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The parents of baby triplets begged for their surviving son to be transferred to a different hospital after his two brothers both died within 24 hours, the trial of nurse Lucy Letby has heard. The 33-year-old is accused of murdering the two baby boys by injecting them with air in the days after they were born in June 2016. Ms Letby, originally from Hereford, is charged with murdering seven babies and attempting to murder 10 others. She denies 22 charges. Manchester Crown Court heard the triplets, who cannot be named for legal reasons, were born one minute apart at the Countess of Chester Hospital and each weighed about 4lb (1.8kg). They were in good condition at birth and were cared for on the hospital's neonatal unit, the jury was told. 'State of panic' In a statement read to the court, their mother recalled the moment she first learned there was something wrong when they were two days old. She said the neonatal unit "was a scene of chaos" and in the intensive care room "lots of medical staff were rushing around... the staff seemed to be in a state of panic and it didn't seem to be controlled". Their mother said the baby - known as Child O - had a swollen body while their father said his stomach "looked like [the film character] ET". In a video interview, which was played to the jury, he cried and pointed to his hand as he explained: "You could see his veins were all bright, bright blue. "All of them were different colours. It looked like he had really bad prickly heat.. you could see something through his veins." The court heard that Child O died that evening. His mother said: "The whole episode came like a bolt out of the blue. "On the face of it everything had been going so well, it was never explained to us how it happened. As a family we were naturally devastated." She added that they had been told that there would be one nurse looking after each baby, but a student nurse from Chester University had been closely involved with their care. The jury heard that 24 hours later the same kind of emergency happened with the second triplet - known as Child P - and their mother said it was "like deja vu". The babies' father said that as medical staff tried to save his son "it was pandemonium and absolutely mental - it was worse than the day before". Child P is said to have looked similar to his brother, with discolouration and prominent veins, although his stomach wasn't swollen, the court heard. He died that evening, just under 24 hours after his brother. The court heard their parents begged a hospital transfer team to take their third triplet to another hospital. Their father said: "We said there's no way he's staying at this hospital. "If you don't take him, we'll take him ourselves." The jury was told the baby was moved to another hospital following their request. The babies' parents said Ms Letby had brought the bodies of the two deceased babies to them, and had dressed them and made memory boxes. Their mother said: "Lucy was extremely upset and emotional and in pieces and almost as upset as we were. "She brought [the babies] to see us in a cooling basket. She was in floods of tears." The trial continues.	Epidemics & Outbreaks
Drop That Hot Dog If You Value Your Health (Bloomberg Opinion) -- The health case against regularly eating red meat keeps getting stronger. At what point is the data convincing enough for Americans to change their diets? One recent study found that eating red meat increases the risk of type 2 diabetes; another paper finds a diet low in meat, sugar and salt but rich in vegetables and legumes is associated with a lower risk of Alzheimer’s. And both studies — which followed thousands of people for decades — show that replacing even a few servings of meat can have an impact. There are also implications here for the legions of people expected to try the new class of obesity drugs called GLP-1s. While studies have shown the drugs can induce enough weight loss to improve cardiovascular and kidney health, a lower BMI doesn’t solve all ills. “Losing weight will not entirely prevent you from developing other chronic diseases. You still have to rely on a healthy diet,” says Xiao Gu, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health. Gu is one of the authors of the new study linking red meat to diabetes. His team found that people who routinely consume more than a serving per day of red meat have a 50% higher risk of developing type 2 diabetes than those who partake at lower levels. More than a serving per day might sound like a lot. But as my Bloomberg Opinion colleague Mark Gongloff recently pointed out, Americans are among the world’s most voracious meat eaters, with each person consuming an average of 280 pounds per year, which amounts to about three servings a day. That meat-heavy diet comes at a clear cost to our climate, as livestock farming is responsible for some 18% of global greenhouse gas emissions. And it is clearly bad for our hearts; the greater a person’s red meat consumption, the greater their risk of cardiovascular disease. But the link to type 2 diabetes has been a subject of ongoing debate. Some research suggests various components of meat can impair insulin function, whether the culprit is saturated fat, the meat’s iron content, or something in how the meat is prepared — grilling, curing and overcooking have all been associated with poorer health outcomes. However, causation has been hard to prove: One recent meta-analysis found the link between saturated fat in red meat and diabetes tenuous at best. Diet’s impact on health is also notoriously hard to study. What we eat changes over time and is just one factor affecting our risk of developing a disease — our genes, environment and lifestyle matter, too, as do socioeconomic factors. The Harvard team took special care to account for those confounders. They used data from the Nurses’ Health Studies, which have followed more than 200,000 health care professionals for more than 40 years. That meant enough cases of diabetes had accumulated — more than 20,000 — to find the association between meat consumption and diabetes. And because volunteers were interviewed every 2 to 4 years, researchers had good information about how participants’ diets changed over time; by contrast, many other studies have only looked at diet at the time a study began. One of the biggest confounders they had to untangle was body mass index. If people who eat a lot of red meat eventually gain weight, it could be their weight — not the meat — that leads to insulin resistance. But the researchers found that BMI only accounts for about half of the increase in risk. That means that red meat increases diabetes risk even for people who aren’t overweight. And processed meat — like sausage and salami — increased diabetes risk the most. If that isn’t enough to convince you to cut back on meat, consider another new study. This one, which mined data from the NYU Women’s Health Study, found that people who ate more red meats, sugar and full-fat dairy had a higher risk of Alzheimer’s disease. Between 1985 and 1991, researchers enlisted some 14,000 middle-aged women and followed up with them for decades. Using data from about 5,000 women in the cohort, they found that people adhering to the “DASH” diet (shorthand for Dietary Approaches to Stop Hypertension) had a 17% lower risk of developing two or more cognitive issues later in life. In other words, a heart-healthy diet favoring plant-based foods fared better than those who consumed more red meat, sodium and sweets. The NYU team’s findings suggest the dietary choices made in midlife have a far-reaching impact on women’s health, whether it protected (or harmed) their heart or their brain, says Yu Chen, a chronic disease epidemiologist at NYU Langone who led the study. Both studies do have some limitations. The Harvard study’s dataset is predominantly White women; the NYU study was more diverse but measured cognitive challenges across a short time frame — more follow up would better capture changes in brain health. But the take-away from both studies is clear. Your health will be better if you swap some lentils for that steak. More From Lisa Jarvis at Bloomberg Opinion: - Telehealth Should Stick Around. Teens Need It. - Do You Really Have to Take Wegovy Forever? - How to Pay for Million-Dollar Cures This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News. More stories like this are available on bloomberg.com/opinion ©2023 Bloomberg L.P.	Nutrition Research
Experts are calling for "do not resuscitate" orders to be scrapped, saying they are being misused and putting people's lives at risk. One woman told BBC News that her elderly father may still be alive if the DNR in his medical file had been properly checked. When Robert Murray began choking on a piece of fruit at breakfast, staff at his care home called 999. He'd stopped breathing and the ambulance service operator immediately sent paramedics to attend. But seconds later, the care home told the dispatcher that the 80-year-old had a do not resuscitate form (DNR) in his medical records. The paramedics were stood down. Mr Murray died minutes later. However, it was all a terrible mistake. It hadn't been made clear to the ambulance service that Mr Murray was choking - the DNR was only meant to apply should he have a cardiac arrest. "As soon as you say DNR, it seems to change what they want to do," says Robert's daughter, Wendy, who heard the 999 call during an inquest into her father's death. "If his heart was failing - he was having a heart attack - I could totally understand that. But when he died of a choking incident, which is not a natural way of dying, it didn't get picked up." Wendy says her father was a kind and patient dad. He'd been diagnosed with early on-set Parkinson's when he was 55. Despite this - and even after the death of his wife from kidney cancer in 2011 - Mr Murray continued to live at home until 2019, when he finally decided he needed to move to a home for round-the-clock care. "He had a DNR in place since 2016," says Wendy. "He completely agreed with it. It was mainly for his heart, as he had a murmur, but he never wanted to come back [if something happened] from Parkinson's. "He was on quite strong medication, he had shakes, it took him a lot to time to get himself moving." Mr Murray's death, at a nursing home in Eastbourne in June 2021, is an example of what experts call "mission creep" in the use of DNR - also known as DNACPR (Do Not Attempt Cardiac Pulmonary Resuscitation) - decisions. Researchers from Essex University say some care home residents are "being inappropriately denied transfer to hospital or access to certain medicines" due to the recommendations. DNR and DNACPR decisions are intended to inform clinicians how someone should be treated if their heart or breathing stops. The decisions are not legally binding. But they can be appropriate if a person is unlikely to withstand the procedure and can be mandated by a doctor - but crucially only after they've consulted with the patient, or their family. During the Covid-19 pandemic, concerns were raised that such decisions were being taken on a blanket basis. Care homes for both elderly and disabled people were accused of making recommendations without considering the merits of individual patients. A 2021 investigation by the care watchdog, the Care Quality Commission, found there may have been more than 500 breaches of individual human rights due to the misuse of DNR decisions. The Essex University research suggests potential confusion around orders. In a small study of 262 care professionals, most of whom had responsibility for applying the 2005 Mental Capacity Act, researchers found: - 17% said they'd seen instances of DNACPR decisions informing care and treatment decisions beyond their intended use - 28% said they'd seen DNACPR forms added to medical notes due to blanket decisions, such as the age of a resident - 55% reported witnessing decisions being made without consultation with the resident or their family In a subsequent focus group carried out by the university, one participant said: "Some staff see DNR as 'do not care', or 'do not seek any medical treatment'." The forms have come to be used "to inform other medical decisions, around eligibility for hospital care, people being refused IV medication," says Professor Wayne Martin, who led the research. "That's what we call mission creep - its not what these forms were designed for. It's really a violation of both law and people's rights to care." Researchers are calling for better training for both care professionals and those advocating for them. But Professor Martin says the starting point should be to "get rid of DNACPR forms", adding: "They look like they're an order, when they're not legally binding." Researchers say new standardised documentation - based on consultation, a person's individual circumstances, and a clear understanding of the law - are needed. For Wendy Murray, it will all come too late. The pandemic meant that she never got to hug or touch her father for over a year before his death. "He would probably still be alive if they'd actually brushed up on what they needed to do, double checking what is in the DNR, not the fact that, 'Oh, he's got a DNR in place, we won't bother.' It's not a nice way to lose your parent." The home in which Mr Murray was staying, Avalon Nursing Home, in Eastbourne, said it had updated advice relating to DNACPR forms in all care plans, and that staff had attended refresher training on basic life support.	Health Policy
New Haven, Conn. — High levels of exposure to the virus that causes COVID-19 may reduce or overcome the protection that vaccination and prior infection provides, according to a new study by researchers from Yale University, the University of Florida, and the Connecticut Department of Correction. The findings, published Aug. 19 in Nature Communications, suggest that in densely crowded settings, control measures that reduce levels of exposure to the virus — such as masking, improved ventilation, and distancing — may afford additional benefit in preventing new infections among people who have been vaccinated or previously infected. The study was performed within the Connecticut Department of Correction system to understand whether the immunity gained after vaccination or a prior infection was less effective or “leaky” in situations where people are exposed to high levels of the virus, said Margaret Lind, lead author of the paper and an associate research scientist at Yale School of Public Health. Answering this question during the pandemic has been a major challenge because “it’s really hard to find a population, such as the residents of the Connecticut Department of Correction, where we know the type of exposure somebody has and we know their vaccination and prior infection status,” Lind said. Dr. Byron Kennedy, chief medical officer for the Connecticut Department of Correction and associate clinical professor at the Yale School of Public Health, added, “We had a unique opportunity to answer this question because the Department of Correction had mounted an intensive COVID-19 testing program and we were identifying and isolating infected individuals.” The researchers tracked infections among 15,444 residents of Connecticut correctional facilities between June 2021 and May 2022, when the state experienced two epidemic waves due to the emergence of the COVID-19 Delta and Omicron variants. They also determined which people had resided with a COVID-19-positive cellmate and, as a result, had high exposure to the COVID-19 virus. The study found that during the Delta and Omicron epidemic waves, immunity acquired after a vaccination, prior infection, and both vaccination and infection (“hybrid immunity”) was weaker when residents were residing with an infected inmate. Specifically, during the Delta wave, vaccination was 68% effective at preventing infection in residents without a documented exposure but was just 26% effective in residents with exposure to an infected cellmate. A previous infection was 79% effective in preventing infection in residents without a documented exposure but was 41% effective when a resident was exposed to an infected person in their cell. Hybrid immunity provided the highest level of protection, at 95% and 71% effectiveness, in residents without a documented exposure and with a cell exposure, respectively. While the overall protection afforded by vaccination, prior infection, and hybrid immunity was lower during the epidemic wave with the more-transmissible Omicron variant, the same pattern in the levels of protection was observed. Vaccination was 43% effective at preventing infection in residents without documented exposure but was just 4% in residents who shared a cell with an infected person. A previous infection was 64% effective without a documented exposure but was only 11% effective when a resident was exposed to an infected person in their cell. Although hybrid immunity afforded higher levels of protection during the Omicron wave, it was only 20% effective in residents with an exposure in their cell as compared to being 76% effective in residents without documented exposure. The study's findings underscore the importance of the state of Connecticut’s efforts to protect its incarcerated population during the pandemic. During the two epidemic waves, residents had a 5 to 10 times increased risk of being infected when they shared a cell with an infected individual and a two to four times increased risk of being infected if there was an infected individual in the same cell block. The majority of infections were detected by the Department of Correction’s contact tracing program, which rapidly identified and tested contacts of infected individuals in cells and cell blocks. “The success of contact tracing was a critical element in keeping our population safe in this high-risk congregate setting during the pandemic,” said Kennedy. “This research is the first study, as far as we are aware, that provides real-world evidence for the exposure-dependent or ‘leaky’ nature of the immunity afforded by vaccination and infection,” Lind said. Biology Professor Derek Cummings, a co-senior author of the paper and associate director of the Emerging Pathogens Institute at the University of Florida, added: “More studies are needed to understand whether the same phenomenon of leaky protection may be occurring among vaccinated and previously infected people in the other congregate settings, such as hospitals and nursing homes, and in the community during mass gatherings.” “We suspect that leaky protection may be the norm for immunity to many infectious diseases of public health importance,” said Dr. Albert Ko, the Raj and Indra Nooyi Professor of Public Health at the Yale School of Public Health and co-senior author of the paper. “This study is a good example of leveraging collaboration between state government and a university to answer a difficult yet fundamental question on how immunity to COVID-19 works, in addition to guiding how we protect our vulnerable populations,” added Ko, who was also co-chair of Governor Ned Lamont’s Reopen Connecticut Advisory Group during the height of the COVID-19 epidemic. Other co-authors of the paper are Murilo Dorion, Sarah Lapidus, Russel Thomas, Inci Yildirim, and Saad Omer from the Yale School of Public Health; Robert Richeson, Amy Houde, and Mary Lansing from the Connecticut Department of Correction; Wade Schulz from the Yale School of Medicine; Jason Andrews from Stanford University, and Matt Hitchings from the University of Florida, Gainesville. Journal Nature Communications Article Title Evidence of leaky protection following COVID-19 vaccination and SARS-CoV-2 infection in an incarcerated population Article Publication Date 19-Aug-2023	Epidemics & Outbreaks
