentoring the agencys account executives and coordinator.

We knew Vallieres proven track record in executive communications and thought leadership, as well as her strategic planning and media relations abilities, would be a tremendous assetso we created a position to leverage her strengths, Aker said. With a wealth of expertise in a wide variety of writing styleseverything from short social media posts to case studies and bylined articlesValliere is perfectly suited to coach our junior staff and help them hone their writing skills.

Gallen, who previously served as digital editor for the Phoenix Business Journal, is an award-winning journalist who crafted news articles and other content on a wide range of topics spanning restaurants, retail, small business, technology, real estate and the economy, diving into business operations, innovations and the latest industry trends.

As a former journalist with deep digital expertise, Tim is a natural fit for Aker Ink, said Aker. He knows what makes a great story, how to tell a great story and how to get that story noticed. He also thinks creatively and is willing to experimenttwo fundamental traits of any successful PR pro.

Jones is a former National President of the Public Relations Student Society of America and graduate of Brigham Young Universitys renowned public relations program. Gallen has a degree in communications with an emphasis in journalism from Pacific Lutheran University.

Sagewood, a Life Plan Community featuring resort-like amenities focused on independence and well-being, has named Jennifer LaForest director of business development at Sagewoods Acacia Health Center.

She brings more than 20 years of experience in the skilled nursing and retirement community industry to Acacia Health Center. LaForest previously served as the campus director of admissions and marketing at Springsdale Village in Mesa, Ariz. and prior was the director of admissions and marketing at Avalon Shadow Mountain in Scottsdale, Ariz.

LaForests background in skilled nursing and senior care is impressive, said Natalie Miko, administrator of Acacia Health Center. She truly understands what goes into working with admissions and helping residents get what they need and will be a great asset at Acacia Health Center.

For more information on Sagewood, visit SagewoodLCS.com and Like the communitys Facebook page at Facebook.com/SagewoodLCS.

Plexus Worldwide, a leading direct-selling health and wellness company focused on health and happiness, is pleased to welcome Dr. Jim Logan to its Medical Advisory Board. Dr. Logan has decades of experience caring for Americas astronauts and is dedicated to helping all people achieve and maintain optimal health.

As a Medical Advisory Board member, Dr. Logan will help guide product development using his experience as a medical doctor and his passion for sharing preventative practices.

Plexus is thrilled to welcome Jim to our team because he is committed to helping people achieve a healthy lifestyle through the art of combining science-backed products with motivational strategies, said Tarl Robinson, CEO and Founder of Plexus. His insight and passion in helping people live happier, healthier lives is already inspiring our team.

Dr. Logan is Board Certified by the American Board of Preventive Medicine and spent 22-years at NASA Space Center serving as Chief of Flight Medicine and Chief of Medical Operations. Among his top priorities was to care for American astronauts and their families for 25-Space Shuttle missions by optimizing their health and preventing medical issues.

I am excited to work with the team at Plexus to help people around the world work towards whole body wellness using a team approach that leverages the power of science to reach maximum health potential, said Dr. Logan. My personal philosophy of medical care is that prevention is vastly superior medically, financially and emotionally to aggressive, long-term, and invasive treatments that result from significant medical issues.

Alden A. Thomas has been named to the Board of Directors of Audreys Angels.

Thomas, an employment law and insurance coverage attorney at Jaburg Wilk, said Audreys Angels is a great organization. The difference that music can make in the life qualify of elderly people is amazing. Im proud of the number of homes that Audreys Angels is currently assisting and look forward to helping them to deliver even more programming.

Audreys Angels provides music and art by bringing live music and craft programs to enrich the lives of elderly who are living in small residential care homes in Maricopa County. Founded in 2001, they have grown to support more than 100 homes and adult day care centers with assistance from 75 music and craft angels.

Thomas received her J.D. from the Sandra Day OConnor College of Law at Arizona State University and her undergraduate degree from the University of Texas at Austin. Prior to starting private practice, Alden clerked for Judge Patricia Orozco of the Arizona Court of Appeals.

AZ Business Leadersis an annual business-to-business publication that combines the whos who of Arizona business community with their valuable leadership advice and knowledge. The magazine is published byAZ Big Media. To learn more about Az Business Leaders, contactSheri Brown, director of sales.

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On the move at Aker Ink, Sagewood, Plexus, Jaburg Wilk - AZ Big Media

(WKOW) -Lyme disease cripples hundreds of people in Wisconsin each year and now researchers are working on a shot to prevent the problem.

The Badger State is a hot spot for the tick-borne disease. According to the Centers for Disease Control and Prevention, the average number of cases has more than doubled over the last decade. In 2018, Wisconsin saw 1,121 cases.

It's a problem that Alicia Cashman knows all too well.

"It destroys your life," she said. " It makes life unbearable."

She said it started with her dog and then moved to her husband.

"All of a sudden he was limping and had to crawl up the stairs."

Finally, Alicia was diagnosed with Lyme disease.

"I would walk into a room and forget why I was there," she said.

Now researchers are looking for a way to prevent the spread of Lyme disease with medicine.

"You give the shot right at the beginning of the season," said Dr. Mark Klempner, a researcher at MassBiologics, University of Massachusetts Medical School. "Take the shot sometime in March or April and then we are anticipating that it would work for eight months."

He said it's the same general idea used in protecting babies from certain viral infections.

"We use an immune molecule called an anti-body that would provide immediate immunity with very little or no side-effects."

After four years of development, Dr. Klempner said things are moving forward. They are about to begin first in human testing to show it's safe and learn how long it will last in the bloodstream.

