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In the ever-evolving skilled nursing landscape, one thing has always remained a constant: the quest for longevity.

We tend to view longevity from the perspective of the patient or resident. For example, a skilled nursing facility that touts their large population of centenarians is associated with an exemplary level of quality care and services. This distinction is considered a metric of their success. To be sure, there is much merit to this and indeed, Ive brought attention to it myself.

Id like to posit that this same logic may be equally applied to the longevity of a healthcare employee, particularly in the skilled nursing arena.

Those of us whove run successful skilled nursing facilities are intimately familiar with the challenges of finding and retaining good staff in all departments. To care for elderly people is a difficult, daunting and sometimes thankless task. It isnt for the faint of heart, and one must have the mental fortitude and requisite compassion to apply and survive as an employee in this line of work.

It is for this reason that websites offering seamless employee recruitment tools flourish in our industry.

With this perspective in mind, allow me to introduce you to Bea Ross and her amazing and heartwarming story.

Beatrice Bea Ross of Wayne, NJ, passed away last month at the age of 91. She was a charming and delightful woman of singular character.

To know her was to love her.

Bea began her professional career in March of 1974 at the Regency Gardens Nursing and Post-Acute Rehabilitation Center in Wayne.

Though her official role was in the front office and bookkeeping departments, she was so much more than that. She would engage in arts and crafts with the residents, cook with them, bake with them and reminisce with them, always in her unassuming and sincere way.

She remained a loyal and devoted Regency Gardens employee for the next 44 years!

Thats three years longer than Ive been alive, which helps place things in perspective for me.

Forty-four years as an employee in a skilled nursing facility is almost unfathomable.

Indeed, it is more than just a testament to longevity, but also to the mutual respect, qualifications and compassion on the part of the employee and the facility.

Both are to be commended for their accomplishments.

But most of all, the amazing story of Bea Ross and Regency Gardens Nursing Center should act as a clarion call to our entire industry.

It is proof that longevity in our healthcare lexicon is possible and meaningful on both ends of the equation. We can achieve great things together by retaining not only our residents, but also our employees.

Judah Gutwein LNHA, is CEO of SkyCare Media

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A new perspective on longevity - Marketplace Experts - McKnight's Long Term Care News

While we have long known that neural activity in the brain is responsible for disorders such as dementia and epilepsy, recent research conducted by scientists in the Blavatnik Institute at Harvard Medical School (HMS) has shown that it also plays a role in human aging and life span.

The study was published in Nature on Oct. 16. Researchers observed mice, worms, and human brains and found that a lot of activity in the brain is correlated with shorter life spans. As such, suppressing brain activity extends life spans. This is the first piece of evidence that supports the hypothesis that nervous system activity impacts longevity in humans. Past studies have demonstrated that portions of the nervous system affect animal aging, but no prior work has shown similar effects in humans.

An intriguing aspect of our findings is that something as transient as the activity state of neural circuits could have such far-ranging consequences for physiology and life span, said study senior author Bruce Yankner, professor of genetics at HMS and co-director of the Paul F. Glenn Center for the Biology of Aging in a HMS press release.

A chain that affects longevity, the insulin and insulin-like growth factor (IGF) signaling pathway, is apparently where neural excitation acts. An integral portion of this signaling cascade is RE1-Silencing Transcription (REST), a protein that the Yankner Lab has shown prevents brains from developing dementia and other disorders.

Neural activity is defined as all of the electrical currents and transmissions contained within the brain. Neural excitation can result in many outcomes such as a muscle twitch or a change in our mood. As for mood, the study has not yet shown if someones thoughts, personality, or actions change their lifespan.

An exciting future area of research will be to determine how these findings relate to such higher-order human brain functions, said Yankner.

Yankner and his colleagues looked at gene expression patterns in donated tissue from people who died between the ages of 60 and 100. None of these adults had dementia.

They found that those who were alive for more than 85 years expressed neural excitation genes to a lesser extent than those who died between the ages of 60 and 80. In order to test if these results were due to correlation or causation, the researchers conducted many experiments on C. elegans, genetically altered mice, and more brain tissue.

They found that blocking REST, a protein responsible for suppressing gene expression and neural activity, caused higher neural activity and earlier deaths. Centenarians brains contained more REST than those who died earlier.

Thanks to this study, the development of new therapies that can treat conditions involving neural excitation such as Alzheimers disease or bipolar disorder is imminent. In addition, the scientists have found that some forms of medicine like drugs that target REST or some actions such as meditation may be capable of increasing lifespan through the modulation of neural activity. Since human variation in neural activity may have both environmental and genetic causes, this study has opened up future avenues for therapeutic intervention.

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Neural activity plays an important role in longevity - CMU The Tartan Online

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The key question you must answer before claiming Social Security benefits or developing a retirement plan is: How long will retirement last? Another way to phrase the question is: What is my life expectancy?

You can start to answer this question by using the average life expectancy for your age group. You also can use that only as a starting point. There are ways to arrive at a better estimate of life expectancy.

The Society of Actuaries and the American Academy of Actuaries jointly developed a free online tool, the Actuaries Longevity Illustrator (ALI).

The actuaries sorted through the data and concluded that a reasonable estimate of an individuals life expectancy can be determined from four factors: age, gender, smoking habits and whether current health is poor, average or excellent. You enter these factors in the ALI, and it gives you an answer.

But it gives you more than a simple estimate of life expectancy. The ALI results show you the probability of living to different ages. In addition, a couple can enter the data for each individual. The ALI will present the probability of life expectancies for each spouse. It will answer the questions How long can we expect to live as a couple? and By how many years might one spouse outlive the other?

The ALI is one way to obtain a personalized estimate of life expectancy. Another type of tool to consider that purports to estimate individual life expectancy is one of the online calculators that are based on questionnaires.

These calculators generally are free and available on the Internet. They usually ask a series of questions about your health and lifestyle. Some ask only a few basic questions while others ask a greater number of questions about lifestyle and recent medical tests.

The most popular of these calculators seems to be Living to 100. Social Security has a life expectancy calculator on its website, and many life insurance companies also do. The Wharton School at the University of Pennsylvania has a calculator that received good reviews. You can access several of the well-regarded calculators in one place at http://www.lifeexpectancycalculators.com. You also can search for life expectancy calculators or something similar on your favorite web search engine.

While better than life expectancy tables and averages, the calculators also have many shortcomings.

Some of the calculators arent updated to reflect the latest research and findings often enough. Many, in a quest to be user-friendly, limit the questions they ask, leaving out issues that others consider important. Most, for example, dont ask if a person ever had cancer.

Some of the calculators make arbitrary decisions. For example, research shows that calcium-rich diets improve bone density and reduce hip fractures late in life. But the research doesnt show how much a calcium-rich diet and avoiding hip fractures increase life expectancy. Yet, at least one calculator asks about calcium in the diet and arbitrarily adjusts life expectancy based on the answer. The calculators also rely on self-reported information from the users, which can be incomplete or inaccurate.

Perhaps most important, the online calculators generally treat each factor in isolation and adjust life expectancy higher or lower based on each answer. In the real world, factors often interact. Two or more factors together can increase or decrease life expectancy more than each factor alone.

Online calculators are valuable tools, and are better ways to estimate life expectancy than the methods most people use. But I recommend that if you go this route you use more than one calculator. Youll see different results, sometimes differences of a decade or more. Then, you decide how to use the different results.

You also can consider one of the scientific services. These services involve your submitting some genetic material, usually either saliva or blood. You might need to go to a medical lab or similar facility to have the blood sample taken. The service will examine your DNA or various blood panels and compare the results to those in its database.

These services purport to offer a more scientific and personalized estimate of longevity. Some also say they can point to health or medical issues. Your life expectancy might be extended by having these issues addressed now instead of later when other symptoms arise.

These are new services, so they are a long way from having a record of accurately estimating the longevity of people who are likely to live another couple of decades or more.

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Better Ways To Estimate How Long Retirement Will Last - Forbes

We all wonder about those long lifespans recorded at the beginning of Genesis. For example, we are told that Adam lived 930 years, that Shet lived 912 years, and that Metushelach lived 969 years. How have Jewish sources understood these numbers over the centuries?

The first Jewish source to address this issue was Josephus (late first century). Here is his statement in Antiquities, book I:

Nor let the reader, comparing the life of the ancients with our own and the brevity of its years, imagine that what is recorded of them is falseFor, in the first place, they were beloved of God and the creatures of God Himself; their diet, too, was more conducive to longevity: it was then natural that they should live so long. Again, alike for their merits and to promote the utility of their discoveries in astronomy and geometry, God would accord them a longer life

Now I will survey the views of our Geonim and Rishonim.

R. Saadiah Gaon (10th cent.) discusses this issue in his introduction to Tehillim. He writes that the longevity of these early generations was part of Gods plan for the rapid proliferation of mankind on the earth. The longer people lived, the more children they could have. It would seem that he believed that everyone in those early generations lived a long lifespan.

R. Yehudah Ha-Levi (12th cent.) discusses the issue in the Kuzari (sec. 95). He believes that it was only the individuals listed who lived long. Each of the individuals listed was the heart and essence of his generation and was physically and spiritually perfect. The Divine Flow was transmitted from one generation to another through these exceptional individuals.

Rambam, in a famous passage in the Guide to the Perplexed (II, chap. 47) writes: I say that only the persons named lived so long, whilst other people enjoyed the ordinary length of life. The men named were exceptions, either in consequence of different causes, as e.g., their food or mode of living, or by way of miracle.

Ramban (comm. to Gen. 5:4) quotes Rambams view and then disagrees, calling Rambams words divrei ruach. Ramban writes that the individuals with long lifespans named in the Bible were not exceptional in their lifespans. Rather, the entire world had long lifespans before the Flood. But after the Flood, the world atmosphere changed and this caused the gradual reduction in lifespans.

Most of the Rishonim who discussed the issue thereafter followed the approach of either the Rambam or the Ramban. Either way, they were taking the Genesis lifespan numbers literally. (An underlying factor that motivated Rishonim to accept the Genesis lifespan numbers literally was that the count from creation was calculated based on these numbers.)

Josephus had mentioned that one of the reasons that God allowed their longevity was to promote the utility of their discoveries in astronomy and geometry. This idea of longevity to enable the acquisition of knowledge and make discoveries (and write them to be passed down) is also included in several of our Rishonim. See, e.g., the commentary of the Radak to Gen. 5:4 and of the Ralbag to Gen. chap. 5 (p. 136), and the Rashbatz, Magen Avot, comm. to Avot 5:21.