By Karen Chen, as told to Stephanie Watson I've had atopic dermatitis for as long as I can remember. When I was little, I remember getting a lot of rashes in the areas where my joints are -- the insides of my elbows and knees. I was itchy all the time. My pediatrician and the other doctors I visited at the time said it was normal for children to have eczema. They told me I'd eventually grow out of it. Constant Itching I was so itchy that I had trouble falling asleep. I wore long-sleeved shirts to bed so that I wouldn't scratch at my skin during the night. My whole life revolved around catering to my eczema. I'd check the weather every day. If it was very dry or windy, I wouldn't go outside. Just my hair hitting my face in the wind would irritate my skin. I used to wear mainly dark clothes. My skin would bleed because I always had open wounds from scratching, and I was afraid of staining my white clothes. I was so self-conscious that I went to great lengths to hide my skin. I wore long sleeves, even in the summer. Sometimes I wouldn't leave my house when my eczema looked particularly bad. Missing Out I felt excluded from normal childhood activities. Many of them would exacerbate my skin. For example, I couldn't swim because it would dry out my skin and make my eczema flare up. And if I got too sweaty while exercising, I would break out in itchy hives. When my friends wanted to go out for something to eat after school, I felt too terrible to join them. I didn't grow out of my eczema as my doctors had predicted. Instead, it started to get worse in high school. I was so itchy that I couldn't focus in class and I couldn't sleep at night. I started falling further and further behind. Because I didn't want to tell my teachers that eczema was to blame, I came across as a student who didn't try very hard. I wish people understood how chronic illnesses affect people. Whenever I had to miss class in high school, I would tell my teachers and friends that I was out becauseÂ I was sick. For most other people, being sick happens for a finite period of time -- as long as it takes to get over a cold or other infection. There was an expectation that I would fully recover within a week and be back at school. But because my condition was/is chronic, whenever I would become "sick" with a bad flare-up, Iâd remain bedridden without any timeline for recovery. It could be days, but more likely weeks and months, before I stopped flaring up and could go outside again. And when I did return, I felt only slightly less terrible and was still barely able to function. Few people realize that eczema is a disability. Those around me were constantly minimizing my experience, and the effect the disease was having on my day-to-day life. If I hid my condition people didn't take me seriously, and if I was honest about it, they didn't want to be near me. It was a lose-lose situation. Eczema affected me so much that it took me an extra year to graduate from high school. It felt like the world was moving on without me. Trying Everything I have tried just about every medication, and a few alternative therapies, to manage my atopic dermatitis. I went to pediatricians, dermatologists, and allergists for advice. I rubbed on topical steroid creams of various potencies, and got steroid injections. I tried phototherapy, which is essentially a tanning booth that blasts UV rays at you. I used antihistamines and various lotions to try to tame the itch. Nothing helped. I went on strong pills that suppressed my immune system. I remember the warnings on the bottles, which said these medicines were for people who had just gotten an organ transplant. That was pretty scary. I just wanted my skin to stop breaking out. I also tried a lot of fad skin care trends over the years, like drinking 10 cups of water a day or rubbing coconut oil on my skin. None of them worked. Neither did the herbal remedies my family recommended. My doctor tested me for allergies, pricking my skin to see if it broke out in hives. During one test, my doctor put patches of common allergens on my back. The tape irritated my skin so much that it itched for the entire 3 days that it took to do the test. I took part in a clinical trial of a biologic drug used to treat psoriasis. I stayed in that study for a whole year, but the drug didn't help me. By the time I was 16, my doctors stopped telling me that my eczema would improve with age. At that point they realized it wasn't going away. Gradual Clearing I was always looking for new treatments. One day, I saw a story about dupilumab (Dupixent) in the news, and it looked very promising. I reached out to my doctor, Emma Guttman-Yassky, MD, at Mount Sinai in New York. I had moved to California by then, because I was hoping the warm climate might help clear my skin. I told Dr. Guttman-Yassky that I really wanted to get on this new drug, and she helped to expedite the process with my insurance company. It's a very expensive drug, so a lot of insurance companies want you to "prove" that you need it. They ask for an exhaustive list of everything you've tried, along with proof that nothing on the market has worked for you. I had to go through an extensive rejection and appeal process before I finally qualified for a patient assistance program. Once I got on the medicine, it took a while for it to take effect. It was very gradual. But at some point, I realized that if I had a scab, it would go away in 3 months instead of the 3 or 4 years it used to take to clear up. And when I would apply steroid creams, for the first time they actually worked. It took 6 months to a year for me to experience the full effects of the drug, but today I see a huge difference. When I was growing up, eczema was all over my body. Now I have only a few patches here and there. It's very manageable. Most of the time I don't even notice it's there. Unfortunately, there's no cure for atopic dermatitis. I still get flare-ups, and I have to be careful about being outside for too long because the wind can dry out my skin. But compared to what I had before, it's really manageable. I feel better than I've felt in my entire life. The year before I started dupilumab, I was failing high school. Now I'm studying mechanical engineering at the University of California, Berkeley. It's been night and day for me. Show Sources Photo Credit: danielle71 / Getty Images Karen Chen, Berkeley, CA.	Disease Research
The U.S. federal government is taking a significant step closer to becoming tolerant of cannabis. On Wednesday, a leaked letter from the U.S. Health and Human Services revealed that the agency has endorsed the rescheduling of the drug from a Schedule I to Schedule III controlled substance, a more lenient designation. Any official move will require approval from the Drug Enforcement Administration (DEA), however, which has repeatedly declined to do so in previous years. The HHS letter is dated August 29 and was first leaked Wednesday by Bloomberg News. It details the agency’s review into how cannabis is currently regulated by federal law. The analysis was requested by the Biden administration almost a year earlier as one of several steps intended to reform national policy on cannabis. During the 2020 presidential campaign, Biden promised that he would seek the decriminalization of cannabis. The Controlled Substance Act mandates that almost every drug available in the country is classified into one of five categories, depending on their potential for abuse and overall medical value. Schedule I drugs are considered to have no currently accepted clinical use as well as high abuse potential and include heroin, LSD, and ecstasy. Schedule III drugs, on the other hand, include Tylenol with codeine, anabolic steroids, and ketamine. Though many states have enacted their own laws legalizing or decriminalizing cannabis use, the drug remains strictly regulated on the federal level. So cannabis becoming a Schedule III drug would lead to much looser nationwide restrictions on how it can be grown, sold, and used. It would also make it easier for scientists to study its potential medicinal properties. And cannabis-related businesses would reportedly be able to save money by claiming certain tax deductions currently unavailable to them, according to NBC News. The review process for potentially rescheduling a drug typically includes the input of HHS. But ultimately, it’s up to the DEA whether such a change will happen. A DEA spokesperson has since confirmed that the agency is now conducting its own review of the evidence. The Biden administration has reportedly hoped that it would be able to announce the drug’s rescheduling this fall. But at this point, no specific timetable for the DEA’s decision has been revealed.	Drug Discoveries
Cervical cancer vaccination levels are on the rise and experts are “highly optimistic” the disease can be eliminated in a little more than a decade, despite the pandemic and interference from “highly religious” schools. Australia will become the first country in the world to eliminate cervical cancer if it hits its 2035 target. Prior to the vaccine, it is estimated up to 90% of Australians were infected with the human papillomavirus (HPV) at some point. HPV causes almost all cervical cancers, as well as a range of other cancers. The free school vaccination program, which began in 2007, has reduced the HPV infection rate by 92%, which in turn has reduced the rate of cervical abnormalities. The executive director of the Australian Centre for the Prevention of Cervical Cancer, Prof Marion Saville, said the latest statistics – up to and including 2020 when the first Covid lockdowns began – show “coverage has been stable and slowly rising”. “Despite the pandemic, we’re seeing pretty good coverage,” she said. Sign up for Guardian Australia’s free morning and afternoon email newsletters for your daily news roundup Asked if pandemic-related vaccine misinformation had affected those rates, Prof Karen Canfell, the director of the Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, said the program has always had to deal with vaccine hesitancy but that the rates of coverage have continued to increase over time. This week, a Four Corners episode aired claims that the Opus Dei-affiliated Tangara School for Girls discouraged students from getting the vaccination, claiming it would promote promiscuity. Former students told the ABC hardly any of their classmates received the vaccine. In a statement, Tangara said it “was attempting to ensure parents were fully informed about the vaccine and its potential risks by sharing medical and other information from the media with them”. It said its advice was now in line with the medical advice. Saville said it wasn’t too late for those who missed out at school. The Pharmaceutical Benefits Advisory Committee has now recommended the vaccination be available on the Pharmaceutical Benefits Scheme for men and women up to 25 years of age. “We see people who’ve been to Opus Dei schools who weren’t vaccinated … That would also be true for highly religious schools,” Saville said. “To people who might have been at Opus Dei and told the vaccine wasn’t for them, they should have a conversation with their practitioner. “We’re hoping the minister will approve the PBAC recommendation so they can have a funded vaccination up to the age of 25.” The health minister, Mark Butler, is now considering the advice, which also includes a recommendation to reduce the doses needed from two to one. Canfell said the increase in age for funded vaccinations and the reduction in doses were a “huge opportunity for Australia”. She said Australia had led an international process of public health innovations on HPV. “From a national screening program to vaccination, then the second generation vaccines, then changing to HPV screening, and now cervical sample self collection,” she said. Saville said Aboriginal and Torres Strait Islander communities had done an “amazing job” engaging with the program, but still lagged a bit on getting the second dose. Only needing one dose would help, Saville said, especially if the vaccinations were still offered twice a year at schools to maximise uptake. “We would like to see maintenance of those two visits to maintain and build on the equity,” she said. While the vaccination is funded up to age 19, it can be prescribed for men up to 26 and women up to 45, if they are willing to pay for it. But while vaccinations at older ages may be beneficial – especially for those at higher risk of abnormalities – Saville said “the older you get the less likely it is to be effective”. In many cases, HPV goes away within a couple of years. Vaccination after that may prevent HPV reinfection, and may reduce but will not eliminate the chance of abnormalities. “At a certain point our message is that your better protection is screening rather than vaccination,” Saville said. Canfell said it was an exciting time and that Australia was well positioned to meet its target, but that it was important it did so “equitably” and while maintaining communication about lifesaving interventions. “It’s really important to communicate well that the vaccine is the best intervention for females under the age of 25 and cervical screening is the best intervention for women over 25, and even in that age group it’s important to have HPV screening, even if they’ve been vaccinated,” she said. Cervical cancer will be considered to be eliminated as a public health problem when there is only a four in 100,000 chance of invasive cancer.	Vaccine Development
The COVID pandemic is in the rearview mirror. We have plenty of data about it, including studies telling us how well our countermeasures worked. A dozen scientists from around the world conducted a massive metastudy of our efforts to fight COVID, as well as similar efforts to fight the flu, and they published the results in the Cochrane Database of Systematic Reviews. The authors examined 78 different studies on the efficacy of different mitigation efforts such as masking, distancing, screening, quarantining, and hand-washing. How did these interventions affect the spread of the flu, COVID, or similar viruses? The studies included were diverse. They covered epidemics as well as periods of low transmission. They covered rich countries and poor countries, suburban schools and inner-city neighborhoods, hospitals and villages. Most important was what they had in common: They were all randomized controlled trials or at least cluster-RCTs. These are the gold standard for studies because they have the greatest chance of avoiding confounding factors. Non-randomized, non-controlled trials — for example, observational studies — can be compromised if, say, people become more likely to wear masks at times or places that already have higher rates of spread, or if people who wore masks were also more fastidious hand-washers. So, what did the studies find? For starters, hand-washing was effective in stopping the spread of these illnesses. That’s not surprising. But here’s the most eye-opening finding: “Wearing masks in the community probably makes little or no difference to the outcome of influenza‐like illness/COVID‐19-like illness compared to not wearing masks.” In other words, masks didn't do much — if anything. It’s possible that a community could drive down spread if everyone wore well-fitted high-quality masks such as N-95s or respirators, but there is no conclusive evidence that it does. With that in mind, think back to late 2020 to mid-2022, when mayors, governors, school districts, and even the U.S. Department of Transportation and Joe Biden were forcing masks on unwilling people — especially children — even when viral transmission was very low. Early on, when public-health officials told us to wear masks, they were simply playing it safe. But as time went on, even as the efficacy of masks became more doubtful, the officials switched from asking to mandating. They went beyond mandating, of course, and attacked everyone who resisted their mandates as selfish grandma-killers. The mayors and county executives who required masks knew they didn’t work, obviously, because these same mayors and county executives personally refused to wear these masks in exactly the situations where they were mandating the masks. What happened in the past happened in the past. The mask mandaters in 2020 had an excuse. The mandaters in 2023 don’t. Today, they should all personally and publicly fess up and explain why they made the mistakes they did. If the mask mandaters don’t explain the source of their error, they are immolating whatever authority and credibility they have left.	Epidemics & Outbreaks
Caring for a child with obsessive-compulsive disorder (OCD) can be extremely difficult. At the moment, parents receive little or no support to manage the demands of their caring role. The CO-ASSIST research programme, funded by the NIHR and supported by GMMH, comprises a team of researchers, a parent co-researcher (who has a child with OCD) and user-led UK charity partners, working together to develop better support for parents of children. In their recently published qualitative study published in the BMC-Psychiatry, the CO-ASSIST team have provided a detailed understanding of support needs and support challenges parents face. Key support needs and challenges were identified from interviews and focus groups with 20 parents of children with OCD and 25 professionals involved in supporting families with OCD. The professionals included CBT therapists, clinical psychologists, psychiatrists, mental health nurses, and practitioners. This is the first qualitative study to have specifically investigated support needs in parents of children with OCD from both a parent and professional perspective. The team found that compassion and sensitivity regarding this demanding caring role, opportunities to share experiences and time out or headspace from the daily caring demands, and guidance on family accommodation (where family members get drawn into enabling rituals and compulsions) were identified as crucial support needs for parents. Nonetheless, these support needs were complicated by the battle parents faced when trying to access OCD treatment for their children. Our findings showed that parents prioritised getting help for their child and struggled to consider their own needs until this was achieved. Public misconceptions about OCD, the lack of a united approach, or clear OCD treatment pathways were additional challenges many parents faced whilst caring for a child with OCD. Parents caring for children with OCD have clear caregiver support needs which are currently not being met. This work forms an essential first step in laying the foundation to develop better care for this group of carers. Debra Robinson, Parent Co-Researcher on the Project and Co-Author said, “I first became involved with the project because I found my family’s OCD journey so devastating that I wanted to see if there was any way I could support other families going through the same thing. Involving myself in this project meant that I was able to use my knowledge and experience to inform the research to ensure that parents’ voices were heard.” Dr Emma Sowden, Project Researcher and Lead Author, said, “Co-production research methods, which involve working in partnership with a parent co-researcher and service user-led charity partners, have made working on this project so rewarding and inspiring and has ensured the needs of parents have been at the forefront of our work.” If you would like any further information about the CO-ASSIST study, you can contact the study lead, Dr Rebecca Pedley at Rebecca.pedley@manchester.ac.uk.	Mental Health Treatments
July 20, 2023 â Gout is a form of arthritis that causes intense pain, redness, and swelling of the joints and extremities.Â Physical complications of gout, if itâs left untreated, can include high blood pressure, heart attacks, diabetes, kidney problems, and obesity. Now, researchers are taking a closer look at another difficult health challenge thatâs linked to gout: depression.Â A recentÂ study from the University of British Columbia found a significant increase in gout patients who also have the mood disorder. Their study looked at 157,426 patients and found that about 13 patients out of every 1,000 person-years received a diagnosis of both gout and depression, compared to 11 patients (1.1%) per 1,000 person-years who did not have gout but who had depression. (Person-years is a type of measurement that takes into account the number of patients in the study and how long the study lasts. In this case, it means there were 13 patients with gout and depression out of each 1,000 patients over the course of 1 year of the study.) But the researchers believe itâs possible that this number may Â be higher. This is because men â who are more likely to have gout than women â donât seek treatment for psychological symptoms often as women, so theyâre less likely to receive an official diagnosis of depression.Â PreviousÂ research by members of this team found that gout patients had a 29% higher risk for depression, depending upon how well-controlled their condition is. This is important, researchers said, because the psychological burden of intense physical pain canât be underestimated. There are other factors at play, too.Â âThe links between gout and depression are complicated and not fully understood,âÂ saidÂ Stephanie Collier, MD, MPHÂ , director of education in the Division of Geriatric Psychiatry at McLean Hospital in Belmont, MA, who is also an instructor in psychiatry at Harvard Medical School. âOne hypothesis is that both depression and gout are related to inflammation. There are also a few risk factors â obesity and diet â that are shared in people with gout and in people with depression. Medications used to treat acute gout flares, such as steroids, can also contribute to or cause depressive symptoms.â The way gout occurs is also an important factor.Â Uric acid is a waste product thatâs created when your body breaks down chemicals called purines.Â âWith gout, uric acid forms into crystals in your joints,â said Nilanjana Bose, MD, a board-certified rheumatologist in Houston and a spokesperson for the American College of Rheumatology. Korean researchers have newly examined how uric acid, which causes gout when produced in excessive amounts by the body, can end up in the blood and cause low-grade inflammation.Â But there are other reasons gout and depression may be linked.Â âItâs thought that high levels of uric acid in the blood can affect brain neurotransmitters, which may contribute to depression,â Collier said. âHowever, not all people with high blood uric acid levels develop gout. There may be common genetic or metabolic associations between gout and depression.â Read on for a closer look at the possible connection between gout and depression â and how to find the right treatment.Â What Are the Symptoms of Gout? Signs of gout can also include:Â - The rapid start of joint pain, most often in your big toe, but also in your knees, wrists, ankles, fingers or elbows - Pain that doesnât go away. A gout flare is at its worst within 4 to 12 hours after it starts, but pain can last for days to weeks. - Limited motion. Gout pain and swelling may restrict movement of your joints.Â What Are the Symptoms of Depression?Â Signs of depression may include:Â - Feeling sad, anxious, empty, hopeless, pessimistic, cranky, frustrated, restless, guilty, worthless, or helplessÂ - Loss of interest in things you like to do - Fatigue, low energy, or feeling like youâre âslowed downâ - Problems with concentration or memory - Changes in sleep, appetite, or your weight - Cramps, headaches, or aches and pains or stomach problems with no physical cause - Suicidal thoughts or thoughts of death What Treatments Can Help? Visiting the doctor regularly for check-ups and to measure the uric acid in the blood can be helpful. Some doctors may want levels of uric acid to stay under 6.0 milligrams per deciliter (mg/dl), according to theÂ American Kidney Fund.Â And it's important to make sure your kidneys are working well: A smallÂ Chinese study found that during an acute flare of gout, frequent urination helped lessen the amount of uric acid in the body. Even with uric acid levels in check, there can be other causes that link gout to depression. People with gout should watch for any notable changes in mood.Â âPatients should let their doctors know if they are feeling down or depressed for more than 2 weeks, or if they lose their ability to feel pleasure or enjoyment in activities,â Collier said. âIf patients develop thoughts about wanting to end their life, they should let their doctor know right away.âÂ Patients should also make sure to take Â gout medication precisely as directed.Â âAsÂ gout flaresÂ can be debilitating, and pain and impaired functioning can limit activities, medications that prevent gout flares may also reduce episodes of depression,â Collier said. And managing any cardiac risk factors a patient may have is important.Â Exercising regularly â as advised by a doctor â limiting alcohol, and eating well can not only help heart health, but can prevent gout flares and, potentially, mood problems linked to them.Â âFlares can be triggered by processed foods, beer, and red meat,â Bose said. âA good diet and overall healthy lifestyle can really help with gout and depression.âÂ	Disease Research