He said he is well aware of a possible challenge in informing people of the difference between this shot and one called Lymrix, taken off the market years ago due to fears of vaccine side-effects and declining sales.

"Lymrix was a vaccine, this is quite different," said the doctor. "Instead of a bacterial protein, this is a human protein that is in the protective molecule."

The shot is still a few years away from being released to the public, but Dr. JoAnne Kriege at SSM Health in Madison says there are some things you can do to protect your family now.

-Stay to the center of trails. Don't go into the brush.-Wear long-sleeved shirts and pants when outside.-Use a repellant with DEET.-Check for ticks right after outdoor activities.

As for Cashman, while the preventative shot comes a little too late, she said she and her husband are doing well now and has found her passion as she continues to recover. Lyme disease education.

She runs amonthly support groupin Wisconsin for people with questions. Each meeting, the group talks about the struggles and successes they've had with the diagnosis.

During the month of February, several businesses across the country are coming together to raise money for Lyme disease research for a cure.

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Researchers move forward with a shot to prevent Lyme disease - WXOW.com

Somehow I let Valentines Day pass without talking about heartworms! This was a big lapse on my part that I will try to make up for now. Those of you who are less veterinary-inclined probably dont automatically associate the two as I do, but you still have to come on this journey with me! Heartworm disease isnt as common in Vermont, but that being said, I am currently treating a few. As the climate of Vermont changes and we bring up more Southern dogs, heartworm becomes more and more prevalent.

What are heartworms?

The easy answer is that they are worms living in a pets heart. Moving, wiggling, worms living in the chambers of the heart. Literally. The microfilariae (which are baby worms) migrate through the bloodstream, then mature in the heart. Heartworms live for about two years. The pets do not clear the infection after two years, however, since the worms continue to reproduce and more and more develop. Without treatment some pets die because there are so many worms that they actually prevent blood from flowing at all. These pets go into heart failure secondary to their worms. Heartworms can also be found in other places in the body if they migrate out of the heart.

How do I prevent heartworm?

Heartworm infection is prevented by a monthly pill or topical treatment. There are several types of drugs depending on the brand, but they all work in the same manner. These drugs kill the microfilariae at a larval stage within the bloodstream so that they dont have a chance to migrate to the heart and mature. It is recommended by the American Heartworm Society to use these medications year-round, but it is essential during the warmer months when mosquitoes are present. Because these medications cannot kill adult worms, it is important not to skip months when mosquitos are present. If your dog is infected and several months go by, the medication will no longer be able to kill the microfilaria and these will be progressing into adults.

How is heartworm spread?

Heartworm is spread by mosquitos. They cannot be spread any other way. Mosquitoes carry the juvenile stage of worms from one infected animal to another. Dogs, foxes, coyotes and wolves are all able to harbor and spread heartworms through mosquito vectors. The microfilariae become infective after spending time in the mosquito, and are then deposited on the skin of pets when the mosquitos bite. The microfilariae then migrate into the animal and into the bloodstream, where they eventually mature in the heart. Heartworm can be spread between wild animals and dogs, so even if your pet doesnt live around other dogs they are at risk if you see mosquitos.

What if my pet has heartworms?

Heartworm is detected on an annual screening test. Heartworm treatment consists of killing the adult worms, the microfilariae, and treating the side effects of the worm death. Your veterinarian will run a confirmation test and stage the heartworm disease based on looking at bloodwork and chest x-rays. Your pet will receive an injection of a medication that kills the adult worms, then two more injections a month later. This injection must be given in the muscles along the back, and because it must be given in a sterile manner your pet will have the hair shaved in those injection areas.

They will also receive heartworm prevention pills beforehand and monthly for a year after treatment (at least.) This will ensure that any baby worms are killed before they have a chance to develop into adults. Dogs will receive antibiotic treatment that will help prevent a bacteria called Wolbachia that lives with the heartworms from developing. They will also get steroids after their injections.

There is another method that consists of treating the juvenile form monthly and waiting for the adults to die. This is less expensive, but not recommended. Worms can live at least two years, during which time they alter how the heart muscles work. These alterations will be permanent and often lead to irreversible heart damage.

How soon after we find heartworm are they treated?

Your pet should be treated as soon as possible after they are diagnosed with heartworm. Since the treatment is staged, starting sooner means the adults live in the heart for less time. The danger of not treating heartworm is that the structure of the heart changes to accommodate the worms. As the blood-flow changes, because it has to go around the worm, the heart and lung structure is affected. The longer the worms are living in the heart the more damage is done which we cannot reverse.

What happens after treatment?

The number-one most important thing that I cannot emphasize enough is that dogs MUST be confined for 4-6 weeks after treatment. Unfortunately, this means they must be quiet from after the first treatment until at least a month after the second and third. They can only go outside to go to the bathroom, and can never never be off-leash. Indoors they need to be crated or confined to a small space unless you are next to them. They cannot run, jump, play or have any sudden bursts of energy.

When we give the injection to kill the worms, they disintegrate into small pieces as they die. If dogs have a burst of energy or their heart is required to pump faster, there is a high chance that the pieces of the worm will become lodged throughout the body. These act just like clots (by stopping blood flow) and can cause serious damage to the heart, lungs, organs, or even lodge in the brain and cause sudden death. After six weeks the pieces will have dissolved to the point that they are no longer dangerous.

It can be very difficult for owners to keep a dog fully confined for that long, especially those that are used to daily exercise. Since they appear normal, the urge to let them loose can be very strong. This is the hardest part of treatment, and some dogs need mild sedation in order to relax. This period of time is a small price to pay, however.

Can cats get heartworm?