Rashbatz also mentions the idea that the early generations were close in time to Adam and Adam was not born from a tipah seruchah like the rest of us, but was made by God from the earth. Those early generations inherited his superior bodily constitution.

Another idea found in some of our Rishonim is that those early individuals did not chase after taavat ha-guf, which reduces the lifespan. See, e.g., the commentary of the Radak to Gen. 5:4.

But there were some Rishonim who were unwilling to take the Genesis lifespan numbers literally.

The earliest such source that we know of was R. Moses Ibn Tibbon (late 13th cent). He suggests that the years given for peoples lives were actually the years of malkhutam ve-nimuseihim, i.e., the dynasties and/or customs that they established.

Another figure who took such an approach was R. Levi ben Hayyim (early 14th cent.). First he mentions several of the possibilities to explain the longevity, e.g., good and simple food and marrying late (!). But then he concludes that in his opinion the names mentioned were just roshei avot. In other words, the number of years given for each individual reflects the total of the years of the several generations of individuals named for that first individual.

R. Nissim of Marseilles (early 14th century) was another who did not take the numbers literally. He took the same approach as R. Moses Ibn Tibbon. The numbers did not indicate the lifespan of the specific individuals named. Rather, it included the total years of the descendants who followed his customs and lifestyle.

The most interesting approach I saw was that of R. Eleazar Ashkenazi ben Nathan ha-Bavli (14th century), in his work Tzafnat Paneach, pp. 29-30. First, R. Eleazar refers to the view that perhaps the individual numbers were not to be taken literally, and points to other statements in the Torah that were not meant to be taken literally, e.g., 1) the Land of Israel was flowing with milk and honey, and 2) the cities in Canaan were fortified up to the Heaven.

But then R. Eleazar suggests the following creative approach. In listing these individual numbers, the Torah was merely recording the legends about these figures, even though they were not accurate. The important thing was to provide data from which the total years from Creation to Matan Torah could be derived, so that the people would be able to know the length of time between these two periods. Even though the numbers for the individual lifespans were not accurate, the Torah made sure that the total that would be arrived at would be accurate. (In contrast, when it came to events from Avraham and forward, the Torah was careful to preserve a more accurate accounting.)

In modern times, one Orthodox scientist who has written much on this topic is Prof. Natan Aviezer of Bar-Ilan Univ. He discusses this topic in a post at their parshah site for Noach, 1998. There he explains that modern science has figured out that aging is largely caused by genes, and not by a wearing out of our bodies. He then suggests that when God stated at Gen. 6:3 that man would be limited to 120 years, this was when God first introduced the gene for aging into the human gene pool.

If you have not found any of the above answers satisfying, I have some good news. R. Saadiah Gaon writes (Emunot Ve-Deot, ch. 7) that in the era of the redemption the human lifespan will be approximately 500 years. Presumably, at that time we wont be bothered by those long lifespans in Genesis anymore!

I would like to acknowledge that most of the material above came from an article by Prof. D. Lasker of Ben-Gurion Univ. in Din Yisrael, vol. 26-27 (2009-10).

Mitchell First aspires to longevity and hopes his children can tolerate him for that long.

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The Longevity of the Ancients Recorded in Genesis - Jewish Link of New Jersey

In the run up to The Superyacht Forum 2019, SuperyachtNews spoke to John Wyborn, training director at BlueWater, to discuss the next generation of operations, considering who operate, maintain and manage the everchanging superyacht fleet in the future. During The Superyacht Forum, Wyborn will take centre stage with a panel of experts in a session called The Next Generation to discuss the future of operations.

What needs to change is the way people are recruited into the sector, starts Wyborn. There are some changes afoot and the industry is starting to develop a pipeline of people coming in that were requiring to have certain skills.

For example, UKSA in Cowes has started an apprenticeship where 16-18-year olds can learn necessary skills, he continues. Our plan then, when they graduate next Spring, is to try and place them in roles with the hope that they will remain in those jobs for longer periods of time than some current crew. The current issue is that the industry is placing too many graduates or lifestyle tourists in junior crew roles. However, the UK is waking up to this and there is a lot of potential government funding to provide training to young people in our sector.

Management companies need to take control. You cant change owners, you can simply manage expectation"

Ensuring the future quality of the workforce is vitally important to ensuring the prosperity of the market itself. How many times have we heard owners complaining about the quality or attitude of their crew? Too often. But, who bears the responsibility for working towards a proliferation of quality junior crew.

Management companies need to take control. You cant change owners, you can simply manage expectation, explains Wyborn, management companies need to lead this and [accept that] they have quite a responsibility. There needs to be a culture of learning on board, thats what they need to focus on.

Wyborn also believes that there needs to general change in crew members approach to safety on board. There is too much focus on tick box compliance and not enough on reality. There are many initiatives to try and improve that, such as the programme implemented by the Merchant Navy training board, which will make life easier for management companies and Im hoping to push that. This would provide training and exposure to potential risk which is a vital lesson for any crew member he says.

As we look towards a new generation hoping to enter the superyacht industry, either as a deck hand or in a management role, steps need to be made to ensure that issues relating to the proficiency and longevity of crew are dealt with. At The Superyacht Forum we look forward to a dynamic discussion in which a number of the markets foremost operational experts will explore the future of operations and discuss actionable market improvements.

The Superyacht Forum will take place from 18-20 November in Amsterdam alongside METSRADE. To register your place at the forum, click the button below.

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Crew - Issues of longevity and proficiency - Superyacht News - The Superyacht Report

Posted: Oct 26, 2019 / 11:19 AM GMT-0600 / Updated: Oct 26, 2019 / 11:46 AM GMT-0600

Courtesy: Utah Department of Natural Resources

Antelope Island (ABC4 News) It looks like a scene from the wild west. Hundreds of volunteers on horseback are rounding up one of the nations oldest and largest herds of wild bison in hopes of ensuring the health of more than 700 animals.

In its 33rd year, wildlife officials say the Utah Bison Round-Up moves the herd from all parts of Antelope Island into one central location where the animals will receive health screenings, vaccinations, and a small external computer chip.

Once the bison are checked, officials say most of the herd is once again released to roam on the island.

Each year about 100 to 200 calves are born into the herd and Utah wildlife officials say the herd needs to be reduced in order to have enough food for herd as well as other animals on the island.

Some of the bison are sold at an auction. The money from the sale goes to help fund the Wildlife and Habitat Management Program, according to Wildlife officials.

Wildlife officials say the round-up happens in two phases: Saturday the bison are rounded up into corrals where they can relax, making them more cooperative for the exams and tests. Phase two takes place next week when the animals are checked one by one and given their vaccinations, before being released.

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Utah bison roundup ensures health and longevity of one of nations largest and oldest herds - ABC 4

Cristiano Ronaldo has revealed his obsession to stay young as he continues to maintain his standards at 34 years of age while at Juventus.

The Portuguese recently scored his 700th career goal.

And Ronaldo believes his longevity comes down to his obsession to look beyond the training pitch to remain on top, including his love of meditation.

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My goal is to stay young as you get older, so competitive. Give me a player of my age who performs as much as I do at age, in a team like Juventus? Its very difficult, you know, Ronaldo told France Football.

They say that I have an athletes body, but its not just the physical or the training.

This week, The Independent is counting down the 100 greatest players of the 21st century. We will be revealing 20 players per day, today revealing the players who placed 100-21.

A brilliant midfielder who had everything: skill, tenacity, power, goals, energy. His defensive capabilities brought him to the fore at Barcelona before his attacking prowess made him such a weapon for Manchester City. He won two Ligas, three Premier Leagues, one Champions League, captained Ivory Coast to the Africa Cup of Nations and was African Player of the Year four times. LO

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His raw statistics are simply phenomenal. 130 Premier League goals for Tottenham Hotspur, in just 186 appearances. 27 in 42 for England. Twice a Premier League Golden Boot winner. A World Cup Golden Boot winner. Tottenhams talisman. Englands captain. And still just 26 years old. In 10 years time, expect to see Kane in the top 20 of a similar list. LB

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A ferociously competitive and combative midfield hard man, who made over 600 appearances for his beloved Roma and over 100 for his national team. A complete midfielder, who could in one passage of play win the ball, race forward and either release a team-mate with a pinpoint pass or score himself. And do not be fooled by his combustible reputation: in 2016, he placed his treasured World Cup winner's medal in the coffin of Pietro Lombardi, Italys kit man at the tournament. LB

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The meticulous German orchestrated Bayern Munich's midfield to eight Bundesliga titles and a Champions League, making over 500 appearances for the club. He was also one of the leaders in Germany's 2014 World Cup-winning campaign and carried an aura in the centre of the pitch few players can claim to have replicated. TK

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Its difficult to define his importance to both Manchester City and Belgium but its safe to say he was one of the most important players of a generation. There may well be a handful of technically better centre-backs but his intangibles were vital to the culture at club and country where there was not a legacy of winning previously. JR

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One of the few strikers on this list who can truly claim to be the complete forward, able to play wide or central, deep linking play or on the shoulder of the last defender, with the ability to sniff out scrappy goals and score beauties too. His medal haul speaks for itself, and he is approaching 300 career goals. But for his strained relationship with the French national team, he would have scored even more. LO

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The heartbeat of Arsenal's defence in the Invincibles season, a double-winner in 2002 and a mainstay of the England team for almost a decade, Campbell is one of the defining defensive figures of the Premier League era. TK

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One of the great villains of the game but a nasty, hard centre-back that would be very high on any great strikers list of defenders he least wanted to play against. While his grit and determination stand out, nobody lasts a decade at the Bernabeu without possessing exceptional quality, with three La Liga titles (which has eluded the club since his departure) and as many Champions Leagues, Zinedine Zidane would be wise to acquire a similar player now. JR

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The four-time Premier League winner made over 300 appearances in England and made an enduring habit of thriving under pressure, winning the man-of-the-match award in Manchester United's Champions League final victory in 2008. TK

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Only the finest players in the world enjoy long and fruitful stints at clubs such as Juventus, Bayern Munich and Barcelona. Il Guerriero has matured into a splendid holding midfielder, aggressive and dominant in the middle of the pitch but equally as effective arriving late into the box to complete attacks. A hero in his native Chile, for his role in the 2015 Copa Amrica victory. LB

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A key player in the glorious Real Madrid side that won La Liga in 2011/12 and the Champions League two seasons later. Widely considered a flop when he left Manchester United after only one miserable season, but the Argentine completely reinvented himself at Paris Saint-Germain, the starring attraction in one of the most expensive squads ever assembled, containing the likes of Neymar, Kylian Mbapp and Edinson Cavani. LB