“While rates of cigarette use are declining, more US adults are using cannabis”, states the study’s abstract. “Perceptions of safety are important drivers of substance use and public policy; however, little is known about the comparative views of US adults on tobacco and cannabis safety.” With that in mind, the objective of this study was to “compare public perceptions of safety of cannabis vs tobacco smoke and evaluate how perceptions may be changing over time.” The study was conducted by researchers at the University of California San Francisco, the San Francisco Veterans Affairs Health Care System, Columbia University in New York, the Northern California Institute for Research and Education and the University of Kansas. This longitudinal survey study was conducted using a web-based survey administered in 2017, 2020, and 2021. US adults participating in Ipsos KnowledgePanel, a nationally representative, population-based survey panel, were included. Data were analyzed from March 2021 through June 2023. Two questions directly compared the perception of safety of cannabis vs tobacco in terms of daily smoking and secondhand smoke exposure. Additional questions assessed perceptions of safety of secondhand tobacco smoke for adults, children, and pregnant women, with an analogous set of questions for secondhand cannabis smoke. A total of 5035 participants (mean age, 53.4) completed all three surveys and provided responses for tobacco and cannabis risk questions. “More than one-third of participants felt that daily smoking of cannabis was safer than tobacco, and their views increasingly favored safety of cannabis vs tobacco over time (1742 participants [36.7%] in 2017 vs 2107 participants [44.3%] in 2021; P < .001)”, found the study’s researchers. “The pattern was similar for secondhand cannabis smoke, with 1668 participants (35.1%) responding that cannabis was safer than tobacco in 2017 vs 1908 participants (40.2%) in 2021 (P < .001).” Participants who were younger or not married were more likely to move toward safer views of cannabis use over time, while those who were retired were less likely to move toward a safer view of cannabis, state sthe study. Participants were also “more likely to rate secondhand smoke exposure to cannabis vs tobacco as completely or somewhat safe in adults (629 participants [12.6%] vs. 119 participants [2.4%]; P < .001), children (238 participants [4.8%] vs. 90 participants [1.8%]; P < .001), and pregnant women (264 participants [5.3%] vs. 69 participants [1.4%]; P < .001).” Researchers conclude by stating: Legalizing medical marijuana reduces the cost of health insurance, according to a new peer-reviewed study. Titled simply Medical cannabis laws lower individual market health insurance premiums, the study is being published in the September issue of International Journal of Drug Policy, and it was published online ahead of print by the National Library of Medicine. It was conducted by researchers at Bowling Green State University, Illinois State University and Eastern Michigan Green State University. For the study researchers examined “whether cannabis legalization significantly impacts aggregate health insurer premiums in the individual market.” Researchers used 2010-2021 state-level U.S. private health insurer financial data from the National Association of Insurance Commissioners. They “examined changes to individual market health insurance premiums after the implementation of medical cannabis laws” and “employed a robust difference-in-differences estimator that accounted for variation in policy timing to exploit temporal and geographic variation in state-level medical cannabis legalization.” Seven years after the implementation of Medical Cannabis laws, researchers “observe lower health insurer premiums in the individual market.” Starting seven years post-MCL implementation, “we find a reduction of $-1662.7 (95% confidence interval [CI -2650.1, -605.7]) for states which implemented MCLs compared to the control group, a reduction of -$1541.8 (95% confidence interval [CI 2602.1, -481.4]) in year 8.” In year 9, there was a reduction of $-1625.8. Researchers say that “Due to the nature of insurance pooling and community rating, these savings are appreciated by cannabis users and non-users alike in states that have implemented MCLs.” The study concludes:	Health Policy
Last month a pet dog in Canada died of H5N1, also known as bird flu, after eating a wild goose. Worryingly this follows a pattern, with an increasing number of bird flu cases appearing in mammals who come into contact with an infected bird, dead or alive. When you see a wild bird such as a duck or seagull, think bird flu. Because it’s actually more likely than not they’re infected with the virus. And many species of wild birds are asymptomatic, meaning that they don’t show any symptoms. The risk of transmission to pets is low, but they can get sick from chewing or eating an infected bird, whether it’s dead or alive. I first wrote about bird flu in November, when domestic birds in Britain were put into an indoor lockdown. The virus had become endemic in most wild bird populations. It’s incredibly infectious, where one bird could infect as many as 100 others. When infected wild birds encountered domestic birds (such as by flying over and defecating on them underneath), huge problems emerged. Avian flu has a near 100% fatality rate in most poultry, which led to shortages of not only turkey for Christmas but also eggs, as farm after farm was decimated by the disease. Since November, the signals emerging across the world continue to be worrying. In January and February this year, more than 3,000 sea lions died of bird flu in Peru (where the death toll in wild birds reached an estimated 50,000). In Russia, 700 Caspian seals died. Then several dolphins in Britain and the US died of H5N1. Normally, even if an animal catches H5N1 from a bird, it can’t pass it to other mammals. This limits its spread. But the large number of cases in these outbreaks suggest the possibility of mammal-to-mammal transmission, although this hasn’t been confirmed yet by genetic sequencing. A more likely hypothesis is that these outbreaks are groups of animals feeding on infected birds. It is not yet 100% clear what’s happening. But the risk of spread among mammals is ever-present. A new research pre-print from Canada showed that H5N1 samples could spread efficiently between ferrets with fatal outcomes. In order to spread efficiently to humans, H5 would need three major categories of genetic changes, according to bird flu expert Prof Richard Webby. So far, the virus has been able to make one of these changes, but not the other two. So right now, H5N1 is a theoretical risk for the next human pandemic, rather than one requiring urgency in response today. And a prime minister or health secretary might say, “Why prepare for something that might never happen?” To those of us scientists working in global health, there are enough concerning signals that action should already be happening. So that if a certain set of mutations do occur and we see an outbreak in humans in Peru or China or Britain, that the harm it could cause is minimal. This is a disease with an estimated 50-60% fatality rate in humans, including children. The cornerstone of infectious disease preparedness is in: surveillance (to know what strain is spreading and where in birds); testing (to identify disease quickly in humans); vaccines (for protection against disease and death); and antivirals (to improve clinical outcomes). The US government is already moving in this direction. Rebecca Katz, professor at Georgetown University Medical Center, has noted that a H5 candidate vaccine virus recently produced by the US Centers for Disease Control and Prevention is likely to provide good protection against the circulating H5N1 viruses. The information has been shared with vaccine manufacturers to start the process of stockpiling adequate doses. But this is a challenge because most influenza vaccines are created by incubating doses in chicken eggs (called egg-based production). If bird flu has killed off many of the chickens, then egg shortages are likely. There’s another H5N1 vaccine which is non-egg based, but they could have a maximum of 150m doses ready within six months. The world’s population is almost 8 billion. In addition, the FDA-approved antiviral treatments for seasonal influenza could also work against bird flu. But again, getting doses to all parts of the world is a challenge given shortages. Preparation must also involve appropriate PPE for healthcare workers to protect against a respiratory disease (flu) and diagnostics to quickly identify if someone is infectious in hospitals. All of these issues are solvable with precise planning, collaboration across countries, scientific ingenuity and good leadership. With post Covid-19 fatigue, the bigger problem is bringing the public along and communicating the facts so that they are trusted and believed. With so much – often understandable – mistrust in our current political leadership, authorities like chief medical officers and independent government advisers become crucial. At the moment most governments aren’t paying attention to bird flu: they’re more interested in another AI (artificial intelligence) rather than this AI (avian influenza), but the avian influenza threat is real, and needs much more immediate attention and preparation. Devi Sridhar is chair of global public health at the University of Edinburgh	Epidemics & Outbreaks
Demand for plastic surgery is on the rise, with several procedures emerging as the most popular. The American Society of Plastic Surgeons (ASPS), the Illinois-based plastic surgery organization that represents 92% of all board-certified plastic surgeons in the country, has released its list of the most sought-after cosmetic and reconstructive procedures in 2022. Roughly 26.2 million surgical and minimally invasive cosmetic and reconstructive procedures were performed in the U.S. last year, according to a news release provided to Fox News Digital. Cosmetic procedures in particular have increased by 19% since 2019. "I am always fascinated to see the yearly trends in plastic surgery," New Jersey-based ASPS President Dr. Gregory A. Greco told Fox News Digital. "As plastic and aesthetic surgeons, our practices experience the trends in real time. I think many plastic surgeons use these statistics to benchmark their practices with the national data." Females have always accounted for over 90% of plastic surgery procedures, Greco said, although that has been slowly changing over the years. "As plastic surgery has become more socially acceptable, male celebrities have shared their experience with surgery and helped create a comfort zone around male plastic surgery," he said. Top 5 cosmetic surgeries overall Of the almost 1.5 million cosmetic surgical procedures performed in 2022, the top five were these: - Liposuction (325,669 procedures, up 23% from 2019) - Breast augmentation (298,568 procedures, up 4% from 2019) - Tummy tuck (161,948 procedures, up 37% from 2019) - Breast lift (143,364 procedures, up 30% from 2019) - Eyelid surgery (115,261 procedures, up 13% from 2019) Breast reduction procedures have also surged 54% since 2019. "Overall, breast augmentation is declining as a surgical procedure," Dr. Brian Reagan of CosmetiCare in Newport Beach told Fox News Digital. "This is due to a more natural, smaller-chested look being more popularized," he went on. "We often see these trends change throughout the years." Top 5 minimally invasive cosmetic procedures Of the almost 23.7 million cosmetic minimally invasive procedures performed in 2022, the top five were these: - Neuromodulator injection (i.e., Botox) (8,736,591 procedures, up 73% from 2019) - Hyaluronic acid fillers (4,883,419 procedures, up 70% from 2019) - Skin resurfacing (3,322,292 procedures)* - Skin treatment, combination lasers (2,915,199 procedures)* - Lip augmentation with injectables (1,378,631 procedures)* (*This was not tracked in 2019.) Top 5 reconstructive procedures Of the almost 1.02 million reconstructive procedures performed in 2022, the top five were these: - Tumor removal (344,697 procedures, down 2% from 2019) - Hand surgery (204,412 procedures, about the same as 2019) - Breast reconstruction (151,641 procedures, up 12% from 2019) - Maxillofacial (lower face) (52,488 procedures, down 29% from 2019) - Scar revision (50,930 procedures, down 9% from 2019) For 2022, the Society used data from its 11,000 member surgeons and from two affiliated companies, CosmetAssure and PatientNow. Overall trends ASPS has seen "significant growth" in the number of procedures performed since the COVID-19 pandemic, according to the news release. "Patients are no longer putting off the procedures they have been considering, which may be attributed to more time spent working from home and the flexibility that hybrid work schedules offer patients for recovery," the ASPS stated. The face and neck were a primary focus in procedures performed in 2022, the report noted. "Patients often enhance their appearance beginning with the features that they first see in the mirror: the face and the neck," said the ASPS. This was likely an extension of trends and behavior that emerged during COVID, the ASPS stated. "Masks made eyes the main focal point of the face for almost a year, which likely contributed to a surge in the number of eyelid surgeries, making it the fourth most popular cosmetic surgery procedure in 2022," the release said. "The past year also saw an 8% rise in facelift procedures and a 150% increase in cheek implants." "Masks made eyes the main focal point of the face for almost a year, which likely contributed to a surge in the number of eyelid surgeries." Body-centric procedures also remain prominent, the report showed, likely stemming from post-COVID weight fluctuations. Last year, there was a 23% rise in liposuction and a 77% rise in noninvasive fat reduction procedures compared to 2019. Dr. Patrick Davis, a Beverly Hills facial plastic surgeon, noted that there were some surprises in this year’s list. "I was surprised that rhinoplasty and facelift procedures were not included on this list, as we have seen a recent uptick in requests for these surgeries in our consultations," he told Fox News Digital. Social media has likely played a part in the mainstreaming and popularity of certain procedures, experts said. "With the rise of social media, we’ve noticed plastic surgery has become less stigmatized as people share their experiences or interest in certain procedures," said Greco. Minimizing potential risks There are risks associated with all surgeries, including the cosmetic ones, Greco of New Jersey noted. "Although certain procedures are statistically known to pose higher risk than others — for example, autologous fat grafting to the buttock, also known as the ‘BBL’ — there are risk mitigation strategies that should be followed, such as injecting fat under ultrasound guidance." "Patients should be certain that their cosmetic procedures are performed in licensed or nationally accredited centers that adhere to the highest safety standards." The first step in any successful procedure is to find a reputable surgeon, he said. "Make sure your plastic surgeon is board-certified by the American Board of Plastic Surgery, the only plastic surgery board that assures surgeons have completed a minimum of six years of surgical training and passed extensive written and oral examinations," Greco said. "Don't be afraid to get several surgical opinions to ensure that you are comfortable with the one you choose to perform your procedure," he also told Fox News Digital. Specialization is also important, Davis noted. "An important question to ask is how often a particular procedure is performed by the surgeon," he said. "Often, a surgeon will develop a reputation and focus on a few surgeries done at a higher volume. Seek out those surgeons who specialize in your particular surgery." Every patient should also request before-and-after photos and references from prior procedures, Greco advised. "Board-certified plastic surgeons are able to help patients determine whether a procedure is right for them and can offer guidance along the way, keeping the patient’s safety and well-being at the forefront."	Medical Innovations
The father of a man who died at the age of 44 after being given contaminated blood in his teens wants the government to recognise affected families' pain. Tony Summers' son Paul died in 2008 having contracted HIV and hepatitis C. Mr Summers said compensation was not as important as recognition after a judge said parents and children of victims of the contaminated blood scandal should receive government compensation. The government must now respond to the recommendations. Mr Summers said nothing could take away the suffering they had endured. "When you've sat alongside your son's bed and watched him die, there is no compensation that can change anything," he said. "My concern over the last 30-odd years has been what we can do to make certain that the bereaved, the infected and the affected, get good compensation and support for the future". More than 3,000 people died after contracting HIV or hepatitis C via NHS treatments in the 1970s and 80s. Now the chairman of the infected blood public inquiry, Sir Brian Langstaff, said it was time to "recognise deaths which have so far gone unrecognised". Mr Summers and his wife Pat, from Llantwit Major, in the Vale of Glamorgan, both gave evidence to the inquiry in Cardiff in 2019. They said their son's HIV diagnosis was kept from him when first detected. He only found out when he went to university in Plymouth and got a new GP. "It would be good of the government to acknowledge what we and every other family have been put through all these years," Mr Summers said. "It was denied initially by his hospital that it could possibly happen. "Initially we were told there wasn't a problem. HIV was not a problem. Only to discover that it was a major problem". Mr Summers said he was hopeful the inquiry would deliver the closure many victims and their families still want, as well as a commitment to learn lessons. "The aim is to make sure that this can't possibly happen again," he said. "Yes, money is important. But it's not important in every situation. "We can never get total closure, but at least when this finishes, I hope that I can walk away and think, 'the last 30 years were not wasted'." Rachel McGuinness, from Bangor, in Gwynedd, lost her father, Christopher Thomas, after he was given infected blood. The recommendation that parents and children get compensation is an important step in achieving justice for families, she said. "It's good to be recognised as a child who lost a father, even though it was a very long time ago," Ms McGuinness said. She said she would be waiting anxiously to see how the UK government responds. "The process as a whole has been helpful for my family," she said. "It's given us a chance to discuss things and ask questions that we didn't have answers to. "It helps recognise the fact that my father had said, from the beginning, that there were issues and that mistakes had been made. I'm very pleased about that."	Epidemics & Outbreaks
When it comes to measuring sleep, most people focus on hitting a certain number of hours each night — and while that’s part of the equation, experts say it might not be the most important metric. Instead, a recent review suggests that the regularity of sleep — drifting off and waking up at roughly the same time each day — is the more critical component. Harvard-affiliated researchers presented the findings during a recent panel of the National Sleep Foundation (NSF). After conducting a review of 63 publications, the panelists concluded that "consistency of sleep onset and offset timing is important for health, safety and performance," according to the published study in the journal Sleep Health. "When we talk about sleep, duration gets the most attention," Matthew Weaver, a member of the Brigham and Women’s Hospital’s Division of Sleep and Circadian Disorders in Boston and co-first author of the panel’s report, said in an interview with The Harvard Gazette. "That is an important component of healthy sleep, but it’s just one component. Increasing evidence has accumulated over the past few years that sleep regularity is also very important." Many studies have shown that irregular sleep has been linked to adverse health outcomes, according to Weaver. "It was associated with worse metabolic outcomes, like obesity and metabolic syndrome, but also cardiovascular disease, hypertension, an increase in a number of different inflammatory markers, and increased pain, to name a few," he said. "When we disrupt our circadian rhythm by going to bed and waking up at different times each day, we can experience a number of negative health consequences." And when people have inconsistent sleep patterns, that tends to have a negative effect on their sleep duration and its quality, research has shown. "Mental health was also worse, with irregular sleep being associated with more depression, a worse mood, lower self-esteem and lower general well-being," Weaver noted. Dr. Harneet Walia, director of sleep medicine at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida, was not part of the Harvard panel, but shared her input on the findings. "Where sleep duration is important, having a regular sleep/wake routine has an important connection to our overall health," she told Fox News Digital in an email. An irregular sleep/wake schedule is associated with a host of negative health consequences, Walia said. These include an increased risk of diabetes, weight gain, high cholesterol and heart-related issues, such as blood pressure and atherosclerosis (hardening of the arteries). It is also associated with an increased risk of depression, she added. "Patients with irregular sleep/wake rhythm disorder may also experience symptoms of difficulty sleeping or/and excessive daytime sleepiness," Walia added. Not everyone has the same optimal bedtimes and wake times, according to Weaver. "There are inter-individual differences in the timing and duration of our sleep that are guided by our circadian rhythms," he said. As far as what constitutes "irregular" sleep, that is not entirely clear, the researcher said. "We wanted to get to a number that tells us how much is too much variability, but we couldn’t quite get there," Weaver said. Some studies have suggested that just one hour of deviation in sleep is enough to negatively impact metabolism and heart health, he noted. The panel shared that irregular sleep — in addition to impacting health outcomes — was also linked to worse academic performance, attention and reasoning. "Some of the strongest papers showed GPA was worse among college students when their sleep was more irregular," Weaver pointed out. Dr. Raj Dasgupta, chief medical adviser at Sleepopolis in California, who was not involved in the study, pointed out that our bodies have a natural circadian rhythm that regulates the sleep-wake cycle and other bodily functions. "When we disrupt our circadian rhythm by going to bed and waking up at different times each day, we can experience a number of negative health consequences, including insomnia, daytime fatigue, difficulty concentrating and increased risk of chronic diseases," he told Fox News Digital. Overall, the experts agreed that regularity is an important component of healthy sleep. "It’s not just duration, but also regularity and quality," Weaver said. "Sleep is the third pillar of health, equally important as diet and exercise, if not more." Sleep impacts all aspects of life, the expert noted — health, performance, learning, memory and even the "critical biological processes related to healthy aging." "When we think about life and what makes us happy, like being able to communicate well, to feel good, and have the energy to do the things we want to do, sleep — not just duration but also regularity — is critical for all of those things," Weaver noted. Tips for more consistent sleep The experts offered some tips for fostering a more regular sleep schedule as part of a healthy lifestyle. "Plan your day so that you get the sleep that you need," Weaver told The Harvard Gazette. "Make it as regular as you can and prioritize sleep." "If you want to have a regular sleep schedule, ask yourself: ‘How do I get there?’" "Sleep is the third pillar of health, equally important as diet and exercise, if not more." "If you need to go to bed at 10 every night to get the full amount of sleep you need, then, ideally, you would settle into a pattern that is regular enough where, after a little while, you don’t even need to set an alarm to wake yourself up, and you would have a healthy, regular sleep schedule that works for you." If Walia’s patients share that they have a lot of variability in their schedules, she said she advises them to start off by waking up every day at the same time, which serves as an "anchor point" for maintaining regularity for the rest of the day.	Stress and Wellness