Cats CAN get heartworm. It is much more prevalent in the southern climates than Vermont, but is still a possibility. Cats are an aberrant host, which means that they cannot spread heartworms to mosquitoes. However, they can get the disease and suffer problems as well. There is also heartworm prevention for cats, so make sure to speak to your veterinarian about it.

The bottom line is that preventing heartworm is much easier than treating it. Treatment is painful since we are injecting a reactive medicine into their muscle. Before treatment, we give pets pain medication and a light sedative because it is uncomfortable. Treatment usually costs between one and two thousand dollars for the bloodwork, x-rays, hospitalization, and medication, depending on the size of the dog and stage of the disease. Confinement after treatment can be difficult as well. Not treating heartworm dramatically shortens the lifespan of pets and leads to serious heart and lung disease. Dogs can be affected by heartworm more than once, so even after treatment they must receive preventative pills. Most dogs look forward to their monthly treat, and there isnt much better than preventing a deadly disease while making your dog happy.

The American Heartworm Society has a very informative website to answer other questions. http://www.heartwormsociety.org.

Continued here:
Heartworm: It's time to fit prevention into your routine - Rutland Herald

China is facing one of its largest public health crises: the outbreak of the novel coronavirus.

But U.S. healthcare officials are far more concerned about the spread of other viruses, like the flu.

WCBU talked to Lori Grooms, director of infection prevention for OSF HealthCare, about why the flu poses a bigger threat.

Dana Vollmer: Explain why people are more at risk of contracting the flu than coronavirus.

Lori Grooms, director of infection prevention for OSF HealthCare, talks to reporter Dana Vollmer.

Lori Grooms: The flu is something that we see every year and it is commonly circulating. The coronavirus that they're hearing on the news, while there are cases in the United States, the chances of coming in contact with the virus itself are very, very low. The flu virus, it's more common. You could come across somebody at the grocery store, because we all feel like we can wait it out. We have a cough, so I can go to the store and I can get the medicine to take care of it. I can go to work when I'm sick, because I'm just that important that I need to be at work. Unfortunately, because we have the idea that the flu is no big deal and we can go to work with it, we tend to spread it on to others.

DV: Why do people tend to worry about things like coronavirus, but not always think of the flu as potentially deadly?

LG:Because it's new. We're always more scared by the things that we don't know about. Because the flu circulates every year, it's something that we're used to seeing. The coronavirus, we don't know a lot about it and we're being told that we don't know a lot about it. That in itself makes people afraid. Even when you hear things from the Centers for Disease Control and Prevention (CDC) or from the World Health Organization, they're still investigating. They can't tell us exactly everything about this virus because it is so new and there's they're still learning about it. That's what makes people afraid.

DV: What role does social media play in spreading misinformation about virus outbreaks?

LG: Social media, while it's a wonderful thing, it can also be a detriment. Not everything you see on the internet is true. With that, misinformation can spread very easily. What I always try to do is defer back to the experts. If you really want information, CDC has a very good website that anyone in the public can get on to and read the World Health Organization the same way. Those are the organizations that are actually investigating and looking at this virus. They have the most up-to-date and the most current information. The Illinois Department of Public Health also has the most current information. You're not always going to find that with every other website.

DV: The coronavirus is not the first major respiratory virus to pop up in recent years.

LG: It happens every two to three years. I've been in my role in infection prevention for over 15 years. Every two or three years, we're having discussions about a virus that has changed and the transmission is a little bit different. We've seen it with SARS, we've seen it with [MERS] in the more recent years. It's not something that is new to the healthcare profession. We've been planning for things like this. And once something like this comes up, infection prevention at your hospitals, your emergency preparedness we're ready to handle it. We keep current on the information and we just make tweaks to what we're doing on an everyday basis.

DV: Is it inevitable that more viruses like this will surface?

LG: Yes. Viruses are genetic makeup, so anytime you have genes you have the ability for them to change as they reproduce. So you will always see changes in viruses. The thing about the coronavirus that you're hearing on the news the one coming out of Wuhan, China is that this was spread from animals to humans at the start. That always causes concern. Once it is caught by humans, we don't know what's going to happen. You're seeing a lot of cases in China because of that because it's a new strain circulating in humans, but it had been in animals for years.

DV: What do you say to people who are still concerned about contracting coronavirus -- should they postpone their travel plans?

LG: My professional answer is to investigate. Would I travel to China right now? Not unless it was essential. CDC has a travel website that anyone can go to and actually put in the country that they are looking to travel to, and they can see whether or not they recommend traveling to that country. At this point in time, Chinais not recommended to travel for leisure and it is only for, like I said, essential travel. Other countries, if you're traveling there, I would go to the website and I would look it up.

DV: Any other advice for people to protect themselves?

LG: All I would say is that with any infection, with any virus it's the basic preventative measures: if there's a vaccine available, get the vaccine; frequent handwashing; avoid touching your eyes, your nose and your mouth without clean without clean hands; coughing into your elbow, coughing into a tissue and throwing it away; cleaning your hands after you've coughed; staying home if you're sick and avoiding purse other persons who are ill.

People like you value experienced, knowledgeable and award-winning journalism that covers meaningful stories in the Peoria area. To support more stories and interviews like this one,please consider making a contribution.

Original post:
Here's Why The Flu Poses A Bigger Risk Than The Coronavirus - Peoria Public Radio

(WKOW) -- Lyme disease cripples hundreds of people in Wisconsin each year and now researchers are working on a shot to prevent the problem.

The Badger State is a hot spot for the tick-borne disease. According to the Centers for Disease Control and Prevention, the average number of cases has more than doubled over the last decade. In 2018, Wisconsin saw 1,121 cases.