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A figure of fun in his early Premier League days at Manchester United, Forlan went on to have the last laugh with a stellar career both internationally with Uruguay and in Spain, where he racked up goals for Villarreal and Atletico Madrid, twice winning the European Golden Shoe. LO

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In his pomp Falcao was probably the best striker on the planet. In a prolific four-year spell playing for Porto and Atletico Madrid he scored 142 goals in 178 games, and had injuries not hindered his career there is little doubt that Colombia's record scorer would be much higher up this list. LO

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Has excelled in a thoroughly mediocre Arsenal side for two seasons now, scoring at a rate better than a goal every other game in a side that has struggled since the departure of Arsne Wenger. But it is primarily for his achievements at Borussia Dortmund that he makes this list. He scored close to 150 Bundesliga goals for that wonderfully attacking team including 31 in one season winning the Bundesliga Player of the Year and Top Goalscorer awards. There have been few strikers as rapid or as decisive in front of goal in the last two decades. LB

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One of the best left foots in Premier League history graced two of its most revered clubs, becoming a star at both Arsenal and Manchester United. The Dutchman had a penchant for the spectacular but suffered with injuries, and it is a sign of what could have been that in the two Premier League seasons he played more than 30 games, he won the Golden Boot in both. LO

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A real pest of a striker who thrived in the hottest atmospheres and regularly overcame adversity. He scored plenty too, 116 league goals in eight seasons with United, City and Juventus (who probably all enjoyed prime Tevez), but it was the way he would trigger his teammates by forcing the first mistake or sparking counterattacks that really made him such an invaluable player. JR

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The midfield maestro could control games and decide them too, and was at the heart of the brilliant Valencia team which reached back-to-back Champions League finals in 2000 and 2001. He became one of the most expensive players of all time when he switched to Lazio, but he would never again reach the heights that made him a legend at the Mestalla. LO

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The defensive talisman cast a spell of leadership over Liverpool's 2019 Champions League-winning side and went the entire campaign without being dribbled past. Few defenders have carried such an overarching influence on any side in recent memory. TK

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One of the finest finishers of a generation but perhaps his best quality was his movement; particularly in the box, where nobody was more lethal at finding a yard of space and punishing opponents. Strong and an aerial threat, he was perhaps unfortunate to follow Gabriel Batistuta with Argentina, otherwise he would have been appreciated even more. Certainly as talented as Sergio Aguero and with perhaps more composure in the biggest occasions - an underrated player. JR

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A gem of a centre-back, who was perhaps ahead of his time, right now he would be even more valuable due to his versatility to thrive under any manager, no matter the philosophy or style of play. Became a real winner and leader at United and formed one of the greatest partnerships in international football history alongside John Terry with England - who should have obviously achieved much more with such an outstanding foundation to their team. JR

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A metronome in the middle, one of the finer passers in the world of football and the beating heart of a number of very successful sides, not least the World Cup winning Germany side of 2014. Four Champions League crowns as a key cog for Bayern Munich and Real Madrid underline his quality, but if you are to criticise it is that there have always seemed to be others doing more around him. HLC

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A traditional No 10 who was unhelpfully branded the new Maradona when he began setting the Primeira Division alight with Boca Juniors. His 10m move to Barcelona in 2002 did not exactly go as planned with another talented Argentine poised to write himself into club folklore instead but Riquelme made a success of himself in Spain with Villarreal under Manuel Pellegrini. A true artist who shone in an advanced playmaker role, before dropping deeper into midfield as his ageing legs lost their pace. LB

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Muller has popped up with important goals for Bayern Munich and Germany throughout his career. The gangly forward has scored nearly 250 goals combined for club and country, which has helped Bayern to eight Bundesliga titles and a single Champions League and Club World Cup. Muller will not be the last player to excel with Bayern and Germany, but he may well be the last sort of his type of player, placing the importance of timing and occupying space above all else in the game. KV

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The Egyptian king has turned into one of the most feared forwards in world football since joining Liverpool from Roma in 2017. After a torrid time at Chelsea, Salahs second spell in England brought about a Premier League history as he netted a record 32 goals in 36 league games. The outright Premier League top scorer in 2018 and the joint winner last season, no longer is anyone laughing at the 35m Liverpool paid for him over two years ago. KV

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The kind of defender every one wants on their team and no one wants to come up against. Godin is tough, utterly committed and completely fearless, and at the peak of his powers when Atletico Madrid won La Liga he was probably the best defender around. LO

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A midfield maestro capable of playing the game at his pace; speeding up and slowing down while painting a picture amid the frantic action in Premier League games. Silva has never been flustered and can always be relied upon to stand up in the most opportune moments, a cornerstone of the Manchester City era and a candidate for their best ever player, despite the money lavished on various other superstars. JR

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Such quality in tight spaces and an almost unrivalled ability to dribble at pace, Hazard is capable of true magic, with his best Premier League seasons propelling Chelsea to two titles, and earning . There have been more fallow years, of course, but at his best Hazard has been magnificent, including in helping Lille to Ligue 1 glory in 2010-11. HLC

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The fulcrum of Arsene Wengers side following Arsenals move to the Emirates Stadium, Fabregas combined vision with genuine goalscoring ability to establish himself as one of the worlds most well-rounded and exciting midfielders. Trophies commensurate to the playmakers ability to precisely pick out forwards runs more often that not did not come in north London, but two Premier League titles with Chelsea after his dream move to Barcelona failed to live up to expectation were just rewards for the midfielder. Nevertheless, he still won La Liga and the Copa del Rey while in Spain, and was part of the squads that won the 2008 and 2012 Euros as well as the 2010 World Cup. KV

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A player at home in any era who blossomed under Jose Mourinho not once but twice. At home at No 10 Deco effortlessly controlled games for Porto and latterly Chelsea as a key cog in two of the Special One's greatest sides. BB

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Enjoyed the best years of his storied career right at the very start of the 21st century, after he moved from Parma to Juventus in a double transfer, along with Gianluigi Buffon. Went on to form a formidable defensive partnership with Igor Tudor as well as Fabio Cannavaro, before a late career swansong at Barcelona. He also won the European Championship with France in 2000. An imperious defender, who now works tirelessly fighting against racism in football and society. LB

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Warrior. Tough as any Premier League centre-half, totemic at times and a pillar of consistency for Manchester United. Indomitable in the air, his partnership with Rio Ferdinand is perhaps the best English football has seen this century, contrasting in styles but with an innate understanding of each others abilities. Superb leader to boot. HLC

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The Brazilian is well renowned as one of the best attacking fullbacks in world football, and has been one of Real Madrids most consistent performers for a number of years. Arriving at the Santiago Bernabeu as a nervous 19-year-old, Marcelo has lived up to his reputation as Roberto Carlos successor at both club and international level, as likely to whip a cross in as he is to audaciously hammer one in from outside the penalty area. Often sporting a smile off the field, Marcelos trophy record makes for pleasant reading having experienced four consecutive Champions League victories as well as four La Liga and Club World Cup titles. KV

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While it can be argued his most captivating moments came before the turn of the millennium, Giggs longevity was remarkable, never truly fading from the first team at Old Trafford as the brighter sparks came and went. Evolved as football evolved, from teenage tearaway to cultured crosser as the legs slowed. Seven post-2000 Premier League titles, a PFA Player of the Year award and the 2009 Sports Personality of the Year. HLC

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A very modern forward, adept anywhere across the offensive line and a true team player, always ready to defend from the front. But it is ultimately for his ability in front of goal that he secures his place on this list. A revelation at Atltico Madrid and as equally important to the world champions: Griezmann was the top goal scorer as France finished as runners-up at Eurp 2016 before playing a starring role in their triumph two years later in Moscow. LB

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Seedorf enjoyed great longevity throughout his career divided into two decades. The latter of which, spent in Italy, easily earns his place here after gliding across the pitch for AC Milan, shining bright in Carlo Ancelotti's diamond to collect two Champions League titles - clinching four in total and becoming the only player to win the competition with three different sides. JR

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Sneijder won league titles in Spain, Italy, Turkey and his native Netherlands, as well as the Champions League with Jose Mourinho's Inter Milan, and built a stellar international career to become the most capped Dutch player of all time. But the lasting memory is simply of his natural grace on the pitch, gliding over the field before bursting into life to change any game in an instant. LO

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A great goalscorer and a scorer of great goals, Batistuta is one of the best strikers ever to have graced Italian football. He remains Fiorentina's top Serie A goalscorer, having spent the majority of his career in Florence before moving to Roma where he finally clinched the title. He is the only footballer ever to have scored a hat-trick at two separate World Cups. LO

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A captain of Atletico at 18 El Nino was destined for greatness ever since his formative years. While he may never have hit those heights for long enough his Liverpool career where he tortured the very best, notably Nemanja Vidic at Old Trafford, saw him comfortably become the most feared No 9 on the planet. Add in a world crown and two European titles and you have a player who more than earns his place here. BB

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Perhaps the most natural poacher in the countdown, Van Nistelrooy ended his career with better than a goal every two games and churned out far more through his peak years with PSV, Manchester United and Real Madrid. Most notable was his brilliance at the highest level, three times finishing a season as the Champions League's top scorer. Disputes with Dutch managers hindered an international career that might have propelled him higher up this list. LO

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Few on this list can say they redefined their position but the little French magician did just that. The Makelele role will go down in the annals for any player with any defensive nous whatsoever, but few since have boasted the football intelligence and positional discipline of the man who coined its name. A player far beyond his era. BB

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An unbroken streak of relentless goalscoring, spurring Manchester City to four Premier League titles, adapting his game to suit Pep Guardiola's style and resisting the challenges of a fleet of world-class temporaries, the Argentine may yet end his career as the greatest striker in English history. TK

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Well over a decade on from his retirement anyone even close to resembling a serviceable right-back is still known as the English, Scottish or Welsh Cafu, a testament to a glittering career where he redefined what was expected from his position. A dynamic, attack-minded full-back he was also an esteemed leader and captained his country to the World Cup with typical class in 2002. Anyone remembered as one of Brazils greatest players is more than worthy of this list. BB

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Only Marta has scored more goals in World Cups than Klose and his supreme record at international level with Germany is what sees him earn his place here. The archetypal target man famously rarely scored from anywhere other than inside the box, but he made the 18-yard area his own in a storied career that saw him score more goals for Germany than anyone before or since. BB

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A maestro and marshal at the heart of Manchester City's midfield, the Belgian is one of the most inventive, tactically astute and well-rounded players to grace the Premier League. He has won back-to-back league titles, an FA Cup and a raft of individual awards and only injuries have prevented him from casting his influence further. TK

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The Swede scored pots of goals for his home town club, Helsingborg, in his early years, and never really stopped until he retired back at his boyhood team. In between he ventured away to write history with Celtic, win the Champions League with Barcelona and even make a memorable cameo at Manchester United. His pinnacle was the season after he broke his leg, when he returned so determined to make up for lost time that he won the European Golden Shoe. LO

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If Roger Federer was a footballer he might have been something like Xabi Alonso: majestic, composed and precise, playing with a wand while barely breaking a sweat. Liverpool fans still adore him and so does everyone else. He was understated, bar those halfway line goals, and that was part of his charm, redefining what a holding role player could be, and he won it all: Champions League, La Liga, Bundesliga, European Championships and the World Cup. LO

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The player who brought the Premier League to the height of technical grace and artistry, the Dutchman was synonymous with moments of unthinkable ingenuity and other-worldly touches as he pulled the attacking strings in both Arsenal's 2002 double-winning campaign and the Invincibles season. TK

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Cristiano Ronaldo reveals the key to his longevity and the importance of meditation - The Independent

Look on the bright side. For real. Scientists at Boston University School of Medicine and Harvard University say just being optimistic can help you live longer. Specifically, their research showed both men and women who had higher levels of optimism had longer life spans, and that both sexes had a greater chance of living past age 85.