The sparkle and warmth the nation has come to love about Britain’s favourite astrologer was gone. Instead, Russell Grant sat silently, almost paralysed with fear and in a state of denial about the action he needed to take to deal with a growing tumour. Medics, friends and family were encouraging him to go ahead with surgery to get rid of the pituitary gland tumour in his brain. “But I was in denial,” says Russell, 72, the star of Strictly and the Mirror’s own astrologer. “I was so scared. “Then one day I had a Zoom call with my neurosurgeon Professor Omar Pathmanaban. He was lovely, so reassuring. “But what topped it off was he then said, ‘It would be an honour and a privilege to take away your tumour…when I was a kid my mother and I used to watch you every morning on breakfast telly. It made me late for school.’” Russell is full of gratitude for all the medics who helped him through his six hour operation last November. This week he revealed his battle in a tweet to mark Brain Tumour Awareness Month. Today he talks to the Mirror about the ordeal - and how in December 2019 the astrological signs told him serious challenges lay ahead. Russell says: “I was giving a lecture at the Northern Lights astrological society in Blackpool. At the end I said, and I have nearly 200 witnesses, ‘The world has some serious challenges coming up over the next three to four years. “The power of the slow moving planets, Saturn, Uranus and Pluto means it won’t just be for the world but for each individual. The weak points of ourselves are going to be seriously challenged.’” Russell thought for himself it might mean problems with his hip, knee or back which had been troublesome. But within a week his beloved mother had a stroke. Covid was coming and unbeknown to him he was developing a tumour. After her stroke and with signs of dementia, his mum moved into a care home near the family home not far from Watford. With the nation in lockdown for much of 2020 he was barely able to leave his home in Wales to visit her. He says: “I spoke to her on the phone twice a day and with the dementia I don’t think it occurred to her I couldn’t get to see her. She was sensational, like Ethel Merman. The hostess with the mostess.” On January 13, 2021 Russell’s mother passed away at 93. But with England and Wales in another lockdown he was unable to attend the funeral and had to say farewell over Zoom. Russell says: “I went into a great deal of grieving. It was terrible. I felt guilty, I felt I had let her down, even though I’d been looking after her since the 1970s, but I wasn’t there at the end.” Over the next six months Russell put sudden weight loss down to grief. Then he began suffering extreme burning sensations all over his body. He weighed himself and found he had lost six stone, dropping from 21st to 15st. In January last year, he went to his GP. Blood tests showed his body had none of the stress hormone cortisone and he was prescribed hydrocortisone tablets. Russell adds: “I began to panic. They wanted me to go for an MRI scan but I didn’t want to face it.” Doctors feared Russell had a brain tumour, like his dad 20 years earlier. But until he agreed to a scan they were unable to diagnose it. He finally had one. It revealed the tumour was benign but was pressing on his optic nerve and without surgery he would lose his sight. But Russell would need a major operation conducted by two surgeons, one a brain specialist and the other an Ear, Nose and Throat expert. He adds: “Thinking back to my 2019 lecture I thought, ‘Well, these planets haven’t f*****g let me down.’” Russell turned for advice to his old showbiz pal, singer Russell Watson, who had the same operation in 2006. He says: “I sent him a text and told him what was happening. He told me, ‘Oh God. Get it out your head NOW.’ “What I wanted to do was run away into the mountains like Heidi.” Then one day in the quiet Catholic church in Snowdonia where Russell worships he received a sign which gave him the strength he needed. He explains: “I was sending a prayer up saying, ‘What shall I do?’ And it was like I saw my dad’s face saying, ‘Get it done.’” Soon after, his schoolboy fan from his morning TV days, now a leading brain surgeon, agreed to do the surgery. But Russell still had one unusual request. He says: “I said to Professor Pathmanaban, ‘Can I choose the date by astrology when you operate.’ He replied: ‘Of course, I would have expected nothing less.’ “So I looked at my astrology charts for a day which would bring optimism and positivity and came up with November 24th. It was a full moon. All we really needed was a Sagittarian on the medical team and it would be fine.” Days before the operation Russell received a call from one of his closest friends, Hi De Hi actress Ruth Madoc. He says: “We chatted. At the end I said, ‘Do take care Ruth, we have some very heavy aspects around us.’ And she died a couple of weeks later.” Russell was in theatre from 2.15pm until 8.15pm as the surgeons removed his tumour through his nose. He is overwhelmed by the NHS care he has received – and incandescent at how staff are being treated by the Tories. He adds: “How dare they not give them a raise?” Russell has healed well. But it has made him reassess life. He says: “It’s reminded me every day is precious and every day I need to do something that is important, not just for me but for the wider world.” Russell spends his time working on his daily stars column but also writing about history. And he is involved in non-league football. So are his stars starting to look brighter? “Not quite yet,” he says. “Things are brighter for me, but they are still not quite right. But they say it will be a six month recovery period.” Oh yes.. and about that operation being such a success. “Ah.. I saw my ear, nose and throat surgeon Dr Raj Bhalla for a check up,” he says. “He asked why November 24th had been such an important day. I explained about the positivity and the moon and he said, ‘Oh, I just wondered because it was my birthday.’ “He’s Sagittarius!”	Disease Research
LONDON -- The publicly funded health service in England has decided it will not routinely offer puberty-blocking drugs to children at gender identity clinics, saying more evidence is needed about the potential benefits and harms. The National Health Service said Friday that “outside of a research setting, puberty suppressing hormones should not be routinely commissioned for children and adolescents.” Children can still be given puberty blockers in exceptional circumstances, the NHS said, and a clinical study on their impact on kids is due to start by next year. The four new regional clinics are due to open later this year. They replace London’s Gender Identity Development Service, previously the only facility of its kind in England. It is scheduled to shut down after a review said it was overburdened by increasing demand and there was not enough evidence about the outcomes of its treatment. Hormone blockers are drugs that can pause the development of puberty, and are sometimes prescribed to help children with gender dysphoria by giving them more time to consider their options. The NHS said the new rules were “an interim policy” that would undergo further review, including the outcome of a research study on the impact puberty suppressing hormones have on gender dysphoria in children and young people. Findings published last year from a review of children’s gender services led by a pediatrician, Dr. Hilary Cass, said there were “gaps in the evidence base” about the blockers. The NHS said doctors at the new clinics still would be allowed to prescribe the drugs outside of a research setting “on an exceptional, case by case basis” and subject to approval from a national team of medical experts. The health service's decision does not prevent children and their families from obtaining puberty blockers elsewhere, but that will be “strongly discouraged,” the NHS said. The issue of gender-affirming care for children is not as heated in Britain as in the U.S., where several Republican-led states have banned puberty blockers and other treatment for transgender minors, but it has ended up in the courts. In 2020, England's High Court ruled that children under 16 were unlikely to be able to give informed consent to medical treatment involving drugs that delay puberty. The court said that because of the experimental nature of the drugs, clinics should seek court authorization before starting such treatment. The ruling came in a lawsuit brought by two claimants. One, Keira Bell, who was prescribed hormone blockers at 16, argued that the clinic should have challenged her more over her decision to transition to male. The decision was overturned in 2021 by the Court of Appeal, which said doctors can prescribe puberty-blocking drugs to children under 16 without a parent’s consent. The NHS said it recognized that once the policy was adopted, it would need to end a related requirement for young people to take puberty blockers for a certain amount of time before they receive the cross-sex hormones many transgender people take to transition. ___ Follow AP's coverage of LGBTQ+ people at https://apnews.com/hub/lgbtq-people	Health Policy
Record numbers of women are freezing their eggs in the hope of having a family later in life, according to a new report. More than 4,000 patients froze their eggs in 2021, compared to 2,500 in 2019, the Human Fertilisation and Embryology Authority (HFEA) said. The "dramatic rise" could be linked to the pandemic, a charity said. But doctors warned there needed to be more awareness of the pros and cons. Sarah Norcross, director of the Progress Educational Trust fertility charity, said some women had considered their fertility during the lockdowns. "Restrictions on socialising may have prompted some women to think more about their fertile window, and decide to try to increase their reproductive choices," she said. Despite the number of egg collections increasing, less women decided to donate their eggs for another woman to use, according to the report. There were nearly 1,500 new egg donors in 2019 but this dropped to just over 1,400 in 2021. Helen Henry, from Thurrock in Essex, donated some of her eggs when she had hers frozen 10 years ago at the age of 34. She was in a long-term relationship with a partner at the time, who did not want children. "I remember having counselling explaining the reason why I wanted to freeze my eggs and being given the opportunity to donate as well. I took that option as I wasn't just doing it for myself. "After donating I started to feel quite guilty. I wasn't sure that I had done the right thing. What if the mother of the child isn't a good one? What if the child ends up in foster care? What if it's neglected? "Fast forward a few years, I found out that a baby girl was born in December 2011 from my donation. Finding out a child was born made those guilty feelings go away," she said. Ms Henry went on to have her own children with a new partner, and never used her frozen eggs, which have now been disposed of. "I fell pregnant naturally and quite quickly and had my first daughter at age 39 and I am currently on maternity leave again having had my son last December, aged 44," she said. "This will be an ongoing conversation with my two children that they have a genetic sister out there in the world. I pray that I will see this child one day. It is one of my last wishes." TV presenter and podcaster Vicky Pattison, who also lives in Essex, has just had some of her eggs frozen, after deciding she was not yet ready for children. Three of her eggs were turned into embryos with her partner's sperm, which she was told have a 20% chance of resulting in a baby. She has also kept three as unfertilised eggs, which have a 10% chance. She shared her feelings throughout the treatment, saying there was "not enough genuine, honest information out there". Success is strongly dependent on the age of the woman at the time of freezing her eggs, the HFEA said, with higher success rates in those aged under 35. Consultant obstetrician and gynaecologist Bassel Wattar said more work was needed to inform patients and support them through their fertility journey. "Unfortunately, there is limited public awareness on the pros and cons of this treatment and how it could be best planned to optimise chances of starting a family in the future," he said.	Women’s Health
A new diabetes medicine dubbed the "King Kong" of weight loss jabs cannot be recommended on the NHS yet because the cost for benefit may not be justified, a spending watchdog says. The National Institute for Health and Care Excellence (NICE) says it needs more evidence on Mounjaro, even though it recently approved a similar weekly injection called Wegovy. Both drugs blunt appetite, so users feel full and eat less. They also help manage blood glucose. Social media posts about people, often celebrities, shedding large amounts of weight has led to big demand for these types of treatment. There have been ongoing global shortages of another injection for type 2 diabetes, called Ozempic, that some people have been buying off-label as a weight loss aid. The pre-filled pens contain a lower dose of of the same medicine - semaglutide - that is in Wegovy. The draft guidelines from NICE say it is yet to be established if Mounjaro, also known as tirzepatide, represents good value for money, alongside diet and exercise, for adults with type 2 diabetes and a high body mass index. The NHS price of the pre-filled pens has not been made public because of commercial sensitivities. Helen Knight, from NICE, said: "Type 2 diabetes is becoming more prevalent in society, so new treatment options are needed to help people with it to control their blood-glucose levels. "Our committee can see the promise in tirzepatide, but it requires more evidence to be able to evaluate both its clinical, and cost, effectiveness." Manufacturer Eli Lilly has been asked to submit more data for the committee to look at ahead of its next meeting. This recommendation in England is not intended to affect treatment with tirzepatide that was started in the NHS before this guidance was published, says NICE. People having treatment outside this recommendation may continue without change, until they and their NHS clinician consider it appropriate to stop. Wegovy (semaglutide), meanwhile, has been approved for use by the NHS in England for adults with at least one obesity-related health problem, which can include type 2 diabetes. Stocks are not yet available, but the prime minister has said GPs in England may soon start offering it to some patients, as well as specialist weight management clinics. Rishi Sunak said it could be a "game-changer", as he announced a Â£40m pilot scheme to increase access to the drug.	Drug Discoveries
The health secretary has announced an investigation into mental health in-patient services across the country. It comes after a series of investigations by Sky News highlighting failings within the system. Steve Barclay said the Health and Safety Investigation Branch would look into the care of young people, examine staffing levels and scrutinise the quality of care within units. In October 2022, our investigation into five hospitals run by The Huntercombe Group revealed repeated allegations of over-restraint and inadequate staffing, which left people at increased risk of self-harm. And in May 2023, Sky News exposed safety risks within Wotton Lawn Mental Health Unit, an NHS service in Gloucester, where patients had got on the roof or absconded, and staff were photographed asleep on the job. In a victory for campaigners, Steve Barclay has also increased the powers of an existing inquiry looking into the deaths of 2,000 patients in mental health care in Essex between 2000 and 2020. Many campaigners had refused to take part in the inquiry until it was given statutory powers, claiming it would never be able to get to the truth without the power to compel witnesses to give evidence. Recently the Chair of the inquiry, Dr Geraldine Strathdee, complained that staff members had refused to take part in the investigation, saying "30% of named staff, those essential witnesses involved in deaths we are investigating, have agreed to attend evidence sessions". "In my assessment, I cannot properly investigate matters with this level of engagement," she added. Mr Barclay said: "I agree with Dr Strathdee that we have now reached the point where the only appropriate course of action is to give the inquiry statutory powers. "Statutory inquiries do take longer, but this doesn't mean we start from scratch." Dr Strathdee has told the health secretary she will be standing aside "due to personal reasons". Work to find a new chair is "proceeding at pace". Initially, around 1,500 deaths were being investigated based on figures from Essex Partnership University NHS Foundation Trust (EPUT). All died while in a mental health ward in Essex or within three months of leaving. Earlier this year, it was confirmed this figure was closer to 2,000. Mr Barclay said: "We recognise that patients and families want to know how their concerns will be taken forward as soon as possible. "I also recognise that a wide-ranging statutory inquiry for other settings or across multiple patient safety issues would not deliver these answers quickly. "That's why my department has agreed to work alongside the Healthcare Safety Investigation Branch to prepare the launch of a national investigation into mental health inpatient services. "This will commence in October when it receives new powers under the Health and Care Act. "The new health services safety investigation body will investigate the following themes: how providers learn from deaths in their care and use this learning to improve services, including post-discharge; how young people are cared for in mental health inpatient settings and how this can be improved; how out-of-area placements are handled; and how to develop a safe staffing model for all mental health inpatient services." Dr Strathdee said she "wholeheartedly" welcomed the news the Essex inquiry will have statutory status. Click to subscribe to the Sky News Daily wherever you get your podcasts She said in a statement: "I am confident that statutory status will allow the inquiry to deliver a full and robust report and make recommendations that will lead to much needed improvements. "While I remain dedicated to the cause of the inquiry, I have taken the very difficult decision to hand over the role of chair. In my view the next stage of the inquiry's work requires a chair who is available for the entire forward duration of a statutory inquiry. Due to personal health reasons, I have decided with my family, that this cannot be me."	Mental Health Treatments