It's a problem that Alicia Cashman knows all too well.

"It destroys your life," she said. " It makes life unbearable."

She said it started with her dog and then moved to her husband.

"All of a sudden he was limping and had to crawl up the stairs."

Finally, Alicia was diagnosed with Lyme disease.

"I would walk into a room and forget why I was there," she said.

Now researchers are looking for a way to prevent the spread of Lyme disease with medicine.

"You give the shot right at the beginning of the season," said Dr. Mark S. Klempner, Executive Vice Chancellor, MassBiologics of UMMS. "Take the shot sometime in March or April and then we are anticipating that it would work for eight months."

He said it's the same general idea used in protecting babies from certain viral infections.

"We use an immune molecule called an anti-body that would provide immediate immunity with very little or no side-effects."

After four years of development, Dr. Klempner said things are moving forward. They are about to begin first in human testing to show it's safe and learn how long it will last in the bloodstream.

He said he is well aware of a possible challenge in informing people of the difference between this shot and one called Lymrix, taken off the market years ago due to fears of vaccine side-effects and declining sales.

"Lymrix was a vaccine, this is quite different," said the doctor. "Instead of a bacterial protein, this is a human protein that is in the protective molecule."

The shot is still a few years away from being released to the public, but Dr. JoAnne Kriege at SSM Health in Madison says there are some things you can do to protect your family now.

-Stay to the center of trails. Don't go into the brush.-Wear long-sleeved shirts and pants when outside.-Use a repellant with DEET.-Check for ticks right after outdoor activities.

As for Cashman, while the preventative shot comes a little too late, she said she and her husband are doing well now and has found her passion as she continues to recover. Lyme disease education.

She runs a monthly support group in Wisconsin for people with questions. Each meeting, the group talks about the struggles and successes they've had with the diagnosis.

During the month of February, several businesses across the country are coming together to raise money for Lyme disease research for a cure.

On Feb. 20, Isthmus Tattoo in Madison is hosting a day of tattooing for Lyme awareness as part of the event. Learn more about the event HERE.

Read the original post:
Researchers move forward with shot to prevent Lyme disease - WKOW

NORTH RYDE , NSW Feb 19, 2020 (Thomson StreetEvents) -- Edited Transcript of Sonic Healthcare Ltd earnings conference call or presentation Tuesday, February 18, 2020 at 11:00:00pm GMT

* Paul J. Alexander

* David A. Low

Citigroup Inc, Research Division - Director & Head of Healthcare in Australia and New Zealand

* Megan J. Kirby-Lewis

Welcome, again, to the Sonic Healthcare half year results presentation.

I will now hand you over to your presenter, Dr. Colin Goldschmidt. Go ahead, please.

Colin Stephen Goldschmidt, Sonic Healthcare Limited - CEO, MD & Executive Director [2]

Thank you very much, Darren, and good morning, ladies and gentlemen. Welcome to Sonic Healthcare's results presentation for the half year ended 31 December, 2019.

As Darren mentioned, my name is Colin Goldschmidt, CEO of Sonic Healthcare. And joining me here in Sydney today are 3 of my colleagues: Chris Wilks, Sonic's CFO; Paul Alexander, Sonic's Deputy CFO; and Dr. Stephen Fairy, Sonic's Chief Medical Officer. I plan to take you through the results presentation. And then, after the presentation, the 3 of us -- or the 3 will join me to discuss your questions.

Before commencing the formal presentation, I'd like to just make a few comments about the coronavirus outbreak or the 2019 novel coronavirus as it's more formally known. And I'd like to make these comments particularly because Sonic Healthcare is a key provider of essential medical services to large numbers of communities around the world.

All Sonic divisions, and that's on a global basis, have been working extensively with local and national health authorities to support and implement all the necessary pandemic control measures. Our teams of people, that's clinical teams, operational teams, have responded rapidly in order to ensure the continuity of our own clinical services.

And to that end, we've done a bunch of things like providing protection for our frontline employees and customers, providing patients and customers with access to testing for coronavirus. We've also provided reliable and up-to-date information and guidance to our staff, to our patients and customers. And we've also made sure that supply lines and logistics are uninterrupted during this period.

It's an interesting fact, just to know that our lab in Bremen, that's Laboratory Bremen in Germany, was the first lab in Germany to establish a validated PCR test for the coronavirus, which has now been shared by 2 other of our labs in Germany. And we believe that this was one of the very first labs in the whole of Europe to begin using a validated test for the virus. Now depending on circumstances, the coronavirus testing can be rapidly established in other Sonic labs, including in our Australian laboratories and we'll play that one as things pan out into the future.

And just a final comment to let everyone know that there's no indication that the coronavirus outbreak has impacted our business in any way, either negatively or positively.

So if I could commence the formal presentation. Going to Slide 3, which is a slide about our headlines. And first up on that headline list just a few points about our guidance. We are today reaffirming our guidance for the full financial year 2020, and that's after 7 months of trading. Our guidance, as you remember, which we issued in August of last year, is for 6% to 8% constant currency EBITDA growth. And so for the first half of the year, our EBITDA growth came in at 11% at constant currency level.

This is a particularly strong number, which was augmented by the Aurora Diagnostics acquisition, which was completed on the 30th of January 2019. So just as a reminder, this first half result includes a full 6 months benefit of Aurora, whereas the second half in train now will only have 1 month of the Aurora acquisition benefit because the deal actually cycled on 30th of January this year.

Another point is that the impacts of both Aurora and the PAMA Medicare fee cuts in the U.S. were both factored into our guidance. And so there is no change to our expectations after the 7 months that we've traded so far.