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Optimism is a psychological attribute characterized as the general expectation that good things will happen, or the belief that the future will be favorable because one can control important outcomes, wrote lead author Lewina O. Lee, of the National Center for Posttraumatic Stress Disorder and the Boston University School of Medicine. Previous studies reported that more optimistic individuals are less likely to suffer from chronic diseases and die prematurely. Our results further suggest that optimism is specifically related to an 11% to 15% longer life span, on average, and to greater odds of achieving exceptional longevity, that is, living to the age of 85 or beyond.

The associations held irregardless of socioeconomic status, health conditions, depression, social integration and health behaviors like smoking, diet and alcohol use, the authors wrote. Overall, findings suggest optimism may be an important psychosocial resource for extending life span in older adults.

Were talking about exceptional longevity. which some define as over 85 and others over 100 years of age.

In January, Robert J. Pignolo, M.D., Ph.D., of the Division of Geriatric Medicine and Gerontology at the Mayo Clinic in Rochester, Minnesota, published a review of literature on exceptional longevity in the clinical journal, Mayo Clinic Proceedings. In it he held that the basis for exceptional longevity is multifactorial and involves disparate combinations of genes, environment, resiliency and chance, all of which are influenced by culture and geography. Pignolo examined how studying the oldest old may give credence to the biological and environmental characteristics of those who seem to defy the odds.

Pignolo said centenarians stave off age-related diseases. And theyre somehow resistant to otherwise lethal illnesses occurring earlier in life. But even so, even the oldest of the old vary in the characteristics they possess that seem to allow them to live so long. Associations between specific clinical or genetic biomarkers exist, but there is unlikely to be a single biomarker predictive of long life, he wrote. He added that while careful observations in the oldest old offer some strategies that favor increased health span and life span, there is unlikely to be a one-size-fits-all prescription for longer life. Exceptional longevity represents an extreme phenotype, he wrote.

Scientists studying longevity have largely investigated the biological and medical factors associated with survival, but the Massachusetts scientists recent work in Proceedings of the National Academy of Sciences, suggests nonbiological factors could also have huge implications to aging.

We tested whether higher optimism was associated with longer life span and greater likelihood of exceptional longevity, the authors wrote. Researchers used a good amount of data to come to their conclusions, though some limitations of their study could limit whether their findings apply to a wide range of people, including that participants were largely white and had higher socioeconomic status than the general population.

The Boston researchers studied about 70,000 women from the Nurses Health Study (NHS) and about 1,400 men from the Veterans Affairs Normative Aging Study (NAS), with follow-ups of 10 years (2004 to 2014) and 30 years (1986 to 2016), respectively.

In both groups, higher levels of optimism were associated with extended lifespan and higher odds of achieving exceptional longevity. The associations persisted even after researchers adjusted for demographics and various health conditions like cancer, heart disease, high cholesterol and stroke, as well as habits like smoking, primary care visits and alcohol use. And the associations still remained after scientists adjusted for whether or not a person suffered from depression.

While prior studies have reported that optimism may reduce risk of premature death in mid- and later life, the current findings suggest that optimism promotes substantially longer life span, the authors wrote. As longer life span appears to accompany longer health span, our findings have implications for understanding psychosocial factors that promote healthy and resilient aging.

In other words, a person who practices optimism over the course of their life is more likely to live long and live healthily while they do it, Inverse.com reported. This study joins others that have explored the health benefits of optimism, including a 2009 study from the University of Pittsburgh showing that women who are optimistic are 14% less likely to die from any causes than pessimists.

Though researchers admit the exact benefits of optimism are hard to pinpoint, they say their new findings indicate that optimism could serve as a valuable target for interventions that promote health.

One explanation is that more optimistic individuals may experience less extreme emotional reactivity, which helps them recover more quickly from stressors, Inverse reported. Still, Lee says that scientists do not fully understand the pathways from optimism to health and longevity.

Even so, it does appear evident that psychological assets can promote good health, and the likelihood of long life cant be limited to genetic factors, Inverse reported.

The Massachusetts researchers defined exceptional longevity as survival to age 85 or older. Optimism was assessed using the Life Orientation Test-Revised in NHSa standard psychological self-help instrument that indicates the level of optimism in a person and gives insight into how one can replace harmful thought patterns with more constructive onesand the Revised Optimism-Pessimism Scale from the Minnesota Multiphasic Personality Inventory-2 in NASa scale measuring the psychological attribute that provides insight into how people explain to themselves why they experience a particular event, either positive or negative. Given work indicating optimism is modifiable, these findings suggest optimism may provide a valuable target to test for strategies to promote longevity, the authors wrote.

The study, according to Inverse, puts the focus on the state of our mindsand finds that exceptional longevity is intimately linked to optimism.

So why might optimism affect longevity? asked David R. Topor, Ph.D., in an article for Harvard Health Publishing. Topor is a clinical psychologist and the associate director for Healthcare Professional Education at the VA Boston Healthcare System. He is also an assistant professor in the Department of Psychiatry at Harvard Medical School. The study wasnt designed to explain this, but the researchers had several thoughts. While one component of optimism appears to be heritablethat is, tied to our genesour environment and learning also shape a significant portion. One takeaway is that we can all learn ways to be more optimistic.

Whether youre naturally optimistic or not, you can take certain steps in that direction, said Topor. He offered the following suggestions on how anyone can become more optimistic:

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What 71,000 Americans Did To Help Them Live Longer - Forbes

The 2019 Trottier Public Science Symposium, hosted by the Office for Science and Society from Oct. 22 23, addressed the unavoidable process of aging in a presentation titled Longing for Longevity. The second night featured keynote speakers Joe Schwarcz, director of the office, and psychosexual therapist and author Ruth Westheimer.

In his opening remarks, Tomlinson Professor of Chemistry Bruce Lennox shared the symposiums mandate.

The Trottier Symposium [] has proven to be a key element in the promotion of science and science communication [] to the public [.] This is the 20th year [for] the office for Science and Society, something thats really quite a landmark in public science outreach in the world, Lennox said. The office, of course, has a national and international presence in its mission [] to separate sense from nonsense on the scientific stage.

According to Schwarcz, there is a long history of nonsensical claims in scientific research about longevity. From believing that urine is a source of longevity to encouraging the so-called rejuvenating practice of lying with young women, there is no shortage of ridiculous methods in history.

This sort of silly science now has hard roots to it, but it goes beyond that, Schwarcz said. Today, researchers are looking at telomeres, [] the end of the chromosomes, [] and every time a cell divides, there is a disturbance of the end of the chromosome, and the belief is that if somehow you could prevent that you could slow down aging [.] In 2009, a nobel prize was awarded for this kind of research [done by] Jack Szostak, [] a McGill graduate.

In his presentation, Schwarcz acknowledged that the cure for aging remains unknown.

No, were not going to cheat death [.] You dont get out of life alive, but the idea is to put off death to the very last minute, Schwarcz said.

Schwarcz also noted the connection between sexuality and mortality by referring to a recent British study that showed sex can slow aging.

Beyond her experience as a sex therapist, Westheimer has lived around the world. She was born in Germany and escaped to Switzerland during the Holocaust, where she continued to live for 10 years.

If you would have told me, the child of orthodox Jewish parents, that I would talk about orgasms at McGill University, I would have said you must be crazy, Westheimer said. The one thing I knew [] is that I had to do something to [justify] that I am alive while one [and a half] million [] Jewish children were killed.

Westheimer emphasized the importance of proper and well-rounded sexual education.

In todays world, we dont have the luxury not to be sex educated, Westheimer said. We have to do sex education. Girls [and] women menstruate at an earlier and earlier age [.] We do have to tell girls and boys about menstruation [.] We do have to talk about nocturnal emission, [and] about wet dreams.

Dr. Ruth believes the roots of sexual illiteracy come from psychologist Sigmund Freuds influence in academia.

Sigmund Freud shouldve taken a course with me, Westhiemer said. He did us women a tremendous disservice, because he said as if sex was only for [] men and that there was nothing in it for women.

The celebration and de-stigmatization of female sexuality is a central theme in Westheimers work. She also advocates for the education of sex beyond traditional methods and the acceptance of diverse types of sexual relationships.

The whole issue of sexual satisfaction [] doesnt have to be a penis inside a vagina [.] It doesnt have to be the way it used to be when they were younger, so people should adjust to that [.] If there is a problem, Im all for going for a few sessions to a sex therapist.

Westheimer left a piece of advice to young and old people in the audience alike.

Make sure that you are sexually literate, that you know what is changing [in the world], and that you do know to go for help if there is a question, Westheimer said.

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Sex and longevity at the Trottier Public Science Symposium - McGill Tribune

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The 901 is your morning blend of Memphis news and commentary

Good morning from Memphis, where U.S. Rep. Steve Cohen has joined the crowd that's calling for Memphis Light, Gas and Water to switch power providers. But first ...

This Saturday,for the first time, ESPN's popular pre-game show "College GameDay" will be in Memphis, on Memphis' most iconic street, talking about Memphis football.

It'll be a great day for the University of Memphis and a great day for head coach Mike Norvell, who with Justin Fuente (2012-15) gets much of the credit for bringing the Tigers to this moment in its history. Andit'll be an especially great day for the die-hard Tigers fans who have cheered on the hometown team through its highs and lows and especially through thedark, disappointing days of coach Larry Porter (2010-11).