If the Supreme Court this upends nearly 50 years of abortion rights as expected, all eyes will be on the White House and a liberal president who has vowed to fight to keep abortion access.But what can he do, really?In recent weeks, dozens of abortion advocacy groups, lawyers, providers and lawmakers have huddled to pitch ideas that range from what advocates call creative to the seemingly far-fetched. The White House has met with many of these officials in recent weeks to hear them out, although it remains tight-lipped on where its legal strategy might be headed.Could the government lease federal buildings and public lands to abortion clinics? Declare a public health emergency, and offer disaster relief money or health care grants to states anticipating an influx of patients?What about federal travel vouchers for patients seeking health care in abortion-friendly states, or relaxed import rules for on abortion pills made overseas? President Joe Biden, some argue, also could say that banning abortion pills by mail -- as some states are trying to do -- violates rules on interstate commerce.The Guardian or Authority of Law statue sits on the side of the U.S. Supreme Court on Sept. 28, 2020 in Washington, DC.Al Drago/Getty Images, FILE"We are all thinking creatively about what administrative solutions might exist," including increasing the availability of abortion pills, said Kimberly Inez McGuire, executive director of Unite for Reproductive & Gender Equity who met with the White House in one of its "listening sessions.""But in this specific moment, what I'm looking for from this administration is leadership," she said.Complicating much of the issue for the Biden administration are decades-long restrictions on federal spending legislation that prohibits the executive branch from spending money on most abortion services. That prohibition is unlikely to change so long as the Senate remains narrowly divided between Democrats and Republicans.Still, abortion rights advocates say, every idea is on the table. Under Biden's control, they argue, are powerful institutions, including the Food and Drug Administration, which has approved access to the abortion pill by mail, and Medicaid, the government's insurance program for low-income families.That means post-Roe, the United States will likely spend years embroiled in legal battles over abortion, as conservative states bump up against the power of the presidency.Biden "can't reverse the Supreme Court with an executive order," said David Cohen, a professor of law at the Drexel Kline School of Law, who has written in favor of fighting abortion restrictions."But there are things that he can do, and ways that he can harness the federal government to increase access, even if some states are trying to limit it," Cohen said.President Joe Biden speaks before signing executive orders on health care, in the Oval Office of the White House in Washington on Jan. 28, 2021.Mandel Ngan/AFP via Getty Images, FILEPresident Joe Biden hinted as much in an interview last week with ABC's "Jimmy Kimmel Live!""I think what we're going to have to do is that there are some executive orders I could employ, we believe. We're looking at that right now," Biden said.Legal experts predict that much of Biden's strategy will likely focus on the idea of "federal preemption" -- the idea rooted in the Constitution that federal law always wins out over state laws.For example, it's possible that Biden might argue that states can't lawfully restrict access to the abortion pill mifepristone because the FDA has already approved its use for all Americans, Cohen said.Under Biden, the FDA also has determined that the drug is safe enough to prescribe through a telehealth appointment and mail to the patient, even as 19 states restrict the drug to being dispensed in-person.That decision to allow access to the abortion pill, Cohen argues, "is rooted in federal law because the agency only exists and only has the authorization to authorize mifepristone because of federal law."The idea of FDA policy outweighing state restrictions is currently being tested in court. GenBioPro, the manufacturer of generic mifepristone, is challenging Mississippi's restrictions on the drug as being at odds with federal rules, with a decision expected this summer.Advocacy lawyers also expect that Biden is working on the idea of expanding access to mifepristone, possibly by easing import restrictions on overseas providers. The drug is widely available in states that don't restrict abortion, although international organizations like Aid Access have been mailing the drug to any U.S. resident even if a state prohibits it and despite objections by the FDA.Another focus by Biden could be on Medicaid, the largest insurance payer of pregnancy-related services.Health and Human Services Secretary Xavier Becerra testifies before a House Committee on Energy and Commerce Health Subcommittee on Capitol Hill, April 27, 2022, in Washington.Kevin Dietsch/Getty Images, FILEWhile federal money can't be used for most abortion services, Medicaid -- which the federal government jointly operates with states -- is required to pay for abortion care in cases of rape, incest and if a physician certifies the pregnancy would put the patient's life at risk.Compliance among states with these rules has been uneven historically, and several conservative legislatures are pursing laws with stricter exceptions. In Oklahoma, for example, the law only allows abortion in cases of rape and incest if it's reported to the police, and to save the life of a mother "in a medical emergency."It's possible Biden could take steps to enforce Medicaid's exceptions as federal law, making it easier for patients to get reimbursed, several advocacy groups predict.John Yoo, a former top legal adviser to the Bush administration, said he thinks the most consequential step Biden could probably take is leveraging his power over Medicaid and Medicare, as well as the federal health care exchanges governed by the Affordable Care Act. For example, Biden could require that insurers cover abortion services, at least in states where it's legal."I don't think those (steps) could pre-empt state laws that make it criminal to carry out abortion, but would provide federal support once (a person) could get to a state where abortion was legal," said Yoo, a law professor at the University of California, Berkley.Still, Yoo said he thinks Congress would have to lift its restrictions on federal spending on abortion -- a provision known as the Hyde amendment -- to make that happen.Democratic lawmakers and advocacy groups say what matters most is that Biden is as aggressive as possible.In a letter to the president, more than two dozen Democrats including Sens. Patty Murray of Washington and Elizabeth Warren of Massachusetts called on Biden to invoke his "unique power to marshal the resources of the entire federal government to respond."URGE's Inez McGuire said even symbolic statements by the president can make a difference.Declaring that abortion access is a human right is an opportunity for the administration "to let young people know (and) communities of color know … that our struggle to fight for abortion access is seen and understood by this administration," she said.	Women’s Health
Inspectors have returned to a troubled mental health unit at the centre of a BBC investigation into poor care. Hill Crest in Redditch, Worcestershire, was rated inadequate by the Care Quality Commission (CQC) after it found a "significant deterioration" in safety on the ward during a visit last year. Claims include staff falling asleep on duty, attacks on patients and staff, and a culture of bullying. The NHS trust has previously apologised. Hill Crest is managed by Herefordshire and Worcestershire Health and Care NHS Trust which said it was focusing on improving care. It submitted its action plan for improvements to the CQC on 5 September. The watchdog said it had wanted to allow the NHS trust time to put that action plan in place before inspectors returned on Tuesday. Asleep on duty The mixed-gender 18-bed Hill Crest ward supports people aged between 18 and 65 with acute mental health difficulties and those detained under the Mental Health Act. A former patient told the BBC she could remember four occasions when staff at the unit were sleeping while they should have been monitoring her. She also said her father had been so concerned about her safety he felt compelled to camp outside the building and refused to leave. When the CQC conducted an unannounced visit over the summer, inspectors found a number of causes for concern including insufficient staffing, sexual safety incidents and poor building maintenance including exposed electrical wires. The watchdog also cited an earlier incident where a patient had attempted to throw boiling water and sugar at a member of staff. It said when it visited, "two boilers were still in use indicating that lessons had not been learned following the incident and no actions had been taken to mitigate any future risk". A report following Tuesday's visit will be published later.	Mental Health Treatments
As a growing number of American parents are giving their kids melatonin to help them fall asleep, some experts are warning of potential risks. Nearly half (46%) of parents in the U.S. have given melatonin to a child under the age of 13, and almost one-third (30%) of parents have given the supplement to a teen over the age of 13 to help him or her fall asleep, according to a recent survey from the American Academy of Sleep Medicine (AASM). Providing melatonin to children might seem like a natural solution — but a 2022 AASM health advisory warns against using it for children because melatonin is not regulated by the federal Food and Drug Administration (FDA). The rise in melatonin use has also led to a spike in reports of melatonin overdose, calls to poison control centers and emergency room visits among children, the AASM has stated. Dr. Anne Marie Morse, a pediatric neurologist in Danville, Pennsylvania, was not surprised to hear about the high prevalence of melatonin use among kids. "We've seen that in pediatrics, it is much more likely for there to be a prescription to help a child sleep as opposed to adults," she said in an interview with Fox News Digital. "So, it doesn't surprise me that even before a prescription is given, a parent is asking, ‘What can I do myself? What can I get my hands on to be able to help my child sleep?’" "Because when your child's not sleeping, the whole house isn't sleeping and it can be extraordinarily disruptive," she added. Overall, Morse sees melatonin as relatively safe. But she emphasized the need to talk with a doctor before doling it out. "If you're going to give your child any supplements, you should really have a conversation with your physician first, to make sure it’s the right solution for the problem you’re experiencing," she said. "The doctor can also discuss dosing and how long to utilize it." As a sleep physician who sees kids and adults, Morse said she "commonly" utilizes melatonin, especially for teenagers who have a delayed sleep phase, meaning that their circadian rhythm has shifted much later than what it should be. "Melatonin can be very helpful in shifting the circadian rhythm," she said. When using it for that purpose, Morse usually recommends much lower doses — sometimes as low as 0.3 to 0.5 mg — and using it further away from bedtime. When using melatonin just for the purpose of helping someone fall asleep, she said she may recommend higher dosing — anywhere between 1 and 10 mg — and recommend taking it closer to bedtime. As far as how long melatonin is used, Morse said it depends on the patients. "Research has demonstrated that some populations, such as individuals with autism spectrum disorder, require longer-term treatment with melatonin," she said. One of the biggest concerns is that melatonin is a hormone produced by the brain, Morse noted, and could potentially influence other hormones the body produces. "In 2022, there was a 600% increase in poison control calls related to taking too much melatonin." In animal studies, melatonin has been shown to affect the sex hormones, which can influence the timing of puberty, she warned. "That's why we tend to be cautious about long-term use if it's not necessary," she said. Morse’s typical approach is to start the medication, identify whether there's a benefit within three months, then take away the melatonin and gauge whether the benefit is still there. "The goal is to partner any medication with behavioral strategies that make the medication less necessary for long-term use," she said. Lack of regulation Another potential concern, Morse noted, is that there is a "high degree of variability" in how much melatonin may be in any given product. In a recent study from earlier this year, it was found that there could be anywhere from half of what was being stated on the bottle to as much as four times the amount, she said. "The challenge is that because it's not a regulated substance in the U.S., there is a lack of predictability," she said. To reduce the risk, Morse recommended starting with the lowest available dose. "That way, you know the child won’t get too high of a dose, because there really is no way to predict how much the bottle is going to have." A study in April by the Cambridge Health Alliance revealed that some melatonin gummies — which can be more appealing to kids — contained amounts far in excess of what the label indicated. "If consumers decide to try melatonin — particularly if giving it to children — they should seek out a product that is certified by either USP (United States Pharmacopeia) or NSF (formerly the National Sanitation Foundation, now NSF International), as that is the only way to be certain that the product is accurately labeled," study author Dr. Pieter Cohen, associate professor of medicine at Harvard Medical School in Somerville, Massachusetts, told Fox News Digital at the time. "It’s hard to say whether the short-term benefits outweigh the possible risks." Although melatonin is a natural hormone, it is possible for people to have adverse effects from taking too much, Morse confirmed. "In 2022, there was a 600% increase in poison control calls related to taking too much melatonin," the doctor said. "Thankfully, there hasn’t been any evidence that it can cause something like respiratory depression, coma or death — but it can cause adverse effects like oversedation, nausea and grogginess the next day," she noted. One study has suggested that melatonin in high doses and for prolonged periods of time could potentially increase the risk of seizures, Morse said, but "that has not been replicated." While melatonin has a role in improving sleep, the doctor noted that it doesn’t treat all types of sleep disorders. "Just like any medical disorder, it is important to make sure that you're identifying and treating the right one," she said. "Make sure to talk with your physician and see a sleep doctor if necessary, to make sure you're getting the appropriate treatment." Dr. Laura Purdy, a board-certified family medicine physician in Miami, Florida, reiterated that the long-term effects of melatonin on kids aren’t known, as there isn’t yet enough research. "I would use caution on things we don’t know more about long-term," she told Fox News Digital. "It’s hard to say whether the short-term benefits outweigh the possible risks." Potential short-term risks include increased bedwetting, agitation and mood swings, fatigue and drowsiness, stomach pains and nausea, Purdy warned. "Just like any medical disorder, it is important to make sure that you're identifying and treating the right one." "Long-term risks that are being looked into more include worries about negative impacts on your child’s growth and development," she added. "There are other ways to help your child fall asleep that I suggest trying first," she said. "If you have any questions or concerns, consult your doctor." Importance of good ‘sleep hygiene’ As far as how much sleep kids need, Morse said it varies by age. "Generally, the younger you are, the more sleep you require," Morse said. "The pattern and duration of sleep changes over time." Newborn babies need around 14 to 17 hours a day, fragmented across the 24-hour period, she said. Five-year-old children generally need 10 to 13 hours of sleep at nighttime. For adolescents, around eight to 10 hours of sleep is needed. "All of these are given in a range because it's not one size fits all," Morse said. The quality of a child’s wakefulness during the day can also help parents understand the personalized amount of sleep that is needed. "If you're noticing impaired quality of wakefulness, which can look like moodiness, irritability, inappropriately falling asleep or reemergence of naps" — that can indicate the need to see a sleep doctor, Morse said. For parents of children who tend to be more wound-up or anxious, additional activities, like writing in a "worry journal" before bed, can help promote better sleep. Good sleep hygiene is also important, Morse said — while it might not fix existing sleep problems, it can prevent them from developing. "Sleep hygiene refers to behaviors prior to bedtime that align with sleepiness," she said. That might mean having a consistent "wind-down" routine each night that will trigger the child's brain to associate it with going to sleep. "That can start with simple things like brushing teeth and washing up, putting on pajamas and then doing a relaxing activity, whether it's reading a book, listening to relaxing or lulling music, or doing some light stretching," Morse said. For parents of children who tend to be more wound-up or anxious, additional activities, like writing in a "worry journal" before bed, can help promote better sleep.	Drug Discoveries
Researchers supply significant genomic insight into tar spot on corn First reported in 2015, tar spot is an emerging disease on corn that has rapidly spread across the United States and Canada, causing tremendous yield loss estimated at $1.2 billion in 2021 alone. Tar spot gets its name from its iconic symptoms that resemble the splatter of "tar" on corn leaves, but these spots are in fact brown lesions formed by the fungal pathogen Phyllachora maydis. This destructive pathogen is challenging to research because it cannot survive outside its plant host; therefore, little information is currently known about the mechanisms that contribute to its disease cycle including spore formation, reproduction, and plant infection. Researchers have consequently come to rely on genome sequencing to identify what genes are present and predict what roles they play during disease development. However, the current draft genome is largely incomplete, and although genes are present in the fungus, they may not be expressed during infection. To address this, a recent study led by Joshua MacCready and Emily Roggenkamp from Martin I. Chilvers's lab at Michigan State University generated a high-quality genome for P. maydis and provided the first global gene expression analysis of tar spot disease infection. The study, published in the journal Molecular Plant-Microbe Interactions, found that the fungus undergoes sexual reproduction early on in lesion formation, and this requires two individuals of different mating types. This finding is significant because sexual reproduction allows the fungus more genetic flexibility to evolve, resulting in potentially more virulent or fungicide resistant isolates. Like many fungal pathogens, P. maydis relies on the secretion of proteins, called effectors, to manipulate and overcome plant immunity. This study identified over 100 effectors, many of which were found to be unique to this fungal pathogen and highly expressed during infection, suggesting that these proteins play a novel role during infection and warrant further investigation to determine their function. The genome and gene expression analysis provides a valuable resource for other researchers studying tar spot on corn. Chilvers states, "This study lays the groundwork for future studies to examine effectors, pathogenesis, and the lifecycle of this pathogen." Armed with an improved understanding about this fungus, these researchers aim to implement improved disease management tactics for this impactful pathogen. More information: Joshua S. MacCready et al, Elucidating the Obligate Nature and Biological Capacity of an Invasive Fungal Corn Pathogen, Molecular Plant-Microbe Interactions (2023). DOI: 10.1094/MPMI-10-22-0213-R Journal information: Molecular Plant-Microbe Interactions Provided by American Phytopathological Society	Disease Research
The publicly funded health service in England has decided it will not routinely offer puberty-blocking drugs to children at gender identity clinics, saying more evidence is needed about the potential benefits and harms. The National Health Service said Friday that “outside of a research setting, puberty-suppressing hormones should not be routinely commissioned for children and adolescents.” People under 18 can still be given puberty blockers in exceptional circumstances, the NHS said, and a clinical study on their impact on kids is due to start by next year. Four new regional clinics are due to open later this year. They replace London’s Gender Identity Development Service, previously the only facility of its kind in England. It is scheduled to shut down after a review said it was overburdened by increasing demand and there was not enough evidence about the outcomes of its treatment. Hormone blockers can pause the development of puberty, and are sometimes prescribed to children with gender dysphoria. Transgender medical care for minors has been available in the United States for more than a decade and is endorsed by major medical associations The issue of gender-affirming care for children is not as heated in Britain as in the U.S., where several Republican-led states have banned puberty blockers and other treatment for transgender minors. But it has been the subject of both political and legal battles. The NHS said the new rules were “an interim policy” that would undergo further review, including the outcome of a research study on the impact puberty-suppressing hormones have on gender dysphoria in children and young people. Findings published last year from a review of children’s gender services led by a pediatrician, Dr. Hilary Cass, said there were “gaps in the evidence base” about the blockers. The NHS said doctors at the new clinics still would be allowed to prescribe the drugs outside of a research setting “on an exceptional, case-by-case basis” and subject to approval from a national team of medical experts. The health service’s decision does not prevent children and their families from obtaining puberty blockers elsewhere, but that will be “strongly discouraged,” the NHS said. The NHS said it recognized that once the policy was adopted, it would need to end a related requirement for young people to take puberty blockers for a certain amount of time before they receive hormone treatments. In 2020, England’s High Court ruled that children under 16 were unlikely to be able to give informed consent to medical treatment involving drugs that delay puberty. The decision was overturned in 2021 by the Court of Appeal, which said doctors can prescribe puberty-blocking drugs to children under 16 without a parent’s consent. Sign up for our weekly newsletter to get more English-language news coverage from EL PAÍS USA Edition	Health Policy