Another point, and that's the -- starting the second major bullet point just for noting is that this is our first reporting period, which incorporates the new lease accounting standard, AASB 16, which, as you know, requires the capitalization of operating leases to the balance sheet, with amortization over the term of the lease and with some associated P&L changes.

So essentially, what this means is that the rental expense line on the P&L largely disappears and is replaced or compensated by an increase in amortization expense, which is below the EBITDA line. AASB 16 has particular relevance and significance for a company like Sonic because we operate so many property leases. In our industries, that's the pathology industry or medical laboratory industry, in radiology and primary care, we use extensively patient centers. So in particular, we operate large numbers of leased collection centers for pathology specimen collection. We also operate large numbers of spaces for laboratories themselves, for imaging centers and for GP medical clinics.

And incredibly, all up, we have over 4,500 leases. So you'll get a sense of the magnitude of the task involved in order to transition to this new accounting standard. And so I guess, this would be a good time for me to acknowledge the incredible work completed by the Sonic finance team, assisted by Sonic's finance staff throughout the world and other staff in order to bring this essentially mammoth project to a successful completion.

So just looking at those headline numbers. Our revenue growth came in at 15% at actual currency level and 12% at constant currency level, and you'll see the Delta there is about 3%, which is due to foreign currency tailwind.

Our organic revenue growth came in at 5% on a constant currency basis. And the underlying EBITDA number, which I mentioned, was 11% at constant currency level and 14% at actual currency level. And net profit growth was at similar metrics. Now pleasingly, we did achieve margin accretion in both the laboratory and imaging segments.

And the next point, just 1 year post acquisition, the Aurora Diagnostics acquisition is tracking well and performing to expectation. And I'll discuss a bit further the interim dividend for FY 2020, which has been declared at $0.34 per share.

If we move on to Slide 4, the table on this slide presents a summary of Sonic's headline financials for the half year. Including in the far right column, that's with the red heading, our headline numbers expressed under AASB 16 for the first time. And you'll see there that the most striking features to change to Sonic's EBITDA number, which for the half increases by around $150 million.

So if we look at the full year expectation, we're anticipating that EBITDA will increase by around $300 million for the full year under this standard. Also, just a reminder that the numbers in this table are expressed in actual currency in Australian dollars.

Just a few further comments about the table. Our actual revenue growth for the half came in at 15%, as mentioned, and the organic growth rate was 5% for the half. And these are pleasing numbers for us, especially in the face of some of the headwinds that we're experiencing with fees in the U.S. and the choppiness in Germany associated with the EBM fee quotas, which we can talk a bit about later.

Also, very pleasingly, we achieved 10 basis points of margin accretion in the global laboratory division. And this is a very good result, given the headwind that we're experiencing in the U.S., in particular, in terms of top line.

The Imaging division continues to perform strongly and achieved 40% -- 40 basis points of margin accretion in the half. The net profit number, the growth of 15% was in line more or less with our growth in revenue. Earnings per share, however, was impacted by the shares issued as part of the equity raise associated with the Aurora acquisition, which does give us balance sheet flexibility for future growth.

And finally, another point, the lower than usual growth in cash generation from operations and the conversion of EBITDA to gross operating cash flow is due to timing of creditor payments in the period, and we do expect this to reverse favorably in the second half of the year. And I guess I should just mention a final point about the FX tailwind. As I mentioned, it comes in at about 3% at both revenue and earnings levels. And just to give you the absolute numbers, the FX tailwind for the half was worth $83 million of revenue and about $13 million of EBITDA.

If we could turn to Slide 5. And this is really for information more than commentary. The first bullet point is essentially a reminder of our first year guidance, which is unchanged from August of last year when it was issued. And then the second major bullet point, we're reaffirming our guidance of 6% to 8% EBITDA growth at constant currency level.

Going to Slide 6, which we show in the table, a $0.01 increase in the interim dividend for FY 2020, which is a 3% increase over the interim dividend last year. The dividend will be franked to 30% and the record and payment dates are 11 and 25 March 2020, respectively. The dividend reinvestment plan is to remain suspended, particularly in light of the major equity raise as part of the Aurora acquisition.

Now if we go to Slide 7, where we show our usual pie chart. In statutory revenue, Australian dollars, split by country and major division, and just to note, this pie does not include small impacts from interest income and AASB 16. At the full year result in August last year, we did flag that Sonic's U.S. division would move clearly into the #1 position as our largest division in FY 2020, and you can see this now clearly on the chart already for the half year.

And just a few other observations about the chart, particularly when you compare it to a year ago. First of all, the pie itself has increased by 15%. That's our actual currency revenue growth. And then just of interest of our total revenue of $3.34 billion for the half, 63% of Sonic's revenue is now international, with 37% in Australia. 5 years ago, that split was around 50-50, Australia to International. So you can really see a trend that is set to continue well into the future.

If you look at just our laboratory division, that's the pathology segment by taking out Imaging and SCS, 73% of Sonic's revenue is international, with 27% Australia. So just for the laboratory division, the split is about 3/4 to 1/4, as we speak right now. And as mentioned, we certainly expect the International division to keep growing, and its growth will outstrip the Australian growth as we capitalize on the greater opportunities in M&A and contracts and joint ventures in the U.S.A., U.K. and Europe.

Now moving on to some commentary on our divisions. First of all, the U.S.A., where revenue came in at 45% in Australian dollars, in actual dollars, and 37% on a constant currency basis. Obviously, that number is big because it includes the Aurora acquisition. Our organic revenue growth came in at 2% on a constant currency basis, and it was impacted by the PAMA Medicare fee cuts to the tune of about 1.3% of revenue. So I guess, ex-PAMA, our organic growth rate would be 3.3% for the half.