But now, as "College GameDay" put it in a tweet yesterday, "THE WAIT IS OVER!"

Our Jason Munzhas the "College GameDay" news, our Evan Barnes looks at how it happened, and columnist Mark Giannotto explainswhy Tigers fans need to show up at the Liberty Bowl Memorial Stadium onSaturday to see the No. 23 Tigers take on the No. 14 SMU onlythe second time ever that a ranked Tiger football team has hosted another ranked team.

But the meaning of "GameDay" coming to Memphis goes beyond sports.

For too many years, despite its rich history, Memphis was a nationalafterthought. We were that place whereElvis Presley lived and Dr. Martin Luther King Jr. died, seldom mentioned except in relation to basketball or as the home of global shipper FedEx. Our growth was stagnant, andour crime and poverty rates among the highest in the nation. In other words, instead of a "happening" city, Memphis was see as a "happened" city.

That's starting to change, and "GameDay" coming is another step in that direction.

ESPN's "College GameDay" is coming to Memphis Saturday.(Photo: ESPN)

Where Memphis' growth was stagnant before, Downtown Memphis now has more than $4 billion with a "b" in its development pipeline, our Desiree Stennett reports. Memphis is featured every Monday night on prime time thanks to NBC's locally filmedlegal drama "Bluff City Law." Overall, crime seems like it's trending downward and both mayors for the city and Shelby County are eyeing improvements to prekindergarten and public transit that could help lower the area's poverty rate in upcoming years.

I've also argued recently that Memphis Mayor Jim Strickland won reelection because he found a way to tap into the newfound optimism many Memphians feel about their city.

Here's the point: Memphis isn't just having a moment right now it's having lots of them. For all of its problems, there's a very real sense thatthe city has momentum. If this were the chase scene in a movie, Memphis would be at the point where the driver has to decide whether to go pedal to the metal to jump chasm or slam the brakes.

Memphis should floor it:The city should continue investing in itself in its football program, in its growth, in its citizens'safety and education, in its film industry, etc.

Because Memphians love Memphis. And it's time the rest of the world understandwhy.

Speaking of sports: Our Tigers basketball beat reporter Jason Munz has three takeaways from the University of Memphis win yesterday against LeMoyne-Owen. Also, check out our David Cobb's latest on the Grizzlies' 134-133 overtime win Sunday.

April 18, 2019 - U.S. Rep. Steve Cohen talks with media about the Mueller Report while in his office Thursday afternoon.(Photo: Brad Vest/The Commercial Appeal)

Ending the city'slong-time contract to buy power fromthe Tennessee Valley Authority could be Memphis Mayor Jim Strickland's "lottery," U.S. Rep. Steve Cohen recently said.

To understand that sentence, based on this story from our Sam Hardiman, you need context:Cohen, a Democrat from Memphis, carried the legislation that established the state's lottery program when he was a state legislator.And the city is currently studying whether switchingpower providers couldsavehundreds of millions of dollars a year.

Jims got momentum. Jims gonna have the [Mid-South Fairgounds]. Theres going to be some other things that Jim does, but if he can save the people hundreds of millions of dollars on utility costs, thats his lottery, Cohen said.

That's all undoubtedly true if (and it's still an "if" at this point)leaving TVA will really save the citymoney. Strickland made that point in a statement in response:

"I have said since we formed the Power Supply Advisory Team that we would let them work, process all the information, and make a recommendation. That process is not complete, and it would be irresponsible to comment before they finish their work. At the end of the day, we want the most reliable service at the best possible price.

Cohenshould let the process work. Yes, several studies haveshown switching power providers would possiblysave theMemphis Light, Gas and Water Division money. And maybe that's what the Power Supply Advisory Team will conclude.

But until then, this is too important a decision to rush. Or to make political.

Speaking of Cohen: The congressman may have jumped the gun on switching MLGW power providers, but he's right on time with his emphasis on making Memphis streets safer. He recently convened a meeting on pedestrian safety, our Sam Hardiman reports.

"The All-American" Episode 106: Jimmy Smits as Elijah Strait(Photo: NBC, Katherine Bomboy/NBC)

NBC may pull the plug on its"Bluff City Law," but no one seems to have told the people behind the shot-in-Memphis legal drama: The show keeps getting better and better.

Our John Beifuss has the recap of last night's episode, titled "The All-American," about a former hometown football star who wants aphysician-assisted suicide and for the"Conference of Collegiate Athletes" to pay his medical bills. Perhaps even more interesting to Memphians, the show introduces several new filming locations, and included a references to the Memphis Tigers. From John's story:

Although the exploitation of athletes is condemned, football itself isn't criticized; a climactic scene involves a playful backyard game of touch football, with Elijah claiming the right to call his team "University of Memphis Tigers."

Memphis-based Black Bettie, the new project from Joshua Cosby, co-founder of the acclaimed folk duoStar & Micey,released its first self-titled album earlier this month. Fading us out this morning, here's "Poor Kids Millennia":

Like The Fadeout?The 901's Spotify playlist has all of the available featuredsongs from local artists.

Columnist Ryan Poe writes The 901, a running commentary on all things Memphis. Reachhim at poe@commercialappeal.com and on Twitter @ryanpoe.

Want to support local journalism? ACommercial Appeal subscriptiongives you unlimited access to stories and columns. You also get the ability to tap into news from the USA TODAY Network's 109 local sites across the country.

Read or Share this story: https://www.commercialappeal.com/story/news/local/the-901/2019/10/29/901-landing-college-gameday-another-string-wins-memphis/2486857001/

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The 901: Landing 'College GameDay' is another in a string of wins for Memphis - Commercial Appeal

with Yeyi Zhu, PhD, Assiamira Ferrara, MD, PhD, and Unjali Gujral, MPH, PhD

Most often we associate having diabetes with overweight or obesity; however, theres a surprising twist to the diabetes storyyou may at risk even if you are at a healthy weight, or even underweight. Although hard to believe, it appears particularly true if you are in a racial or ethnic group other than Caucasian.1,2

If you are Hispanic, Asian, or Hawaiian, you are at increased risk of developing diabetes, even if you are thin. Be sure to have your blood sugar checked regularly. Photo: fstop123@iStock

Diabetes ranks as one of the most common chronic diseases in the United States, with at least 12% of the population likely to develop diabetes.2 The numbers do not give a full picture of the rising rate of diabetes. What does this mean for you?

According to data gathered by Kaiser Permanente, a California-based managed care medical organization, a startling new discovery has been made regarding risk of diabeteseven if you are at a healthy weight but you are biracial or fall into one of four racial/ethnic categories other than White, you may have a higher risk of developing T2D.3

Hoping to tease out an explanation for this unexpected relationship between obesity and ethnicity in diabetes, the researchers looked at the prevalence of diabetes and prediabetes among different racial groups in various ranges of body weight. Using records from three integrated healthcare organizations, they evaluated medical records of more than 4.9 million patients who met established criteria.

The racial makeup of the study group was diverse:

The rates of diabetes increased across all races as both age and body mass index (BMI) increased, which was as expected. Now for the plot twistCompared to their white counterparts, individuals from all other races were more likely to be develop diabetic across all body weight ranges. More stunning, the risk of diabetes was more pronounced among individuals who were underweight, at a healthy weight, or slightly overweight than anyone who reached the level of obesity,3 according to study measures.

The risk of developing prediabetes, similarly, rose with increasing age and body weight. Yet, among individuals who are Hispanic, Asian, or a Hawaiian/Pacific Islander, the chance of developing diabetes at lower ranges of body weight was significantly higher. These findings suggest that something other than body mass index must be behind the development of diabetes in these racial groups.

Our research identified a group of people at risk who dont get as much attention for diabetes: those who are underweight, says Yeyi Zhu, PhD, a research scientist with the Kaiser Permanente, and the study lead author. In particular, we found significant differences in diabetes prevalence among underweight men, from 7.3% in Whites to more than double that, or16.8%, in American Indians/Alaskan Natives.

So while many individuals who are overweight may be screened by the doctor, as a matter of course, if you fall into one of the high risk minority groups, you might want to ask your healthcare provider to check your blood sugar, to evaluate your risk of prediabetes and diabetes, even if you are in a healthy body weight range, or BMI. This is particularly true as you get older, says Dr. Assiamira Ferrara, MD, PhD, a senior research scientist at Kaiser Permanente.

The study has important implications to both providers and patients, says Unjali Gujral, MPH, PhD, assistant professor with the Emory Global Diabetes Research Center in Atlanta, Georgia. From a provider standpoint, the US Preventive Services Task Force for Diabetes Screening currently recommends using overweight/obesity as the main screening criteria in all adults ages 40-70 years. Clearly, continuing to do so will likely lead us to miss a substantial number of racial/ethnic minorities at risk of diabetes.

Previous work has suggested a BMI cut-off point of 23 kg/m2 for Asian populations. However, it seems likely that a much lower body weight cut-point may need to be established to assure that we are identifying more high risk individuals in other race/ethnic groups, Dr. Gujral tells EndocrineWeb.

In addition, there isnt a lot of data about the most appropriate approach to treatment for those who are not overweight. While the first-line pharmaceutical treatment for type 2 diabetes is currently metformin, which targets insulin resistance, this may not work in non-overweight individuals; instead, may be a more prudent strategy for these individuals may be to introduce treatments aimed at promoting the preservation and recovery of -cells, which secrete insulin. But much more research is needed in this aspect, she says.

Weve been lead to believe that if our weight is under control, there would be no reason to think we should worry about having diabetes. But Dr. Gujral says that the evidence is strong enough to suggest we rethink this. She adds: People should still be mindful that you are eating a healthy diet and getting regular physical activityat all weights, and you should consider getting screened for diabetes even when you have a low BMI, particularly if you have a family history of the disease.

Why those who avoid being overweight may be at increased risk for diabetes isnt fully understood, says Dr. Zhu. Body composition and factors such as physiology and susceptibility to impaired insulin secretion may play a role. In previous studies, for instance, researchers have found that Asians have a higher visceral fat than Whites at a similar body mass index. Having a higher percentages of visceral fat [eg, adipose fat surrounding internal organs] are associated with having an abnormal glucose metabolism.

To gain a clearer understanding of the factors which may prompt diabetes, well need to look more closely at body composition, genetics, and other lifestyle factors that may contribute to disparities in this chronic disease burden, Dr. Zhu says.

In addition, Dr. Gujral believes that there are likely to be different mechanisms and causes in distinct populations, and with that, differences in the effectiveness of the current screening tools for those whose diabetes stems from causes other than overweight.