A full public inquiry will be held into the disgraced neurosurgeon Sam Eljamel, Scottish ministers have announced – the direct result of a decade-long fight by the doctor’s patients for recognition of the harm done to them. After the announcement, the patients expressed disappointment that the government response had taken so many years, while opposition parties accused the SNP government of a U-turn on its previous stance against such a move. Humza Yousaf confirmed the inquiry into the more than 100 botched surgeries, which resulted in life-changing injuries, at first minister’s questions before an afternoon statement to Holyrood from the Scottish health secretary, Michael Matheson, who had previously said an independent review would be sufficient. The doctor’s patients have always insisted that a full public inquiry – with the ability to compel witnesses – was necessary to expose what they said were years of negligence, cover-ups and bad governance. Their campaign group also underlined the importance of ensuring the patients had their healthcare reviewed alongside the setting up of the inquiry. Yousaf said the decision was taken after careful consideration of the “extremely disturbing” findings of a due diligence review into NHS Tayside’s handling of the case. Last week the damning internal report found that NHS Tayside allowed the neurosurgeon to continue operating on patients and failed to put in place adequate monitoring, despite a rising number of complaints. The due diligence review criticised management for “inadequate assessment of risk and consideration of patient safety”, and said the doctor – then head of neurosurgery – was put under indirect supervision in June 2013 rather than suspended, which did not happen until December. Matheson said that this review had “changed his view” on holding a full public inquiry, which he now said was necessary “to get to the bottom of who knew what and when and get to the bottom of the failures described”. He said it was “unacceptable” that after eight internal reviews the Scottish government was still learning new detail about the handling of the case. But Matheson added that he still believed individual case reviews conducted independently of NHS Tayside remained necessary, which would “offer answers [about patient’s own healthcare] in a bespoke, personalised way that an inquiry will not”. Jules Rose, a longtime campaigner who had a tear gland removed by Eljamel instead of a brain tumour, said she welcomed the progress but added: “It shouldn’t have taken the efforts from a group of patients who to this day remain affected by the harm caused by such levels of negligence. We hope this is the start of getting to root of what can only be significant and prolonged corporate governance failings”. At a vocal protest outside the Holyrood parliament on Wednesday, about 50 former patients wearing hospital gowns splattered with fake blood shared their stories. Many men and women in the group have faced devastating consequences after treatment by Eljamel, including paralysis, blindness, nerve damage, constant pain and severe incontinence. Rose said that the patients’ campaign group now numbered 152, with five new members coming forward in the past 24 hours. This is in addition to more than 100 other patients who Eljamel was allowed to operate on unsupervised in the months before his suspension. Eljamel gave up his right to practise in the UK in 2015 and is believed to be working in Libya. Earlier this week, Matheson said Eljamel could be extradited back to Scotland depending on a continuing police investigation. In July, one patient, Theresa Mallett, told the Guardian she had suffered “soul-destroying” pain for more than a decade since a botched sciatica operation. Mallett’s angry intervention during a speech by Yousaf at a SNP convention added to mounting pressure on ministers. Also earlier this week, the MSP Jim Fairlie, who counts Rose as one of his constituents, became the first SNP MSP to come out for a public inquiry, saying that the ability to compel witnesses to appear was “the only way to get to the answers needed by the patients who were Eljamal’s victims”. Rose thanked the Scottish Conservative MSP Liz Smith, who had first taken up her case in 2013. After Matheson’s statement, Smith credited the “relentless campaigning” by Rose and her fellow patients, adding that their experiences were “some of the most harrowing stories I have ever heard”.	Medical Innovations
People who have recovered from bowel cancer and are on NHS waiting lists for colonoscopies will be the first in the UK to be offered alternative pioneering blood tests.Â Swansea Bay scientists will offer 200 people in the area the test to check the disease has not returned.Â Leading cancer charities have called the development a "positive step" for those waiting for check-ups.Â It will be funded by Wales-based Moondance Cancer Initiative. Thousands of people across Wales are diagnosed with bowel cancer each year.Â Those who are treated and survive the disease are monitored through regular scans or colonoscopies.Â 'Absolutely devastated' Prof Dean Harris, a colorectal surgeon at Swansea's Singleton hospital, hopes the blood test can be a cheap and an easy alternative for those who are waiting.Â "It has only really been possible to do colonoscopies on patients who are suspected of having cancer - those that have come through the GP route, the urgent suspected cancer pathway," he said. "There are about 4,000 patients in Swansea Bay alone who have been waiting years for a follow-up colonoscopy after they've had bowel cancer or polyps removed. "Guidelines say they need to have a check colonoscopy done, sometimes a year later, sometimes three years later. "But all that activity stopped in the pandemic, and now there's a huge backlog, not just in Swansea, but everywhere in Wales and the UK. "These patients still can't get appointments unless they are developing symptoms and then they get expedited. "And we know that there are people forming cancers while they are on the waiting list and coming to harm. "We want to help prioritise which of those patients need to be bumped up the list to have their test done soonest because they're more likely to have a cancer or a polyp present, based on having the blood test done." The 200 hundred patients chosen will be invited over the next few months. If the tests are effective, the hope is that the project can be developed elsewhere in Wales - a move welcomed by cancer patients and cancer charities. Paul Scanlon, a recent cancer patient from Cardiff said anything which can save lives and make check-ups easier is a welcomed development.Â The 53-year-old was training for the London Marathon when he spotted blood in his poo.Â After months of "putting off going to the doctor" and "chronic back pain", he quickly realised something was not right.Â "Cancer didn't even enter my head," he said.Â In April 2022, an endoscopy confirmed he was living with two large tumours and had stage three bowel cancer.Â "I was absolutely devastated," he said adding the following months were "hell" for him and his family.Â Mr Scanlon, who will still need scans every six months for the next five years, said he welcomes any scientific developments to improve lives and reduce anxiety for survivors. But Lowri Griffiths from cancer charity Tenovus, said: "People are reluctant to come forward because of the nature of the colonoscopy." The Welsh government has set out a national endoscopy programme to "prioritise people waiting", adding that they are also doing broader work such as "training more clinicians that can perform endoscopy".	Medical Innovations
A couple whose baby died after being in the care of an NHS trust that was under review were made to feel "insignificant" and like they "don't have a voice". Adaora, the daughter of Ama Maduako and Sharma Thomas, died on 25 January this year, almost five months after being born at Queen's Medical Centre (QMC) in Nottingham. Her death is forming part of an independent review of maternity services at Nottingham University Hospitals Trust, which manages QMC. Ms Thomas, 23, who previously worked as a private community healthcare assistant, said: "It's opened my eyes a bit because I never thought that people that work in a profession where they're working with such vulnerable people, babies, I just never thought that people would be capable of acting the way that they do. "It's just a shock because I would never do that personally, myself. "I've got my own children now, but even before I had my own children, I was caring for someone else's child. "It never would have never crossed my mind to treat a child or just treat that family in a certain way that makes them feel like they don't have a voice or makes them feel bullied or insignificant, or make them feel like they're doing something wrong or they can't look after their child." Adaora, and her twin brother Zikora, were born 25 weeks and one day into Ms Thomas's pregnancy on 5 September 2022, having not experienced any problems up until then - but both babies were placed on ventilators after being told their lungs were bleeding. Mr Maduako, a 26-year-old medical salesman, also alleged Adaora had damage to her eyes and ears as a result of equipment being applied wrong, adding they watched her heart rate flatline three times because the ventilator did not provide pressure. He also said their concerns were dismissed or seen as being resistant to treatment - which they deny. Read more: Nottingham maternity scandal set to be biggest in NHS Why do maternity scandals keep happening? While Zikora celebrates his first birthday on Tuesday, his sister never made it out of QMC. The parents claim said Adaora's death was put down as pulmonary hypertension, combined with the effects of COVID by the hospital, but claim a post-mortem carried out showed no evidence of COVID, and instead found damage to her lungs. Michelle Rhodes, chief nurse at Nottingham University Hospitals said: "We offer our deepest condolences to Sharma Thomas and Ama Maduako for the loss of Adaora. "We want to assure Sharma and Ama that we have heard the concerns that they have raised and are committed to working with them to review each of the concerns and respond in a way that best meets their needs." More than 1,700 cases of possible harm to newborn babies and mothers are being examined at Nottingham University Hospitals NHS Trust over a 10-year period. The investigation is led by midwife Donna Ockenden, who led a similar review into maternity care at Shrewsbury and Telford NHS Trust. In 2022, she concluded that catastrophic failures there may have led to the deaths of more than 200 babies.	Epidemics & Outbreaks
- Between August 2021 and July 2022, COVID-19 was a leading cause of death in children and young people in the US, ranking eighth overall. - COVID-19 was the top cause of death in children from an infectious disease, in the same period. - Deaths in children from COVID-19 were highest in the US during the Delta and Omicron waves. - Infants aged less than one year were the most vulnerable, with a COVID-19 death rate of 4 per 100,000. - Pharmaceutical and public health interventions continue to be important to limit transmission of the virus and to mitigate severe disease in this age group. COVID-19 was the underlying cause of death for more than 940,000 people in the US, including over 1,300 deaths among children and young people aged 0–19 years. Until now, it had been unclear how the burden of deaths from COVID-19 compared with other leading causes of deaths in this age group. A new study led by researchers at the University of Oxford’s Department of Computer Science investigated this using data from US Centers for Disease Control and Prevention databases. The results are published today in the journal JAMA Network Open. Key findings for the study period 1 August 2021 to 31 July 2022: - Among children and young people aged 0 – 19 years in the US, COVID-19 ranked eighth among all causes of death; fifth among all disease-related causes of death; and first in deaths caused by infectious or respiratory diseases. - By age group, COVID-19 ranked seventh (infants), seventh (1–4 year olds), sixth (5–9 year olds), sixth (10–14 year olds), and fifth (15–19 year olds). - COVID-19 was the underlying cause for 2% of deaths in children and young people (800 out of 43,000), with an overall death rate of 1.0 per 100,000 of the population aged 0–19. The leading cause of death (perinatal conditions) had an overall death rate of 12.7 per 100,000; COVID-19 ranked ahead of influenza and pneumonia, which together had a death rate of 0.6 per 100,000. - Like many diseases, COVID-19 death rates followed a U-shaped pattern across this age-range. COVID-19 death rates were highest in infants aged less than one year (4.3 per 100,000), second highest in those aged 15–19 years (1.8 per 100,000), and lowest in children aged 5 –9 years (0.4 per 100,000). - Overall, deaths in children and young people were higher during the Delta and Omicron waves compared to previous waves (pre-July 2021), likely reflecting the higher numbers infected during these periods. Nevertheless, in the pre-Delta period of the pandemic, COVID-19 still ranked as the ninth leading cause of death overall. - The month with the highest number of COVID-19 related deaths in 0 - 19 year-olds was January 2022 at 160. Although COVID-19 amplifies the impacts of other diseases (such as pneumonia and influenza), this study focuses on deaths that were directly caused by COVID-19, rather than those where COVID-19 was a contributing cause. Therefore, it is likely that these results understate the true burden of COVID-19 related deaths in this age-group. Compared with other age-groups, the overall risk of death from COVID-19 was substantially lower in children and young people. For instance, between 1 August 2021 and 31 July 2022, the COVID-19 death rate among all ages in the US was 109 per 100,000. However, because deaths among children and young people in the US are rare, the mortality burden of COVID-19 is best understood in the context of all other causes of death in this age-group. According to the researchers, these results suggest that, with variants of COVID-19 continuing to circulate, public health measures such as vaccinations, staying home when sick, and ventilation still have an important role to play in limiting transmission of the virus and mitigating severe disease in children and young people. Associate Professor Seth Flaxman (Department of Computer Science, University of Oxford), lead author of the study, said: ‘These results demonstrate that while it's rare for kids and teens to die in the US, COVID-19 is now the leading underlying cause of death from infectious disease for this age group. Many of the 82 million American children and young people were infected during the big Delta and Omicron waves, and as a result more than 1,300 children and young people have died from COVID-19 during the pandemic, most in the last two years. Fortunately, we now have an array of effective tools to minimize risk, from building ventilation to air purifiers to safe vaccines. Working together, communities can significantly limit the extent of infection and severe disease.’ Assistant Professor Robbie M. Parks of Mailman School of Public Health, Columbia University, a co-author of the study, said: ‘If you look at infectious diseases in children in the US historically, in the period before vaccines became available, hepatitis A, rotavirus, rubella, and measles were all major causes of death. But when we compared those diseases to COVID-19, we found that COVID-19 caused substantially more deaths in children and young people than those other diseases did before vaccines became available; this demonstrates how seriously we need to take COVID-19 prevention and mitigation measures for the youngest age groups in the US and worldwide.’ Associate Professor Deepti Gurdasani, Kirby Institute, University of New South Wales, Sydney, a fellow co-author of the study, said: ‘It's clear that COVID-19 is a significant cause of death in children, being the leading cause of death from infectious disease. Unfortunately, deaths from COVID-19 have continued to be significant in children, even during the Omicron era. We need mitigations (e.g., ventilation, air cleaning) to protect children from infection, alongside accessible vaccination to reduce the risk from severe disease.’ Co-author Dr Oliver Ratmann, from the Department of Mathematics at Imperial College London, said: ‘The central point of this study is that in children, the severity of COVID-19 infection is best understood by comparing like for like, i.e. relative to other causes of death in children. We show that COVID-19 was a top-ten leading cause of death in children in 2021-22 and the leading cause of death in children from any infectious disease. So, COVID-19 is far from a harmless infection in children.’ Notes to editors: The study ‘Assessment of COVID-19 as the underlying cause of death among children and young people aged 0 to 19 years in the US’ will be published in JAMA Network Open at 16:00 GMT / 11:00 ET on 30 January 2023. After the embargo lifts, the paper will be available at doi:10.1001/jamanetworkopen.2022.53590. To view a copy of the paper ahead of publication, please contact seth.flaxman@cs.ox.ac.uk or mediarelations@jamanetwork.org. About the University of Oxford Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the seventh year running, and number 2 in the QS World Rankings 2022. At the heart of this success are the twin-pillars of our ground-breaking research and innovation and our distinctive educational offer. Oxford is world-famous for research and teaching excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research alongside our personalised approach to teaching sparks imaginative and inventive insights and solutions. Through its research commercialisation arm, Oxford University Innovation, Oxford is the highest university patent filer in the UK and is ranked first in the UK for university spinouts, having created more than 200 new companies since 1988. Over a third of these companies have been created in the past three years. The university is a catalyst for prosperity in Oxfordshire and the United Kingdom, contributing £15.7 billion to the UK economy in 2018/19, and supports more than 28,000 full time jobs.	Epidemics & Outbreaks
A case of bovine spongiform encephalopathy—more colorfully known as mad cow disease—has been detected on a farm in the Netherlands. It’s the first time that an infected cow has been reported in the country in over a decade. Authorities say the cow should not pose a threat to human health, but they’re looking for other animals that may have been infected by the cow or from the same source. Bovine spongiform encephalopathy, or BSE, is a type of prion disease found in cows. Prions are the misfolded and damaging forms of naturally occurring proteins that are often found in the brain. When these rogue proteins encounter their normal counterparts, they somehow force the latter to misfold as well, causing a domino effect that destroys the brain over time. There are different incubation periods, depending on the disease, but all prion diseases are currently 100% fatal once symptoms appear. In humans, the most common prion illness (but still very rare in general) is Creutzfeldt-Jakob disease, or CJD. Most cases of CJD are sporadic, meaning they spontaneously appear, usually in later life. Other forms can be caused by inherited mutations or caught from contaminated surgical equipment or donated human organs during certain procedures. But the most notorious form of the disease is variant CJD, which is caught from eating the beef of cows infected with BSE. In the 1980s and 1990s, at least hundreds of people developed variant CJD from contaminated beef. The bulk of these cases were limited to the UK, where earlier outbreaks of mad cow were similarly concentrated. These outbreaks appeared to have been fueled through the practice of feeding cows the meat of other infected cows or from sheep infected with their own prion disease, called scrapie. Widespread bans of British beef, along with changes in feeding and slaughter regulations, appeared to stem the threat of mad cow by the mid-1990s. Since then, there haven’t been large-scale outbreaks of either BSE or variant CJD. But much like in humans, BSE can still pop up in cows, making any discovery on a farm an urgent priority to contain. On Wednesday, the Netherlands’ Ministry of Agriculture reported the BSE case, the first to be detected since 2011. According to local officials, the cow was found before it entered the food chain, so it shouldn’t directly pose any danger to people. But given the possibility that the cow may have infected surrounding animals on the farm or contracted BSE from contaminated feed, authorities are looking for other transmission chains. “Offspring, and animals that have had the same feed, and animals that have grown up with this bovine are being tracked down, tested for BSE,” and will be put down, Agriculture Minister Piet Adema said, the NL Times reported. “There is a chance that other cattle have also eaten this feed and become infected from it. In that case, measures must be taken to manage risks to food safety and public health.” The exact type of BSE found in this cow is not known at the time. “Classic” BSE occurs when cows eat contaminated meat, but atypical BSE seems to happen spontaneously, usually in older cows. It’s unknown whether eating contaminated beef from cows with atypical BSE can cause variant CJD in people. But there does seem to be a strong genetic component to catching variant CJD from cows in general. The initial human outbreaks were much smaller than experts expected, and it’s since become apparent that the vast majority of cases have occurred among people with a particular version of their human prion protein gene. Some scientists have wondered whether having a different version of the gene may only delay the onset of variant CJD, though, not prevent it entirely (in at least one case of transmitted CJD, it reportedly took three decades for symptoms to appear following exposure). And if that’s true, then there still could be future cases stemming from the original BSE outbreaks in the years to come. Another potential prion-related threat may come from the spread of chronic wasting disease among North America’s deer population, though no evidence of deer-to-human transmission has been found yet.	Epidemics & Outbreaks