About the Aurora acquisition, as I mentioned, the business is performing to expectation, and we are well underway with a major cost and revenue synergy program. The cost synergies include things like procurement, IT and administration. And as flagged previously, the revenue synergies include things like cross-sell between anatomical pathology and clinical pathology, but we also get revenue synergies in oncology and molecular pathology offerings. And also in ThyroSeq, which is a new test, which I'll discuss in a moment.

And just for interest, an example of cross-sell is that, at the moment, we -- one example is that we are referring dermatopathology specimens, that's skin pathology specimens, from our Los Angeles operations where we do not have a histopathology lab, to our Aurora anatomical pathology lab in Las Vegas. That's one example. And we believe there will be several more to come.

In terms of our U.S. operations, our growth strategies are gaining momentum. It's likely that despite the slight headwind from the PAMA Medicare fee cuts, we will be presented with additional opportunities because this is probably going to encourage further consolidation of the market. We certainly feel we are large enough and strong enough not only to weather the somewhat choppy conditions, but, in fact, also to benefit from them.

Under the strong leadership of Sonic's U.S. CEO, that's Dr. Jerry Hussong, we are pushing forward with a comprehensive program to enhance Sonic's position in the U.S. lab market, which is the largest medical lab market in the world. This is a program which includes a growth initiative. And that's particularly following the Aurora acquisition, but it also includes an efficiency drive and a push to greater service excellence, and these are all under the guidance of our medical leadership principles.

Finally, just a word about ThyroSeq. This is a relatively new and clinically valuable genetic test, which predicts the malignant potential of thyroid masses or thyroid nodules. Something like 20% to 30% of thyroid nodules are diagnosed as indeterminate after they undergo fine needle aspiration, which is the normal way of initial assessment of a thyroid mass.

The ThyroSeq test then allows classification of these indeterminate cases into those that need immediate surgery and those that can be watched. And the whole purpose of this is to avoid the unnecessary costs and complications of unnecessary surgery. We have licensed this test on an exclusive basis from UPMC, that's the University of Pittsburgh Medical Center, and we offer the test out of our CBLPath lab in New York, which is already an established thyroid cancer center of excellence. The test is fully reimbursed by Medicare and by most of the private payers that we deal with. And we're embarking on a national sales initiative to push this test as strongly as possible into the market, and it certainly does present a very exciting opportunity for Sonic in the U.S.A. We also have and are pursuing an active pipeline of further acquisitions in the U.S. market.

Moving on to Slide 9, which is Australian Pathology. And by way of a general comment about Australian Pathology or an introduction, I should say, we are the #1 player and the market leader in Australia. And our Australian Pathology division is an outstanding Sonic division, which is in a strong and very stable position. And also performing to the highest standards of laboratory medicine. We have outstanding leadership teams and staff throughout Australia who are essentially continually pushing to the edges of best practice, both at operational level and at financial level. And again, under Sonic's medical leadership model.

Revenue for the half came in strong at 7%. At an earnings level, the result was also strong, and we delivered margin accretion to boot. The margin accretion was largely due to the healthy top line growth, but also due to the stabilization of collection center costs and the ongoing scale and synergy benefits, we continue to work on in this division.

At operational level, we are currently building a dedicated Sonic Pathology Australia management team under the leadership of our Australian Pathology CEO, Dr. Ian Clark. And as flagged previously, we've almost completed the national rollout of our total automation system, which is actually the GLP Systems -- Total Lab System, which commenced some years ago, first in Sydney and then in Brisbane and now being rolled out nationally. This rollout brings us absolute cutting-edge operations in our labs. It'll add to our financial efficiencies, and it's also going to improve workflows and are already excellent turnaround times.

In our Australian division, we continue to record strong growth in our genetics sub-division, and we expect this positive trend to continue as demand increases for the existing tests. And as we bring onstream new genetic tests, which keep happening as we go.

Now moving on to Slide 10, which is Germany. And just as an introduction, Germany, as you can see on that pie chart, is one of our 3 largest divisions. Its annual revenues are well in excess of $1 billion. So it's a pretty big division and growing all the time. We are the market leader, the #1 player in the German clinical pathology market. And excitingly now, we've also entered the fragmented anatomical pathology market as well. And so when you put the 2 together, we are very optimistic about our future growth in Germany.

Sonic's medical leadership culture, and I think I've made this point at previous presentations, is deeply embedded in our German division. And it's a division which consistently delivers outstanding services and financial results. And I have to say, the ongoing performance of Sonic Healthcare Germany is a function of not only our staff, but an incredibly dedicated leadership team, headed by our CEO in Germany, Evangelos Kotsopoulos, whom some of you on the call will know.

So looking at the numbers for the half, we achieved 5% revenue growth or 3% organic at constant currency level. That organic growth has been impacted by statutory insurance fee quota changes. But on a positive note, I can say that we are, more recently, sensing that the fluctuations around the EBM fee quotas as they are known, are slowly subsiding. And just a reminder to all that EBM fees represent about 40% of our total Sonic Germany revenues.

What we're observing this financial year is that our organic volume growth is slowly strengthening as we proceed through the year, and we certainly expect that to continue in the remaining 5 months of the year.

In terms of our operations, there continue to be a wide range of activities underway, all aimed at extracting synergies. These include a few laboratory mergers. A comment about our Trier acquisition, which was some 18 months ago. This is an anatomic -- our first anatomical pathology acquisition. This business is performing strongly and we expect that performance to continue. We're working and succeeding at synergy capture between anatomical pathology and clinical pathology. And these can be divided into revenue and cost synergies, as I've mentioned in the U.S. market.