What we hypothesize at this point is that individuals with ancestry from regions of the world that historically had less access to food may have evolved to metabolize energy differently, say Dr. Gujral. These minority groups, therefore, may have innate susceptibility to poor insulin production, and may have higher levels of ectopic fat that settles around the organs such as the liverthese differences may contribute to increased diabetes risk. Since these factors likely vary by race and ethnicity, a lot more additional research is needed to truly understand the reasons behind this, so we can improve detection and treatments.

The experts advice remains the same for now: evaluate your lifestyle and adjust your food choices and activity level, regardless of your weight.

Focus beyond your weight, to be sure you are doing whatever you can to promote good overall health, Dr. Gujral tells EndocrineWeb.This can be practiced by eating a diet high in fiber-rich foods including more vegetables, having limited lean meats, and avoiding saturated fats and added sugars.

She adds:Also keep hydrated (ie, drink plenty of water), get adequate sleep, and it is important to aim for at least 150 minutes a week of mild to moderate physical activity.This should be something sustainable and enjoyable whether it is hiking, playing tennis, running, or simply walking around the block.

Last updated on 10/29/2019

Type 2 Diabetes Causes

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You Could Have Diabetes While at a Healthy Weight: Heres How - EndocrineWeb

On Wednesday night in Waco, Texas, the 2019 Division I national champion Baylor Lady Bears and the 2019 Division II national champion Lubbock Christian Lady Chaps face off in an exhibition game. Itll also be a family affair, as Baylor senior Lauren Cox takes the court against her younger sister, LCU freshman Whitney Cox.

But its also much more than a high-profile exhibition more than basketball, even.

Wednesday night is Baylors fourth annual Type 1 Diabetes Awareness Game. And in case youre doing some math in your head, yes, this is Laurens fourth season at Baylor.

My freshman year, Coach [Kim] Mulkey was really interested in my diabetes, she wanted to see my insulin pump, she wanted me to watch me test my blood sugar, Lauren told High Post Hoops. And it was kind of her idea, like, lets do a Type 1 awareness game.

Type 1 diabetes is a condition where the pancreas has trouble producing insulin, the hormone that lets glucose be used to produce energy. It typically develops in children and adolescents Lauren was seven years old when she was diagnosed.

Her sister Whitney, on the other hand, was a junior in high school when she learned she also had Type 1. She told High Post Hoops that after she came home from the hospital after her diagnosis, Lauren came home to surprise her.

We just kind of sat there, like hugging and crying, Whitney said. She just knew what I was going to be going through. She just gets it.

I think me being able to be there for her when she was first diagnosed, I think that was really important, just to show her that she can still do whatever she wants to do, Lauren said.

Type 1 diabetes can be very manageable, and both sisters take advantage of the latest medical technology to ensure it doesnt affect their game. They wear continuous glucose monitors and insulin pumps, and both devices work in tandem to avoid any issues on the court.

Having the new technology helps a ton, just making it so much more convenient, Whitney said. She and the teams trainer use an app on their phones to keep track of her blood sugar level.

Lauren felt the same way, saying the technology she uses hasdefinitely made life a whole lot easier for me, and for my trainers.

Baylor put on its first Type 1 Awareness Game in January 2017. Not much has changed since, aside from moving the game to the fall its a simple opportunity for diabetic fans to interact with someone succeeding at a high level while managing her condition. Type 1 fans will sit together during the games, then meet Lauren after.

And, this season, Whitney.

Its really special [sharing this years game with her], Lauren said. Whitney hasnt been diabetic for long, but it still means a lot that they were willing to work it out to get [LCU] here for a game, and to make it the Type 1 game, so its gonna be a really special night.

Lauren is coming up on four years of using her platform at Baylor to spread awareness of Type 1 diabetes, and Whitney, a freshman, hopes to follow in her footsteps.

In addition to wanting to start a Type 1 awareness game at LCU, in her first couple of weeks on campus, she participated in a health fair where she had the opportunity to talk about her diabetes.

They had a diabetic brunch that I spoke at, just kind of explaining day-to-day operations of being a diabetic, pretty much, Whitney said. That was the very first time I actually kind of spoke out about it. So that was pretty cool. I definitely hope to do some more things like that around campus, as well as in the basketball world.

The sisters have only faced off in a competitive game once they were on different club teams within the same organization when Lauren was in high school and met in a tournament championship game. But with the exhibition tag attached to Wednesdays game, the competition wont be the important part this time.

TAMPA, FL APRIL 05: Oregon forward Oti Gildon (32) guards Baylor forward Lauren Cox (15) in 2019 NCAA Womens National Semifinal Game One between the Oregon Ducks and the Baylor Bears at at Amelie Arena in Tampa, FL on on April 5. (Photo by Mary Holt/Icon Sportswire via Getty Images)

I think itsjust gonna be fun, Lauren said. Just because we have so many family and friends coming to that game, and everyones really excited. They got split shirts made that have the BU and the LCU colors on opposite sides and all that. Yeah, its just gonna be really fun and kind of our last time ever on the same court again.

Whitney expressed a similar sentiment at playing her first two collegiate games against two of Texas best teams (LCU visited Texas for an exhibition on Monday night).

My coach actually asked me earlier this week if I was nervous for any of it. And I told him, not at all, Whitney said. Im really excited for it.

When asked what they want people to know about being a diabetic athlete, the sisters answers were almost identical.

It cant stop you from doing whatever you want to do, Lauren said. As long as you stay on top of it and control it, then youre going to be perfectly fine and you can do anything that you set your mind to.

It doesnt stop you from doing anything, Whitney said. Its completely manageable. And its just another thing you have to take care of. At the end of the day, you can still do whatever you want to do.

Baylor hosts Lubbock Christian on Wednesday, Oct. 30, at 7 p.m. CT. The game wont be televised, but you can listen to it on Oldies 97.7 FM or follow the live stats.

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Its just gonna be really fun: Cox sisters to face off in Baylors Type 1 Diabetes Awareness Game - High Post Hoops

ATKINSON The Atkinson Lions, in partnership with the Salem Lions, will be offering free diabetes testing (A1C) on Nov. 13.

The testing will be done on a first-come, first-served basis from 4 to 7 p.m. at the Atkinson Community Center on 4 Main St.

The Lions will bring in health professionals to do the A1C testing and will also bring in a nutritionist to provide information on nutrition to the public.

The diabetes A1C test measures the average blood sugar level over the past two to three months.

Its like a memory of your blood sugar levels and shows how well your body is controlling your blood sugar levels over time, the Lions said in a news release.

The American Diabetes Association recommends an A1C level of 5.7% or less.

If you test higher than this level, you will be advised to see your primary care doctor, the news release states. Note that all information will be kept strictly confidential. The test takes about five minutes to provide results.

Fasting is not required for the A1C test.

By some accounts, 1 in 4 Americans do not know they have pre-diabetes or diabetes. Complications include eye disease, cardiovascular disease, kidney disease, nerve damage, pregnancy complications, and amputations.

Free information concerning diabetes and diabetic-appropriate refreshments will be on hand at the event.

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Free A1C diabetes testing offered in Atkinson | Health - The Union Leader

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Alzheimers disease and type 2 diabetes could be linked in ways were only beginning understand, according to scientists presenting the latest research findings at Neuroscience 2019, the annual meeting of the Society for Neuroscience. Untangling the connection could lead to earlier Alzheimers diagnosis and better treatments for both diseases.

The crux of the connection is how the brain metabolizes its energy sourceblood glucose (aka blood sugar)and the variety of factors that influence that process, including diet, sleep, and cardiovascular health.

Not much is known about the connection between dementia and the metabolic system that fuels the brain, said panel moderator David Holtzman, MD, a professor at Washington University and scientific director of the Hope Center for Neurological Disorders. Further research can help us understand how to manipulate these functions for treatment purposes, as well as better identify the underpinnings of the disease.

Researchers presented findings approaching the problem from several angles.

Sami Gabbouj, a researcher from the University of Eastern Finland, discussed a study showing that the typical Western diet, high in fat and carbohydrates, leads to decreased brain insulin signaling and eventually impaired memory in mice genetically prone to Alzheimers. Insulin signaling is key to how the brain monitors and manages insulin release to balance blood sugar. Previous research has found a link between damaged insulin signaling and the development of Alzheimer's.

The typical western diet made worse age-related memory impairment in the mice, Gabbouj said.

The results suggest the possibility that the Western diet may handicap the brains energy metabolism and serve as a trigger for worsening memory in those genetically predisposed to Alzheimers.

Steven W. Barger, PhD, from the University of Arkansas for Medical Sciences, presented research showing that Alzheimers disease mimics diabetes by impairing how the brain metabolizes blood sugar. By examining mice genetically altered to develop Alzheimer's, researchers observed that a flaw in glucose delivery to neurons leaves extra glucose in the blood.

Alzheimers mice show diabetes traits on a normal diet, [with the] same physical activity levels and same feeding habits, Barger added. The findings shed light on why human Alzheimers patients often have higher blood sugar levels, and further confirm a link between the diseases.

Sleep research has also revealed connections between blood glucose metabolism and Alzheimers.A study presented by Shannon L. Macauley, PhD, from the Wake Forest School of Medicine, showed that glucose resistance and abnormal sleep patterns are prevalent in Alzheimers [predisposed] mice prior to the appearance of any other disease symptoms, such as cognitive decline.

This research points to the early role sleep loss seems to play in the development of Alzheimers, and suggests that poor sleep combined with type 2 diabetes may be especially dangerous for those at genetic risk for dementia.

The researchers were careful to note that the cause and effect across all of these studies isnt entirely clear. We dont yet know whether diabetes is a precursor to Alzheimers or if impaired blood sugar metabolism is a side-effect of Alzheimers. Its just too early to know either way. Ultimately we may find that both are true. And since much of the research to-date relies on animal models, were also not sure how closely these results will translate in humans.

What we do have is a strong starting point for understanding the link between these diseases that affect millions, and that may eventually lead to improved diagnosis and treatments.

Research was presented at Neuroscience 2019, the annual meeting of the Society for Neuroscience in Chicago. Studies are considered preliminary prior to being published.

Read more from the original source:
Untangling The Link Between Alzheimers Disease And Diabetes: What The Latest Science Tells Us - Forbes

November is National Diabetes Month, with World Diabetes Day on Nov. 14.

Conemaugh Health System encourages all individuals to learn more about diabetes and potential symptoms that could point to a problem.

More than 30 million Americans have diabetes, and 84 million adults have prediabetes, according to the Centers for Disease Control and Prevention. Diabetes is the seventh-leading cause of death in the United States.