In the movie “Spider-Man – Far From Home” Peter said “Everywhere I go, I see his face”, he said this line with respect to Iron Man. Here, I want to link this statement to the fact that everywhere I go, I see the impact of AI. Almost every industry is now moving towards digital transformation (DX) by implementing Artificial Intelligence (AI), Machine Learning (ML), IoT, and many more. The healthcare industry is also experiencing the intervention of AI-powered chatbots. According to Fortune Business Insights, North America’s AI technology in the medical field is expected to grow up to $164.10 billion by the year 2029. This growth accounts for a CAGR rate of 42.2%. The medical industry is trying to automate its operations through chatbots for customer services, collecting data of patients, appointment scheduling, and enhancing the overall customer experience. You Must Also Read: Digital Healthcare Solutions – Everything You Need to Know Let’s check out this article to figure out the specific benefits of chatbots in the healthcare sector. 11 Benefits of Healthcare Chatbots: Perfect Match for Better Patient Engagement Chatbots in healthcare can mimic human-like responses so that you can automate many daily activities of your nurses or doctors. From patient support to diagnosis, there are 11 specific ways in which chatbots are revolutionizing healthcare. 1. Enabling prompt responses Chatbots incorporate pre-programmed scripts and machine-learning algorithms that help in generating prompt responses for patients. They search for the user’s query through their knowledge database and present a profound answer. Currently, they are able to resolve simpler medical issues with prompt responses. In the future, machine learning & natural language processing (NLP) may begin to provide customized solutions for complex medical issues as well. 2. Insurance coverage & claims can be handled by chatbots in healthcare In reality, availing of any insurance policy is similar to “grabbing the piece of cake” but seeking an insurance claim incorporates a lot of headaches and paperwork. Patients need to complete a lot of verification rounds to get the claim. Many times insurance companies face allegations for not keeping transparency in their policies. So, the use of health insurance chatbots in healthcare can be helpful in guiding patients about an entire insurance coverage process. Furthermore, a chatbot can offer complete guidance to patients and it can even solve their queries related to filling insurance claims. It can eventually support them in getting claims faster in the healthcare sector. 3. Assess Symptoms with an accuracy of 74.65% Journal of the South Carolina, conducted a study on 16,733 patients for testing whether chatbots are able to deduct the patient’s symptoms or not. The chatbots scored an astonishing accuracy rate of 74.65%. In the future, chatbots in healthcare will be able to enhance their symptoms detection rate more accurately through collective patient data. This emphasizes that the healthcare sector will be going to witness the massive impact of AI-enabled operations. 4. They can act as a virtual assistant for mental health Healthcare chatbots are disrupting the industry or jobs of psychiatrists as well as mental health counselors. Patients can ignite a meaningful conversion with bots and then bots can provide them with profound practical solutions for enhancing their mental health. 5. Goodbye to long call-holding time for appointment scheduling, because medical chatbots can do it in “seconds” The reception area of almost all the hospitals keeps ringing with phone calls. Patients also do not feel comfortable during long call holdings. Thus, artificial intelligence in the medical field has started answering questions through medical chatbots. Image Source: inbenta.com Now, patients are not required to connect with doctors or nurses at least for getting answers to their basic queries. At the global level, patients and loved ones have started to use chatbots for appointment scheduling & other activities. 6. It makes the patient’s journey smooth & effective For decades, the healthcare industry is trying to reduce the obstacles that patients faced before availing of treatment. So, “ai healthcare chatbots” are no less than a blessing because patients can perform below functions: - ♦ The patient can take pre-visit assistance. - ♦ Post-visit follow-up. - ♦ Medication Reminders. - ♦ Appointment scheduling. - ♦ Getting personalized recommendations. 7. Doctors may close their window after working for 13-14hours/day but AI healthcare chatbots stay available for 24 hours We all know that health-related emergencies can arise at any time and it is not necessary that our doctors are available for us whenever we get indulged in any emergency. However, chatbots are available for patients round the clock – they can be used for checking symptoms, assisting patients during emergencies, and many more. 8. Conversational AI chatbots can collect patient’s data and then transfer it for further analysis To revolutionize the healthcare service, AI & Machine Learning (ML) analyze the questions asked by patients, their responses, and more. AI Chatbots use natural language processing (NLP) and algorithms to get trained further. 9. Minimizing costs of operations Healthcare chatbots can eliminate huge manual efforts that can result in reduced overall to a certain extent. Moreover, to reduce the further cost you can hire remote developers for preparing AI-enabled chatbots and mobile applications. 10. Chatbots can reduce the workload of the nurses The use of Chatbots in healthcare can ease the shortage of staffing shortages. As, nurses and frontline workers can automate their operations – such as discharging materials, taking frequent follow-ups, and many more. 11. Personalized answers To provide personalized answers, the patient engagement chatbot required interaction history of patients, their preferences, current medications, current treatment cycle, etc. On the bases of these factors, they can provide specific answers to them. Tools To Prepare AI-Enabled Chatbots In today’s IT universe, there are ample amount of tools available for constructing chatbots. However, below are the 5 top most renowned tools that you can utilize: - ♦ “Google Dialogflow” - ♦ “Microsoft Bot Framework” - ♦ “Amazon Lex” - ♦ “BotMan” - ♦ “Botsify” Conclusion With the support of ai chatbots for healthcare, it will be much easier for you to streamline your hospital’s functions. At Competenza Innovare, our developers incorporate expertise into diverse domains and we can help you to create advanced conversational ai healthcare chatbots for your hospitals or clinics. So, connect with our project managers and share your requirements. For developing chatbots, we have well-versed IT labs, the latest software, API integration functions, and all the tools to execute your requirements.	Medical Innovations
Ethical experts from leading Scottish universities have backed assisted dying proposals for those with a terminal illness. Liberal Democrat MSP Liam McArthur’s Member’s Bill would allow competent terminally ill adults to request assistance to end their lives. The Philosophers’ Consortium on Assisted Dying in Scotland, comprising of ethical philosophy professors at Edinburgh, Glasgow and St Andrews universities, said the proposals would give vulnerable people “control” over their decision-making. Joseph Millum, of St Andrews University, said the proposals have “strong safeguards” to protect against misuse. Mr McArthur’s proposed assisted dying Bill is currently being drafted, with the final text to be made available later this year. It would be available to those aged 16 and over who have a prognosis of no longer than six months to live, deemed to be of competent mind and able to administer and ingest the medication themselves. Two independent doctors would have to determine the patient met the criteria before being allowed to proceed. Dr Millum said: “Even with the best that modern medicine can provide, many patients suffer terribly at the end of life. “That suffering is made worse by their lack of control. This Bill would give adults with terminal illnesses the power to control how their lives end. “It would give doctors who are willing to be involved another means to help their patients." Liam McArthur signing a pledge card in support of his Assisted Dying Bill He added: “And it has strong safeguards against misuse. Decades of experience from around the world show that assisted dying can be legalised safely and practiced responsibility. “It’s time that Scotland gave patients the right to assistance in dying.” In response, Mr McArthur said: “As I finalise the Bill that will go before Parliament, I very much welcome the input and support of such experts on end-of-life ethics. “The Assisted Dying for Terminally Ill Adults Bill will work alongside palliative care to offer compassionate choice to dying people and put safety and transparency in place where none currently exists. “The group has considered the evidence on both the need for a new law on assisted dying and how it works in practice; evidence I look forward to sharing further with my MSP colleagues. “The majority of the Scottish public are in favour of changing the law on assisted dying and I’m pleased to add this expert group to their number.” However, faith leaders held a meeting in Holyrood last week to voice their strong opposition to the proposals. A joint statement from leaders of the Church of Scotland, the Catholic Church and the Scottish Association of Mosques said the Bill “inevitably undermines the dignity of the human person”, adding that “common humanity” would be lost by its introduction.	Medical Innovations
Nearly Â£20,000 has been raised for a family in Nottingham after their nine-month-old daughter was found to have a life-limiting genetic condition. Milanna was diagnosed with mitochondrial disease a few weeks after she started having seizures. Reanna and Malaky were told their daughter would lose her sight, hearing and eventually her organs would fail. They plan to use the money to meet with experts in the US in the hope they can give her the best quality of life. Reanna was originally told her daughter had an ear infection when she took her to the doctors with a temperature on 7 January. While waiting to collect antibiotics at Queen's Medical Centre, in Nottingham, Milanna had a seizure in her pram. Reanna said: "She had a starry bib on and I thought she was just looking at the stars. "I said 'Milanna' and she wouldn't look at me." Reanna stopped a passing nurse and explained her daughter was unresponsive. "The nurse just whipped her out the pram and said 'she's having a seizure'. "They put us in a side room and loads of people came rushing," she said. Reanna said the seizure lasted for about two hours and 40 minutes. Milanna spent the next few weeks in intensive care, having seizures every two hours. She was eventually diagnosed with epilepsy and given medication but doctors said the frequency of the seizures was unusual. They suggested Reanna and Malaky had a blood test to see if their daughter could have a genetic condition. Last week, it was confirmed Milanna has mitochondrial disease. What is mitochondrial disease? - It is a term used for conditions caused by faulty mitochondria. - Mitochondria are responsible for energy production that allows cells to work properly. - The disease can affect different parts of the body, particularly those that require a lot of energy like the brain, heart and liver. - It is genetic, caused by mutations of DNA. - There is no cure but many of the problems associated with it can be treated. Source: Muscular Dystrophy UK Reanna said Milanna had already started to deteriorate. "My daughter, prior to these seizures, was crawling, she was sitting on her own, she could eat finger food - she can't do any of that any more," she said. The family was told by doctors that Milanna could live for a few weeks, months or maybe a few years. "As a parent it is your worst nightmare. She's our first and we tried so long for a baby. "It just feels like we're in a dream at the minute and we're just waiting to wake up," said Reanna. Reanna said the condition was rare in the UK and there was not much information available. The family plan to travel to the US to meet with experts and potentially request a drug that could help make the time Milanna has left more enjoyable. "There is a drug over there that they give to patients to energise all their muscles and hopefully prolong their life," Reanna said. The drug is available in the UK but Reanna said her daughter would not be eligible for it until she had become much more poorly. She said the money raised by donations would be "extremely helpful" with their plans to make the most of Milanna's short life.	Disease Research
People over 60 who take a daily multivitamin pill may be slowing age-related memory decline, according to a new study that amplifies similar findings from last year. More than 3,500 American adults over the age of 60 were randomly assigned to take either a daily multivitamin supplement or placebo for three years. At the end of each year, participants performed a series of online cognitive assessments at home designed to test memory function of the hippocampus, an area of the brain that is normally affected by aging. By the end of the first year, memory improved for the people taking a daily multivitamin, compared with those taking a placebo—and the benefits were sustained over the three-year period. The researchers at Columbia University and Brigham and Women’s Hospital at Harvard said the results are consistent with another recent study from Wake Forest University that followed more than 2,200 older adults and found that taking a daily multivitamin improved overall cognition, memory recall, and attention. The earlier study showed that three years of multivitamin supplementation roughly translated to a 60% slowing of cognitive decline, equating to around 1.8 years of normal mental capacity. “Because of our innovative approach of assessing cognitive outcomes using internet-based tests, we were able to examine the effects of a multivitamin in thousands of study participants,” said Professor Adam Brickman, of Columbia University. “The aging brain may be more sensitive to nutrition than we realized,” said first author Dr. Lok-Kin Yeung, also of Columbia. “Our study suggests that supplementation with multivitamins may be a simple and inexpensive way for older adults to slow down memory loss.” Co-author Dr. JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital, said: “The finding that a daily multivitamin improved memory in two separate cognition studies…is remarkable.” The effect was even more pronounced in participants with underlying heart disease, according to the findings published in the American Journal of Clinical Nutrition. “There is evidence that people with cardiovascular disease may have lower micronutrient levels that multivitamins may correct, but we don’t really know right now why the effect is stronger in this group.” The researchers, whose work was partially funded by the National Institutes of Health, did not look at whether any specific component of the multivitamin supplement was linked to the improvement in memory. “Though it may not be so important to find out which specific nutrient helps slow age-related cognitive decline,” said Yeung. “The findings are promising and certainly set the stage for important follow-up studies about the impact of multivitamin supplementation on cognition,” concluded Brickman, who reminds people that getting nutrients from your food is always preferable. REMIND SENIORS to Take Their Vitamins By Sharing the News on Social Media…	Nutrition Research
In recent months ominous ads about prescription drugs have flooded the TV airwaves. Perhaps by design, it’s not always clear who’s sponsoring the ads or why. Or, for that matter, why now? The short answer is that Congress is paying attention. House and Senate members from both parties have launched at least nine bills, parts of which may be packaged together this fall, that take aim at pharmacy benefit managers, companies that channel prescription drugs to patients. Here’s a primer to help you decipher what’s happening. - What are pharmacy benefit managers? Known as PBMs, these companies were created in the 1960s to help employers and insurers select and purchase medications for their health plans. The industry mushroomed as prescription drug spending grew about 200-fold between 1967 and 2021. In addition to negotiating discounts with manufacturers, the PBMs set payment terms for the pharmacies that buy and dispense the drugs to patients. In effect, they are the dominant middlemen among drugmakers, drugstores, insurers, employers, and patients. - How big is the PBM industry? There are around 70 PBMs in the U.S. Through mergers, three of them — CVS Caremark, Optum Rx, and Express Scripts — have come to control 80% of the prescription drug market, and each brings in tens of billions of dollars in revenue annually. The PBMs control the drug pipeline from manufacturers to the pharmacy counter. Their buying power allows them to obtain discounted drugs for health plans while setting prices and terms for sales at drugstores. The big three are part of massive conglomerates with important stakes in almost every sector of health care; each of them owns a powerful health insurer — Aetna, UnitedHealth, and Cigna, respectively — as well as pharmacies and medical providers. For example, UnitedHealth contracts with 70,000 doctors, making it the biggest employer of physicians in the country. CVS Health, with the big pharmacy chain, also owns Caremark and Aetna. Secret price negotiations and hidden corners of each PBM-linked corporation make it hard to track where the money ends up. - Why am I seeing all these ads about PBMs? Other sectors of health care are alarmed by the power of the PBMs and are appealing to the Biden administration and Congress to rein them in. Drugmakers, employers, pharmacies, doctors, and even patients chafe at PBM practices like “spread pricing,” in which the companies pocket money negotiated on behalf of health plans. Non-PBM-affiliated pharmacists, from mom and pop stores to large chains like Kroger, say the PBMs squeeze their businesses by forcing them to sign opaque contracts that include clawbacks of money long after sales take place. PBMs often steer patients using expensive drugs to their affiliated pharmacies, cutting revenue to independents. Doctors say PBMs act as gatekeepers for the insurers they represent, blocking or slowing coverage of necessary drugs. Finally, the pharmaceutical industry has lost a share of sales revenue to PBM middlemen in recent years — even while getting most of the bad publicity for high drug prices. (The median launch price for newly marketed brand-name drugs went from $2,100 to $180,000 a year between 2008 and 2021, yet net revenues for drug companies have stagnated in recent years.) PBMs in some cases prefer high producer list prices, because the rebates that drugmakers pay the PBMs in exchange for favorable health plan coverage of their drugs often are calculated as a percentage of those list prices. - Who’s paying for the ads? The Pharmaceutical Research and Manufacturers of America, the trade group for most of the big drug companies, is the top driver of the anti-PBM campaign. Some of the ads are sponsored by the PBM Accountability Project, a pop-up lobby, funded partly by the drug industry, that includes unions and patient advocates whose membership complains of restrictive PBM and insurance industry policies. In one PhRMA ad, a smarmy guy in a suit snatches away a young woman’s prescription. The Pharmaceutical Care Management Association, the PBM trade group, has responded with its own ads, blaming drug companies for high prices and for “targeting your pharmacy benefits.” AHIP, the health insurance lobby, has piled on with its own campaign. - What’s Congress doing about it? Members from both parties talk indignantly about PBM behavior and have fired up bills to address it. The Senate Finance Committee, whose jurisdiction over Medicare and Medicaid gives it a lead role, has introduced a bill that would prohibit PBMs from collecting rebates and fees calculated as a percentage of a drug’s list price, to discourage PBMs from favoring expensive drugs. The committee also plans legislation to require PBMs to pass along discounts directly to seniors, allow patients to use the pharmacy they prefer, and release more information about where their money ends up. Sen. Bernie Sanders, who leads the Senate Health, Education, Labor and Pensions Committee, introduced a bill that bans spread pricing, while measures in the Senate and House would crack down on PBM practices seen as harming independent and rural pharmacies. Other measures require more transparency or limit patient waits for drug approvals. Meanwhile, several states have taken a pragmatic path to lower PBM-related costs, using high-tech auctions to get the best deals for their employee health care plans. What’s the bottom line? While the PBMs’ secrecy, ubiquity, and power make them a target of outrage, they generally operate on behalf of their customers, which are insurance plans and employers, whose goal is to hold down prices. The PBMs do that by extracting painful concessions, a double-edged sword. “PBMs are the only thing we have to lower brand-name drug prices and prevent the drug industry from charging whatever they want,” said Benjamin Rome, an internist and health policy researcher at Harvard Medical School. If those drug prices were 100% covered by insurance, that might sit fine with consumers, but it would further blow up health care spending, already nearly a fifth of the economy. Hospitals, insurers, the drug industry, and PBMs all point fingers at one another to shift blame, but they all benefit from the system. The smarmy PBM guy in the suit may prevent you from getting the drug your doctor ordered, but that’s only because the maker of another drug gave him — and therefore your insurance company — a better deal. On the other hand, the vertical integration of the PBMs — an issue the Federal Trade Commission is studying but that is not the subject of any bill in Congress — enables unfair competition. “My concern with any bills is the unintended consequences,” Rome said. “Will the new structures they create be any better for patients?”	Health Policy