We're achieving revenue synergies via new hospital contracts also via new molecular pathology testing. And also, interestingly, by international referrals of histopathology specimens into our anatomical pathology labs. We do service countries like the Middle East in the clinical pathology space. And so we've now been able to add significant volumes of anatomical pathology specimens, which we can now refer to our own labs.

And in terms of cost synergies, we're finding these in areas of molecular testing and logistics and administration, similar to the situation in the U.S.A. We also have an active pipeline of potential further acquisitions that we're looking at, and these are both in the clinical pathology and anatomical pathology spaces.

And in terms of the regulatory environment in Germany, we continue to work through these ongoing fluctuations in the EBM quota levels, but they are manageable. And I guess we can say that the environment is essentially stable.

Moving on to the next slide, which is the U.K. and Ireland, our revenue growth for the half was 16% or 13% at organic and constant currency level. We continue to enjoy strong growth in both private and the National Health Service market segments.

We're certainly very proud to have won the contract to provide cervical cytology screening, which includes HPV testing for the Greater London region. And I should say that exceptional work was done by our U.K. team, assisted by senior Australian cytology specialists with prior experience in this space here in Australia to launch this program successfully and to deliver it on time. So that cervical cytology contract commenced in the December just past. It's a GBP 15 million per annum contract and a 7-year term on it.

We were also successful in the half in renewing for 10 years the London North West NHS Trust contract, that's an existing contract, but we were pleased to renew that one for a 10-year period. We were not successful in our bid for the large, but I have to say, highly complicated, South East London NHS contract. In this particular situation, our bid was very competitively priced. And I should say that if we were under bid on this deal, as we do suspect, then this would be a deal that we would probably not be comfortable to proceed with at that sort of pricing. We are bidding on further NHS contract opportunities, and these have significant revenue potential as well.

There's also a bit of late-breaking good news in that Sonic's TDL business has been selected to provide laboratory services to the Cleveland Clinic London, which is a flagship new private hospital in Central London, slated to open sometime next year. This is a GBP 1 billion investment by the Cleveland Clinic from the U.S.A. and it seems sure to become a masthead for the brand outside of the U.S.

We are going to open an in-house lab at the same time that the hospital opens next year. But we are going to begin providing outpatient services to this hospital sometime later this year. So the hospital plans to commence outpatient clinical work much sooner than the inpatient beds will open sometime next year.

Now obviously, this is a great honor for Sonic, not only to have been selected, but for us to become now closely associated with the Cleveland Clinic brand, which is certainly one of the most respected medical brands in the world. Our NHS -- our non-NHS business, such as our private business, also remains very strong in the U.K. So this is made up of private hospital pathology, private referrals from the Harley Street market, direct-to-consumer testing, and other non NHS work as well.

We've also, in the period, established a couple of new laboratories to facilitate centralization of our service and this includes the creation of the U.K.'s largest anatomical pathology laboratory. This new anatomical pathology laboratory is located at 60 Whitfield Street, which is the address of our previous central laboratory in London before we relocated to the Halo lab on Houston Road. So we're now processing all the histopathology from UCLH and from the Royal Free Hospitals, which, as you know, are large tertiary teaching hospitals. And we're also processing privately referred specimens coming from private hospitals and the Harley Street market as well.

So you can tell from this particular slide how busy we are and how active we are in the U.K. pathology market. It's certainly a dynamic, if not, sometimes complicated market, but a market that's offering us great opportunities for the future. We're certainly very lucky to have an outstanding leadership team in London. So ably led by Sonic's U.K. CEO, David Byrne.

Moving on to Slide 12, which is Switzerland. We are the market leader in Switzerland as well. We operate in Switzerland under 2 brands: the Medica brand, which is the dominant player in Zurich; and Medisupport, which is headquartered in Geneva on the other side of Switzerland, which has extensive operations throughout the French and German-speaking regions of Switzerland. Both of our Sonic practices continue to operate at exemplary levels. Again, both at operational and financial levels together.

The revenue was strong at 13%, actual currency, 6% constant currency organic. At operational level, we've added a few hospital contracts following the major Zug Cantonal Hospital contract that we won, which we announced previously. We're -- we've completed an upgrade of our Zurich laboratory and efficiency programs have resulted from that upgrade. And the regulatory environment in Switzerland remains stable.

Belgium, and just an introductory few words, this is a strong and stable business, which continues to perform with distinction. Our main laboratory, as you know, is located in Antwerp, but we also run several other laboratories scattered throughout the northern part of Belgium or the Flanders part of Belgium.

All these labs are working together cooperatively to achieve synergies. The revenue growth for the half was 4%, 2% organic growth at constant currency level. And at operational level in keeping with our aim to drive synergies, we've completed the standardization of a Sonic National IT system or LIS system, laboratory information system. We're also expanding our menu of complex testing, and this include genetic tests and we're also working to enhance efficiencies at operational levels wherever we can. And in this half, this included 2 small mergers. The regulatory environment in Belgium also remains stable.

Moving on to Slide 14, which is a slide on Sonic Imaging. The Imaging division produced another strong result, with 8% revenue growth and 10% earnings growth, including a 40 basis point increment in margin, which is a great outcome. On the operations side, I'm pleased to announce that our Queensland X-Ray practice commenced providing imaging services at the Mater Public Hospital Brisbane, and this commenced in November 2019 under a long-term agreement.