Diabetes is a medical condition in which the body does not make insulin or has a reduced response to insulin, causing sugar levels to be too high. Symptoms of diabetes including urinating often, blurry vision, being very thirsty, losing weight unexpectedly, being very hungry, experiencing more fatigue than usual, and being irritable.

Individuals at risk for diabetes or pre-diabetes include being over 45 years of age, having high blood pressure, being overweight, low physical activity, family history of diabetes or history of diabetes during pregnancy.

While people with diabetes can exhibit noticeable symptoms, most patients diagnosed with type 2 diabetes do not show overt warning signs that they have developed the disease.Unfortunately, many do not know they have diabetes until they have developed one or more of its serious complications.

Conemaugh Diabetes Institute provides extensive education and support services to patients diagnosed with diabetes and individuals at risk for developing diabetes.

Staff members of the institute work with family members and primary care physicians to coordinate an effective plan of care for each patient. Individual and group education and appointments are available.

Conemaughs education programs are recognized by the American Diabetes Association and are led by Certified Diabetes Educators including registered nurses, registered dietitians, and additional healthcare professionals.

One of the key components of preventing and managing diabetes is following a healthy meal plan that focuses on achieving good nutrition, said Ashley Staruch, registered dietitian at the Conemaugh Diabetes Institute and Certified Diabetes Educator. Its not about following a fad diet that is popular at the current moment. Its about finding the right balance between eating the foods we enjoy and maintaining optimal blood-sugar control. Quality of life is such an integral part of healthy nutrition.

All foods, in moderation, can fit into a healthy meal plan.

Education for diabetes patients includes understanding healthy and unhealthy food options, meal planning, reading food labels, tips for grocery shopping, the best options when eating out and how to make the foods they enjoy fit into their daily meal plan.

We show patients that diabetes is manageable and they can still eat great tasting foods, Staruch said.

Its about balance and finding the healthiest ingredients for meals they are preparing. Once they experience small successes of seeing their blood sugars improve, feeling great and having more energy, it makes sustaining the healthy lifestyle easier.

One main concern for a person with diabetes is carbohydrates, which come primarily from starch, fruit and milk.

Carbohydrates are broken down into sugar by an individuals digestive system and cause an increase in blood glucose.

The more carbohydrates eaten, the higher the patients blood sugar.

A person with diabetes should focus on consuming healthy sources of carbohydrate found in fruit, vegetables, whole grains, beans and low-fat milk.

Foods that should be limited are those that provide calories, but have little nutritional value. These foods include sugary beverages such as soda and juice, sweetened breakfast cereals, desserts and snack foods.

Its important to be aware of the foods we are eating and to keep track of what goes into our bodies, Staruch said.

Eating too many calories, specifically too many calories from carbohydrates, can cause the blood sugar level to significantly increase.

We need to focus on choosing healthy options, especially when it comes to carbohydrates.

Patients that appropriately manage diabetes and their blood sugar levels can lead normal lifestyles with limited or no complications. However, uncontrolled or unmanaged diabetes can lead to serious, irreversible long-term health conditions such as damage to blood vessels in the heart, brain, legs, eyes, kidneys, feet and nervous system.

Prevention and management are key, Staruch said. Whether trying to prevent diabetes or manage diabetes, we can help patients get back on track and enjoy their daily lives.

Diabetes meal planning tips and related informationare available on the CDC website at CDC.gov, and the American Diabetes Association at diabetes.org.

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Family Life | Health tips: Know the risks of diabetes and follow a healthy meal plan - TribDem.com

For many, including myself, this syndrome is an invisible but real burden. For some, it is even a disability. When we are forced to live out of sync with our internal clocks, our health suffers. The mismatch between internal time and environmental time has been linked to problems including depression, diabetes, obesity and poor cardiovascular health. Our immune systems become a mess. Many night-shift workers have similar problems; for us, a traditional 9-to-5 schedule is the equivalent of night-shift work.

This happens because, even if we force ourselves to wake up early, our metabolism is not ready to perform simple tasks such as properly digesting a meal, for example we do not produce as much insulin in the morning as normal people do. Our core body temperature also follows an internal rhythm, producing sleepiness or alertness much later. This is true as well for the release of cortisol, melatonin and other hormones essential to the sleep-wake cycle. In the morning, our eyes might be open, but, for all intents and purposes, we are still sleeping.

And its no use getting exhausted and deliberately undersleeping with the intention of falling asleep early the next day a recommendation Ive heard a lot, including from doctors. Circadian rhythms operate independently of the sleep-pressure system. This is the case even among normal people: Even if you slept miserably last night and woke up very early, it is unlikely that youll fall asleep at 6 p.m.; thats because your circadian rhythms are cycling on as usual, unaffected by your lack of sleep. Your attempt to hit the sack would clash with something called the wake-maintenance zone, a three- to four-hour interval of maximum physiological alertness. (In normal sleepers, it occurs from 6 p.m. to 9 p.m.)

Delayed sleep phase syndrome has a genetic basis, as my own unscientific sample demonstrates: My mom also has it, though her case is not so extreme. Apart from that, other mechanisms can account for the disorder. Some studies indicate that our built-in circadian period might be unusually long (say, 25 hours instead of 24); others find dysfunction in our homeostatic sleep drive, a reduced response to the phase-resetting effects of daylight, or an excessive response to the sleep-delaying effects of artificial evening light. There is, as of yet, no cure only short-term fixes that include the use of a light therapy box and the administration of well-timed melatonin pills. But in the long run, most of us fail to adapt.

Heres the thing, though. If left to our own devices if allowed to follow our own biological clocks we sleep just fine.

Individuals with extreme cases of the syndrome are unable to work conventional jobs. We are also famously unreliable at keeping appointments and participating in diurnal social activities. We learn to make excuses and tell lies. I often say that I work nights, which is true its just not the whole story. Most people respect work-related excuses, but sneer at health conditions theyve never heard of.

Thats the worst thing about having a circadian rhythm disorder: living in a society that places a moral value on the time your alarm clock goes off. Most cultures emphatically equate early rising with righteousness: As we say in Brazil, God helps those who wake up early.

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Early to Bed, Early to Rise Makes Me Exhausted, Depressed and Sick - The New York Times

Type 2 diabetes is a condition in which the body cant control the amount of glucose in the blood. The body doesnt respond to insulin properly and may not produce enough, causing a person's blood sugar levels to become too high. If blood glucose isnt controlled properly and stays too high, it can lead to a number of serious health problems, including kidney failure, nerve damage, heart disease and stroke.

Regularly eating a poor diet can increase your risk of developing type 2 diabetes, but diet can also play a part in lowering and controlling blood sugar.

Experts say theres nothing you cannot eat if you have type 2 diabetes, but certain foods should be limited.

As some general rules, the NHS advises eating a wide range of foods - including fruit, vegetables and some starchy foods like pasta.

Sugar, fat and salt should also be kept to a minimum, and its important to eat breakfast, lunch and dinner every day and not to skip meals.

READ MORE: Type 2 diabetes: Best fruit to include in your breakfast to lower blood sugar

But certain food and drink have also been found to hold blood sugar lowering properties, and when it comes to the first meal of the day, breakfast, one food proven to have a positive impact on blood sugar levels is eggs.

According to a 2015 study in men aged between 42 and 60 years, those who ate the most eggs were 38 percent less likely to develop type 2 diabetes than those who ate the fewest eggs.

The explanation for this may be that eggs provide essential nutrients that can benefit overall health, and can help replace higher-carb or more processed breakfast choices.

Another study found participants who ate two eggs a day for 12 weeks saw a significant reduction in their body fat and body mass index (BMI) compared with those who ate no eggs during this period.

DON'T MISS

Excessive egg consumption should be avoided as research suggests eating a high number of eggs may raise the risk of developing type 2 diabetes and heart disease.

While the connection isnt clear, researchers believe excessive cholesterol intake, when it comes from animal foods, may increase those risks.

Eggs are high in cholesterol, but whether or not this negatively effects the body is still being debated.

If you have type 2 diabetes and find it hard to change your diet, a dietician may be able to help.

Read more:
Type 2 diabetes: Eating this food for breakfast could lower blood sugar - Express

I do think the data are so clear about what this benefit can be, said Matt Longjohn, the former chief medical officer of the Y, whose pilots of the diabetes prevention program established the benefits of the program for CMS actuaries. Longjohn, who ran for the House of Representatives as a Democrat from Michigan last year, said it seems like regulators are making decisions that are penny-wise and pound-foolish.

The program, approved late in the Obama administration and carried out in the Trump era, targets patients on the verge of developing diabetes. It provides weight loss training and education proven methods of prevention. Rules set in 2017 projected widespread popularity for the benefit, estimating that between 50,000 and 110,000 people would take advantage of it each year from 2018 to 2027. The resulting weight loss and fewer cases of type 2 diabetes would improve health and lower Medicare health care spending by $182 million during that period, the agency estimated.

But the first year of the program appears to have fallen dramatically short of the agencys estimates: Claims data from the Centers for Medicare and Medicaid Services for 2018 shows that only 202 people used the program, according to an analysis conducted exclusively for POLITICO by open data startup CareJourney, which has access to the agencys chronic care claims database. The pace has accelerated somewhat in the first quarter of 2019, with 396 using the service.

The statistics come with some caveats suggesting they may underestimate the true numbers of Medicare beneficiaries using the program. They dont include Medicare Advantage beneficiaries and dont reflect lags in paid claims. Some providers have said CMSs contractors have been slow to pay claims as they adjust to the new program; for example, the Y, which includes YMCAs nationwide, told POLITICO that claims submitted in 2018 still havent been paid.

CMS would neither confirm nor deny the figures and said its data would not be complete until 2020. It did not answer other questions about its implementation of the program.

But the paltry figures come as a disappointment to the diabetes prevention programs most vocal advocates. The American Medical Association, for example, says half of all Medicare beneficiaries have prediabetes, and has argued that CMS action would be helpful in promoting the success of the new benefit.

The benefit has added challenges as suppliers include community-based organizations that need training in applying and billing Medicare, said the associations president, Patrice Harris, in a statement.

The timing of the new benefit introduced at the end of the Obama administration may have slowed its impact. HHS had a huge amount of turnover from folks who understood the benefit, the rationale, the cost-saving and life-saving benefits, said Matt Longjohn.

Longjohn says he believes Trump administration officials appreciate the program, but I think they got caught flatfooted. I think they had a couple bureaucratic false starts, he said.

He attributed the slow growth of the program to a lack of providers and a lack of promotion that might have stoked demand for the services of the 600 program providers thus far authorized by CMS.

But the figure obscures significant holes in the network. Ten states have zero providers, said Brenda Schmidt, the CEO of Solera Health, a network of diabetes prevention and social providers. Many major metropolitan areas have few or no providers: Dallas has no providers within a 100-mile radius, according to CMSs provider finder, to take one example. The closest providers for a Philadelphian might well be a thirty-mile schlep to Wilmington, Del.; a Washington resident might need to go to Baltimore.

The lack of providers can be traced back to a pair of CMS decisions restricting supply. The agency has not yet authorized digital providers, and imposes numerous regulations on bricks-and-mortar-based providers to prevent fraud. The latter have been medicalized, Schmidt said, saddled with regulations befitting medical doctors.

Providers have to run a gauntlet of requirements, including gathering the Social Security numbers of all board members, hiring a full-time privacy director, conducting penetration to test their organizations cybersecurity and building IT infrastructure to handle billing, Schmidt and the Ys Heather Hodge said. Complying with just one of those requirements penetration testing can cost $30,000, Schmidt said.

Non-profits just throw up their hands, said Longjohn, whos been consulting with providers on CMS requirements. The cost of keeping up with regulatory requirements leads them to leave the market. Pharmacies and supermarkets showed interest at one point but have opted out of the program, Schmidt said.

Twenty Y locations are qualified to provide diabetes prevention program services to Medicare recipients, said Hodge, the Ys lead on the program. But none, so far, have broken even, she said.

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Researchers have come to similar conclusions about the programs economics. In 2018, two studies examining programs based in Denver and the Bronx concluded that Medicares proposed reimbursements were hundreds of dollars per beneficiary lower than the costs of running the program.

Meanwhile, the agency has also shut out a class of startups seeking to offer a digital version of the program. Numerous companies like Omada Health, Livongo, Canary Health, and Noom offer virtual prevention programs that have won over private payers and employers. But Medicare hasnt even agreed to a demonstration model to test their products.

No progress, Canary health co-founder Neal Kaufman said of Medicares interest.

Interest groups have tried to convince the agency: in May 2018, the AMA sent a letter to Adam Boehler, then director of CMSs innovation center, arguing that a demonstration of virtual diabetes prevention, or DPP, would be helpful. That letter was followed by comments on two subsequent rules pushing virtual DPP in both traditional Medicare and Medicare Advantage. The main goal of allowing virtual DPP in traditional Medicare has proven elusive, however.

Schmidt said her Medicare Advantage clients collectively had hundreds of thousands of beneficiaries who qualify for the benefit, but are unable to use it.

The programs lack of success so far has implications that extend beyond individuals at risk for developing Type 2 diabetes. Although CMS and the private health sector frequently declare their interest in addressing social determinants of health and some state Medicaid programs have started such programs CMSs approach to DPP suggests it may have trouble reimbursing even simple things like pest abatement to lower asthma risks.

If those services get reimbursed, I wouldnt want to see them apply the same standards, said Schmidt.

See original here:
Medicare diabetes prevention program helps a few hundred instead of hundreds of thousands - Politico

UniQure has started screening patients for its phase 1/2 trial of gene therapy AMT-130 for Huntingtons disease, and says it hopes to start treating the first subject in late 2019 or early 2020.

The start of the trial will give the Dutch biotech a second gene therapy in clinical trials to go along with AMT-061 (etranacogene dezaparvovec), its one-shot therapy for haemophilia B which is in phase 3 testing.

Huntingtons disease is a rare, devastating neurodegenerative genetic disorder that affects motor function and causes severe cognitive decline, eventually leading to total physical and mental deterioration.

The disease is caused by a mutation in the gene coding for huntingtin which causes the formation of an abnormally long and unstable form of the protein that is chopped up by cellular repair mechanisms into smaller, toxic fragments.

AMT-130 consists of an adeno-associated virus (AAV) vector carrying a micro-RNA that is designed to switch off the huntingtin gene and prevent it from producing the mutant form of the protein.

In annual models, a single dose of AMT-130 was shown to reduce huntingtin levels, initially in deep structures of the brain like the striatum that are affected first by the disease and spreading to higher structures such as the cerebral cortex that come into play later in the course of Huntingtons.

The phase 1/2 trial will be conducted in around 26 patients at several clinical sites, who will be treated either with a single dose of the gene therapy directly into the striatum or an imitation procedure with no drug.

The main outcome measures will be safety and the persistence of AMT-130 in the brain, but the trial will look at clinical outcomes including motor, cognition, and behavioural function over a five-year period. First results should be available in 2022.

Other companies notably Wave Life Sciences/Takeda and Ionis/Roche are developing antisense drugs to switch off production of huntingtin, but these would require continuous dosing in order to be effective.

The announcement was made in UniQures third-quarter results update, at which it also said it had completed enrolment of 62 patients into its HOPE-B trial of haemophilia B therapy AMT-061, setting it on course for a readout in 2020 and possible filing in early 2021.

In July, UniQure reported phase 2b results with AMT-061 showing that it could restore Factor IX levels into the normal range for two out of three subjects.

UniQure was the first company to launch a gene therapy onto the market in Europe, introducing Glybera (alipogene tiparvovec) for familial lipoprotein lipase deficiency (LPLD) in 2012, but the product was a commercial flop and was withdrawn from sale in 2017.

Read more from the original source:
UniQure presses go on Huntington's gene therapy trial - - pharmaphorum

PTC Therapeutics gene therapy candidate PTC-AADC (formerly AGIL-AADC) provided clinically meaningful and sustained improvements in motor, cognitive, and language milestones in children with aromaticl-amino acid decarboxylase (AADC) deficiency up to five years following the one-time treatment, trial analyses show.

A single dose of PTC-AADC delivered into the brain lowered the number of oculogyric crises (involuntary upward eye movement) and recovered childrens weight, as well as improved their ability to sit, walk, and talk over a five-year period.

PTC Therapeutics will request marketing approval soon, with plans to submit a Biologics License Application (BLA) to the U.S. Food and Drug Administration later this year.

The new findings were shared at the 48th Annual Meeting of the Child Neurology Society (CNS), held recently inCharlotte, NC. Data were presented in two posters titled AGIL-AADC gene therapy results in sustained improvements in motor and developmental milestones through 5 years in children with AADC deficiency (page S136), and Safety and Improved Efficacy Outcomes in Children With AADC Deficiency Treated with AGIL-AADC Gene Therapy: Results From Three Clinical Trials (page S148).

We are excited to see the transformational effects in AADC deficiency patients in this long-term study as patients with severe AADC deficiency never achieve the ability to sit, walk or talk, Stuart Peltz, PhD, PTC Therapeutics CEO, said in a news release.

We are on track to submit a BLA to the FDA by the end of the year and are proud to be on the verge of bringing the first commercial treatment for AADC deficiency patients which is in line with our mission of bringing clinically differentiated treatments to patients with rare disorders, he added.

PTC-AADC is an investigationalgene therapy designed to deliver a healthy copy of the DDCgene the faulty gene in patients with AADC deficiency to nerve cells. The goal is to restore the production of AADC enzyme which is missing because of this genetic defect and counter the symptoms caused by this deficiency.

A working copy of DDC is passed on to cells through an adeno-associated virus that is modified to be non-infectious.

The gene therapy is injected via a surgical procedure into an area of the brain called the putamen. This region is crucial for producing chemical messengers (neurotransmitters) such as dopamine and serotonin, which are involved in movement control but fail to be produced in patients with the disease.

In one of its presentations, PTC Therapeutics provided the most extensive study of PTC-AADCs efficacy and safety to date. It conducted a joint analysis of three open-label clinical trials, which together enrolled 26 children with AADC deficiency, ranging in age from 21 months to 8.5 years.

At the beginning of these studies, children had no full head control and were unable to sit, stand, or walk. They were given a single dose of PTC-AADC (total dose, 1.81011 vector genomes, vg) which was injected into the patients putamen during a single surgery session.

One year after treatment, the patients mean body weight had increased from 12.0 kg to 15.2 kg, and there was a reduction in the frequency of involuntary upward eye movements characteristic of the disease (oculogyric crises).

Dyskinesia (uncontrolled erratic movements) was a common adverse event, affecting 23 of 26 patients, but most events were mild or moderate in severity, and all cases had resolved within 10 months from dosing.

In addition to failing to reach key developmental milestones, such as walking and talking, children with AADC deficiency can experience severe symptoms that affect their everyday lives. These symptoms can include episodes of oculogyric crises, which can last for minutes or hours and involve sustained upward movement of the eyes, involuntary movements of the neck, tongue protrusions and jaw spasms, which can be very distressing for patients and their families, said Claudio Santos, MD, senior vice president of global medical affairs at PTC Therapeutics.

The post-treatment data presented at CNS confirm reductions in the number of patients experiencing oculogyric crises, suggesting that this gene therapy treatment has the potential to make a real difference in the lives of patients with AADC deficiency, he added.

A second analysis demonstrated that PTC-AADCs benefits can hold up to five years after treatment, the longest data available for any investigational therapy for AADC deficiency.

The findings came from the latest follow-up data of two open-label clinical studies: AADC-1601 (NCT02926066), a trial in which patients were enrolled under individual compassionate use consents, and AADC-010 (NCT01395641).

Together, the studies enrolled 18 patients who were 21 months to 8.5 years old. None had full head control or could sit unassisted or stand. In this update, all patients had two years of follow-up data, and eight of these patients had five years of post-treatment data.

Prior results shared by PTC Therapeutics showed that at two years, eight patients (44%) had achieved full head control, six (35%) were able to sit unassisted, and three (17%) could stand without support. Among the eight patients followed for five or more years, four (50%) had full head control, four (50%) could sit unassisted, and two (25%) could stand without support.

The latest results continue to support these meaningful improvements in motor, cognitive, and language skills, and importantly, show that effects from a single dose of PTC-AADC can last at least five years post-treatment.

In addition, all treated patients continued to demonstrate sustained production of dopamine in the body, one of the neurotransmitters missing in patients with AADC deficiency.

No new safety signals were observed during these long-term evaluations.

Ana is a molecular biologist enthusiastic about innovation and communication. In her role as a science writer she wishes to bring the advances in medical science and technology closer to the public, particularly to those most in need of them. Ana holds a PhD in Biomedical Sciences from the University of Lisbon, Portugal, where she focused her research on molecular biology, epigenetics and infectious diseases.

Continued here:
AADC Improvements Sustained with Gene Therapy PTC-AADC, Data Say - AADC News