Like some of the other deals that we've won or contracts that we've won, this is a great honor for Sonic Imaging, and it really is a tribute to the outstanding stature of our Queensland X-Ray practice. I should say that the strong result in our Imaging division does sheet to our excellent team of Sonic radiologists and imaging staff as well as to our very, very capable leadership teams in all 4 of our practices. It's also in part due to continuing investments that we're making in greenfield sites and in new equipment, and it's good to see the benefits flowing through from those capital investments.

At a regulatory level, the environment is stable. We are going to gain, though, a small benefit from the implementation, a partial fee indexation, which is due to commence July of this year. And also from the introduction of a new MRI and PET CT fee for breast cancer, which has already commenced last November.

And finally, just while on the imaging slide, I'm also pleased to announce that Dr. Julian Adler is to take on the role of CEO Sonic Imaging, and that'll be from the end of this month. But for those of you who don't know Julian, he's a radiologist who joined Sonic 12 years ago. And he has been the CEO of Sonic's Castlereagh Imaging and Illawarra Radiology Group for most of his time with Sonic. And I want to take this opportunity to welcome Julian to Sonic's corporate leadership team.

Slide 15 on Sonic Clinical Services. Again, just to revise, SCS includes all our medical centers under a sub-division, IPN, and a large occupational health division under the brand Sonic HealthPlus. We are the largest primary care provider in Australia and the largest occupational health provider as well. We're operating 229 medical centers at the moment. And we have 2,450 GPs working in our centers, both IPN and Sonic HealthPlus.

Revenue growth for the half came in at 3%. And our sense is that the slightly difficult market conditions in terms of volumes or consultation levels is beginning to improve. Our operations are strong and active. And certainly benefit from an outstanding and very experienced corporate leadership team, headed by our SCS CEO, Dr. Ged Foley, who is an experienced ex-GP himself.

Our doctor recruitment and retention remains strong, and we're actively also engaged in the streamlining of our operations and rationalization of our low-performing centers, and we do this to enhance our efficiencies. And I guess, this will be one of those continuous improvement programs, of which we have many around Sonic Healthcare. The regulatory environment is stable in the private care market.

Moving on to Slide 16. The table on this slide shows only little change in our debt metrics over the prior period. But in summary, our balance sheet is very strong. It's at investment-grade level. And we have around $1 billion of headroom to fund our future growth, which is a nice position for us to be in.

And just a final slide, looking ahead, just a few points. And I guess on that first bullet point, I wanted to say that Sonic is in a strong and stable position. We've -- and it's very much enriched by our deeply embedded culture of medical leadership. As I've said before, it's this culture which continues to drive our brands, which are highly respected and our very high-quality services as well.

So I guess, overall, I feel I can say that Sonic Healthcare is in very good health at this point in time. But having said that, I want to reassure people that we are never complacent. There's no evidence of complacency anywhere around Sonic. And in fact, when I look around the company, I am constantly impressed by the energy, the flexibility or agility of our leaders and staff. And how can I put it? There's a sheer will to win attitude right across our global operations. And it's a good thing to know that Sonic is a company in which culture does run deep. And personally, as just one of our 37,000 employees in Sonic, I can say that it feels pretty good to be part of the spirit that is so strong within the company.

Moving on, and as we look ahead, we are also fortunate in Healthcare to enjoy favorable industry dynamics, which doesn't apply to all industries around the traps. Our industry provides fairly stable, ongoing, noncyclical organic growth. And this is driven by population, aging, new tests, preventative medicine, et cetera.

Looking into the future, our organic growth will obviously be assisted by these favorable industry dynamics, but of course, we also expect major enhancements to that growth to come from new acquisitions, joint ventures and contracts. In other words, the nonorganic growth -- growth of the nonorganic kind.

Our geographical diversification is another thing that we value enormously because it continues to provide benefits going forward. And that's both in terms of new growth opportunities in various markets, but also very much in terms of risk mitigation. We talk about the risk mitigation. If we were experiencing a bit of headwind in the U.S. at the moment with PAMA fee cuts, other divisions are performing strongly, and that leads to a smoothing out of our portfolio. And this has occurred going back many, many years. So there is a huge benefit in being in the 8 good markets that we currently operate in.

Our balance sheet remains pretty strong, as I mentioned, with investment-grade credit metrics, providing us flexibility for growth. And I guess, I do want to acknowledge this as -- and the whole Sonic finance team, which is obviously headed up by Chris and Paul sitting with me today, but also to make special mention of our treasury management team who've done an outstanding job over many years in managing Sonic's balance sheet as well as they have.

The last 2 bullet points on this slide are there to emphasize the ultimate importance of culture, which, as you know, I talk a lot about. Maybe too much about, although I say never too much about, but it's there to emphasize the importance of our -- not only culture, but leadership and our people as well in Sonic's future. And I guess, I have covered off on those sufficiently in this presentation.

So at this point, thank you very much for listening to the presentation. I'm now going to hand you back to our operator, Darren. And ask Chris, Paul and Stephen to join me to take your questions.

Thank you, and thank you, Darren.

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Questions and Answers

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Operator [1]

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The first question is from Lyanne Harrison from Bank of America, Sydney.

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Lyanne Harrison, BofA Merrill Lynch, Research Division - VP [2]

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First of all, can we touch on a little bit on the Australian market. Obviously, some very good organic growth there.

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Colin Stephen Goldschmidt, Sonic Healthcare Limited - CEO, MD & Executive Director [3]

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Sure. What's the question?

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Lyanne Harrison, BofA Merrill Lynch, Research Division - VP [4]

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Edited Transcript of SHL.AX earnings conference call or presentation 18-Feb-20 11:00pm GMT - Yahoo Finance