In a trial run by , a Cambridge–based biotech company, researchers discovered that a single infusion of a gene-editing treatment called VERVE-101 was able to reduce cholesterol levels in patients. This treatment was tested in individuals with hereditary conditions that made them susceptible to developing clogged arteries and heart attacks. Scientists were able to use techniques to tweak liver gene cells. The researchers a cholesterol-raising gene called PCSK9, which is found in the liver, in order to lower — sometimes called "bad" cholesterol — which causes plaque to build up in arteries in the first place. PCSK9 was lowered by as much as 84 percent in the cohorts that received higher infusion rates of the treatment. At those higher treatment doses, Verve scientists said that the reduction of those LDL-C-related proteins lasted in previous studies on primates. From a clinical standpoint, this gene editing therapy has the potential to disrupt the current standard treatment for high cholesterol. The current go-to's include prescription statins and PCSK9 inhibitors, but they require strict adherence and can have CRISPR, while seemingly miraculous, is a long way from replacing daily medications though. According to , two of the 10 participants in the study suffered from a “cardiovascular event” that coincided with the infusion. Verve says one was not related to the treatment at all and the second was “potentially related to treatment due to proximity to dosing.” The use of a gene-editing technology will always carry some risk because the edits . Before a single infusion therapy for high cholesterol can reach consumers, the that the treatment will need to be studied for up to 15 years. Verve recently received FDA clearance for an for VERVE-101, meaning that the company can begin to conduct trials in the US. The current trials in New Zealand and the United Kingdom will look for willing clinical trial participants to expand the study.	Drug Discoveries
Mealtimes are something that many parents dread, with mums and dads notoriously having a hard time getting their children to eat enough vegetables. But a new study suggests that contrary to popular belief, just 16 per cent of children should be classed as 'fussy' eaters. Researchers from Aston University surveyed almost 1,000 British parents about their children's eating styles. Their findings suggest that all children fit into one of four eating categories. While 16 per cent of kids are classed as 'fussy', the other 84 per cent are either 'avid', 'happy', or 'typical' eaters, they say. In the study, the team set out to investigate eating behaviour patterns in primary school children, and how they are associated with feeding practices. The researchers surveyed 995 parents and carers of three to five-year-olds in England and Wales about their children's eating habits across eight behaviours. These were food responsiveness, emotional overeating, food enjoyment, desire to drink, satiety responsiveness, slowness in eating, emotional undereating, and food fussiness. The results were then collated, revealing four distinct categories of eaters. Fourty-four per cent of children had 'average' levels across all eight behaviours, and should be classed a 'typical' eaters, according to the researchers. Meanwhile, 16 per cent are classed as 'avoidant' (or fussy) eaters. '"Avoidant eating" was characterised by significantly high levels of food fussiness, satiety responsiveness, slowness in eating, and emotional undereating concomitant with significantly low levels of food enjoyment in comparison to the three other profiles,' the researchers wrote in their study, published in Appetite. Eighteen per cent are 'happy' eaters, who had high levels of food enjoyment, but low levels of slowness of eating, food fussiness, emotional overeating, and emotional undereating. Finally, 22 per cent were classed as 'avid' eaters, who had an increased enjoyment of food, faster eating speed, and weaker sensitivity to internal cues of 'fullness'. The researchers say that children in this group are at highest risk of overeating and subsequent weight gain. The team hopes the findings could be used to pave out more personalised strategies to improve healthy eating in children. Dr Abigail Pickard, lead author of the study, said: 'Parents can use this research to help them understand what type of eating pattern their child presents. 'Then based on the child’s eating profile the parent can adapt their feeding strategies to the child. 'For example, children in the avid eating profile may benefit more from covert restriction of food, i.e., not bringing snacks into the home or not having foods on display, to reduce the temptation to eat foods in the absence of hunger. 'Whereas, if a child shows fussy eating behaviour it would be more beneficial for the child to have a balanced and varied selection of foods on show to promote trying foods without pressure to eat.'	Nutrition Research
Catching malaria in the US is extremely rare, but when it happens, the mosquito-borne parasite can masquerade as another parasite that's regularly found in the country, leading to a misdiagnosis that has foiled doctors around the world for years. Such was the case this year in Maryland, when the state saw its first locally acquired malaria case in over 40 years, according to a report this week.The misdiagnosis led the patient to a weeks-long treatment for the wrong infection and held up public health responses to pinpoint and thwart further transmission. To date, the source of the patient's infection remains a mystery. As global travel and climate warming expand malaria's range, awareness of the diagnostic pitfall and better testing will be increasingly needed, the report's authors suggest. The report was published Thursday in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Malaria rages in large swaths of the world but was considered eliminated from the US in 1951. Still, there are around 2,000 malaria cases in the US each year, all linked to travel to areas with malaria transmission. The state of Maryland sees around 200 such cases in a typical year. Then there are years like this one—when there were nine malaria cases that were locally acquired (not linked to travel) in the US: seven in Florida, one in Texas, and one in Maryland. It was the first year in two decades that any locally acquired malaria was found anywhere in the US. The last local cases occurred in 2003 in Palm Beach, Florida. Yet, the three states' cases were not linked. The seven cases in Florida clustered in a swampy area near an imported malaria case. The unrelated Texas case was also in the vicinity of an imported case. In Florida and Texas, the cases were caused by the malaria parasite Plasmodium vivax, which spreads in many places around the world, including South and East Asia, the Western Pacific, and South America. In Maryland, the case involved P. falciparum, which causes the deadliest form of malaria and spreads heavily in African countries. Maryland case On August 6, a previously healthy Maryland resident showed up at a health facility after seven days of fever, muscle pain, and malaise. The person had no recent international travel but noted taking daily walks near home and having recently been bitten by a tick. Lab tests showed anemia, low blood platelets, and a buildup of bilirubin (which occurs when red blood cells break down). The patient also had parasites in their red blood cells. These symptoms and findings match two diseases: malaria and another parasitic infection called babesiosis, which is caused by Babesia parasites and spread in the US by ticks. Given the circumstances, doctors admitted him to a hospital and began treatment for babesiosis. On August 9, a blood smear report indicated P. falciparum, though. The doctors shared the smear images with the CDC, but the images weren't clear enough for CDC experts to distinguish whether Babesia or P. falciparum were in the patient's red blood cells. With special stains and microscopy, both parasites look like little rings inside red blood cells.	Epidemics & Outbreaks
The Host A divided three-judge federal appeals court panel has ruled that a lower court was wrong to try to reverse entirely the FDA’s approval of the abortion drug mifepristone. The panel did find, however, that the agency violated regulatory rules in making the drug more easily available and that those rules should be rolled back. In practice, nothing changes immediately, because the Supreme Court has blocked the lower court’s order that the drug effectively be removed from the U.S. market — for now. The case is pivotal for the future of reproductive health, as the pill is part of a regimen that is now the most common way American women terminate early pregnancies and is also widely used by doctors to manage miscarriages. Meanwhile, as President Joe Biden’s Inflation Reduction Act turns one, Medicare officials are preparing to unveil which 10 drugs will be the first to face price negotiation under the new law. This week’s panelists are Julie Rovner of KFF Health News, Shefali Luthra of The 19th, Sarah Karlin-Smith of the Pink Sheet, and Alice Miranda Ollstein of Politico. Panelists Among the takeaways from this week’s episode: - Wednesday’s federal appeals court decision siding with conservative medical groups challenging mifepristone regulations has perhaps the biggest implications for the drug’s distribution via telemedicine, which has been key to securing abortion access for people in areas where abortion is unavailable. - The ongoing legal threat to mifepristone is reverberating through the drug industry, as drugmakers worry challenges to the FDA’s scientific authority could cause serious problems for future drug development — especially in an industry that takes big financial risks on getting products approved. - Texas is suing Planned Parenthood over past Medicaid payments made to the program, charging that the health organization “defrauded” the state, even though the claims were made while a court had specifically allowed Planned Parenthood to remain in the program. Still, the lawsuit emphasizes just how far Texas has gone, and will go, to maintain the legal authority to not support Planned Parenthood, even in its non-abortion work. - The federal government is expected to release the list of 10 pharmaceuticals subject to Medicare price negotiations by Sept. 1. The drugs’ identities are the subject of much educated speculation, as Congress laid out in the law how drugs qualify for consideration — though even stakeholders in the drug industry are wondering which specific drugs will be up for discussion. - A national survey of pharmacists finds drug shortages are widespread and leading to rationing at the pharmacy level. A lack of incentives to produce generic drugs is complicating supply-chain problems, leaving fewer options when there are manufacturing or other types of issues with a particular drugmaker. Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too: Julie Rovner: Time’s “She Wasn’t Able to Get an Abortion. Now She’s a Mom. Soon She’ll Start 7th Grade,” by Charlotte Alter. Sarah Karlin-Smith: MIT Technology Review’s “Microplastics Are Everywhere. What Does That Mean for Our Immune Systems”? by Jessica Hamzelou. Shefali Luthra: The Atlantic’s “Right Price, Wrong Politics,” by Annie Lowrey. Alice Miranda Ollstein: Politico’s “We’re on the Cusp of Another Psychedelic Era. But This Time Washington Is Along for the Ride,” by Erin Schumaker and Katherine Ellen Foley. Also mentioned in this week’s episode: - States Newsroom/The Georgia Recorder’s “Study Cited by Texas Judge in Abortion-Pill Case Under Investigation,” by Sofia Resnick. - Stat’s “From Drug Shortages to High Prices, U.S. System’s Shortcomings Have Deep Roots,” by Matthew Herper. Credits To hear all our podcasts, click here.	Drug Discoveries
It is just a question of time before our jittery, ultra-globalised world is hit by the next lethal pandemic. Nobody knows when it will strike, or what the Next Big One will be – an entirely new pathogen, perhaps, rather than bird flu or the Marburg virus – but I’m certain of one thing: Britain won’t be ready. We will run out of hospital and testing capacity. Our politicians will panic, dig out their catastrophically flawed Covid playbooks, and seek to terrorise us into another lockdown, guaranteeing our final moral and financial degradation. Let’s face it: Whitehall has learned almost nothing from the fiasco of 2020-22. There has been no proper cost-benefit analysis of lockdown. We haven’t engaged in a genuine inquest, our institutions haven’t been reformed, and the official inquiry will take too long and risks being captured by an establishment desperate to defend its legacy. Sir Keir Starmer, favourite to be our next prime minister, was at one with the Government and Matt Hancock on lockdowns – his only criticism was that he wanted more of the same, faster. This is why The Telegraph’s Lockdown Files are so important, and so clearly in the public interest. Given officialdom’s glacial progress, the free press has a duty to release information, accelerate debate and hold power to account. One question in particular that should trouble all of us is why so many of the claims made during the pandemic turned out not to be true. How much of this was genuine error or science not having caught up yet with a novel virus, and how much was it propaganda to make life easier for politicians, or to allow officials to save face? Why weren’t incorrect conclusions quickly rectified when the facts became clearer? We need to know. Why, for example, were we often told that the virus “doesn’t discriminate” while of course the old and very ill were the ones really at risk? It was obvious very early on – from the cruise ships that suffered early outbreaks, for instance, or from Italy – that fatality rates were massively age-contingent. Children were exceptionally safe. Or take the origins of the virus. Those who sought to explore whether it might have originated in a Chinese laboratory in Wuhan were demonised, ridiculed or cancelled. Now, the director of the FBI has concluded that this is the most likely explanation. This begs a crucial question: would we have followed China’s methods – lockdown and extreme social control – had we imagined the Beijing authorities were covering up a Chernobyl-style disaster? Might we not have gone for a more voluntarist, Swedish style approach? Where are the profuse apologies from all those who tarred supporters of the lab leak hypothesis as “racist”, “Trumpites” or “conspiracy theorists”? In some cases, at least at first, the experts really didn’t know: in the virus’s earliest days, its mortality rate was unclear. It was also plausible that it might spread via touch, hence the hand-washing campaign launched in March 2020. Three years on, a seminal meta-analysis by the Cochrane Library suggests that hand-washing does in fact cut the number of infections by 14 per cent, but only enough to slow spread down slightly in an exponential growth situation. There was also some justification at first for believing that the virus could be caught outside – but it soon became evident that this was in fact extremely unlikely, with the fresh air immediately diluting and dispersing the virus. When did the Government find out, and why didn’t it scrap all restrictions on outside gatherings early on? Many independent analysts realised pretty quickly that Covid was caught via airborne transmission, or aerosols, and that these were only really effective indoors. Yet a great many people were so scared by official pronouncements that they even washed their shopping. It was deemed dangerous to ask questions. What about masks? It is obviously true that a high-tech contraption able to filter out all particles would help greatly. In the real world, however, masks as they actually exist and are worn by fallible humans (including, ludicrously, children) were for show: the government encouraged people to wear useless (and often filthy or badly fastened) cloth garments that did nothing to stop the virus. Basic surgical face masks were useless, too. In theory, N95 masks are more effective, and can protect some individuals under certain conditions. In practice, however, the Cochrane meta-review is devastating: it finds, having analysed all available studies and randomised trials, that they do “not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers”. The authorities’ and scientific establishment’s decision to massively downplay the role of natural immunity in reducing the disease’s severity was another grave distortion of the truth. Yet the Lancet has now published a meta-review of 65 studies that finds that natural immunity (acquired as a result of catching Covid) protects as well as two vaccine shots. There were good reasons for people to get vaccinated: there was no need for officialdom to exaggerate the case. Crucially, the principal beneficiary of a vaccine is the person who is vaccinated: they are much less likely to die (especially if they are elderly or otherwise at elevated risk), and the illness is likely to be a lot less severe. It was never likely that vaccines would eliminate, or even drastically reduce, transmission: there are plenty of “breakthrough infections”, usually with much milder symptoms. The case for vaccine passports was always thus extremely weak – and in my view, massively outweighed by the loss in liberty. Covid saw endless politicians, bureaucrats, public health officials, scientists, professional journal editors, Twitter activists, Left-wing broadcasters and especially big tech firms transmogrify into authoritarian censors. They thought that “following the science” meant that their role was to amplify whatever the public health establishment’s most risk-averse current consensus was, rather than to pursue the truth independently. They convinced themselves that dissidents were heartless, paranoid freaks. They went on a terrifying power and ego trip. The lesson is clear. Even in a crisis, free speech and open inquiry must be nurtured: elite groupthink is too often wrong, and must at all times be scrutinised. Long live the free press.	Epidemics & Outbreaks
Moving towards a four-day working week across the NHS could help tackle burnout and stem the exodus of exhausted health workers, campaigners argue in a new report. “This year is the 75th birthday of the NHS. The government should mark this occasion by delivering a comprehensive workforce strategy that places work-time reduction at its core,” the report says. The 12-hour shifts that are the norm across much of the health service are worked only by 14% of nurses across Europe, according to research highlighted in the report – most of them in the UK, Ireland or Poland. In the short term, the campaign is calling for a pilot within the NHS of a 32-hour week, without a reduction in pay. “As the NHS is a 24/7 environment, it is likely that some additional staff will be needed to cover the hours across the week. There will be a cost involved to train, recruit, onboard and pay these additional employees, and it will require a strategically managed rollout,” the report says. “However, these additional costs must be measured alongside anticipated cost savings that will be made through reduced absenteeism, reduced reliance on more expensive agency staff and all-round improved job retention.” Companies participating in the recent pilot reported reduced sickness rates and staff turnover during the trial, as well as lower levels of burnout. Many NHS workers already work flexibly, but proponents of a four-day week argue that it is a way of ensuring the benefits of technology and innovative working practices trickle down to staff. The report suggests better use of technology could help to free up some staff time. “Data collection, processing, and other bureaucratic tasks such as appointment scheduling and prescription management take up a considerable amount of working time but have the potential to be automated to some degree,” it says. The report argues that NHS bosses should “lay out a clear pathway across five, 10, and 20-year horizons to have achieved a meaningful work-time reduction target well ahead of the centenary of the NHS in 2048”. The proposal is backed by Prof John Ashton, a former president of the Faculty of Public Health, who said a shorter working week in the NHS could “reduce sickness absence and improve morale, which would improve the quality of what people are doing when they are working”. Leaked projections from the government’s long-awaited workforce plan for the NHS suggest it could be short of 571,000 workers by 2036 unless current trends are reversed. Analysing data from recent NHS staff surveys, the new report shows a growing proportion of those leaving are citing work-life balance as the reason. Almost half of NHS staff – 47% – said they had felt unwell as a result of work-related stress at some point in 2021, up from 29% in 2010. Hundreds of thousands of NHS staff are being balloted on an enhanced pay offer after months of strikes that underlined staff shortages and rock bottom morale. The Trades Union Congress (TUC) general secretary, Paul Nowak, said that “staff burnout is a huge problem in the NHS and has directly contributed to the recruitment and retention crisis”, adding: “The TUC has called for advances in technology to pave the way for a shorter working week. In the immediate term we need a proper, fully funded NHS and social care workforce strategy.” The workforce plan for the NHS is believed to have been sent to ministers, but it is unclear whether the Treasury is willing to set aside additional funding to pay for training and retaining tens of thousands of extra health workers. When he was chair of the Commons health and social care select committee, Jeremy Hunt – now the chancellor – was a firm advocate of a workforce strategy, but the Treasury has been reluctant to find additional money to fund the NHS pay offer.	Stress and Wellness
Dr Nick Scriven can pinpoint the exact day he realised the NHS could no longer cope. “I first noticed it when I was on call on New Year’s Day 2012. We ran out of beds in our hospital. As a result medical patients had to occupy the beds in a surgical ward meant for people with broken bones waiting to have planned orthopaedic surgery. “We’d always had ‘outliers’, the occasional medical patient who’d ended up in a surgical bed. But this was the first time cases like that had ended up taking over almost all the 30 beds on the orthopaedic ward. This went on for a month and was a massive stress for everyone as we’d never had to cope with this amount of patients being looked after elsewhere before. “I hoped it was an anomaly but sadly the same thing happened every year after that,” says Scriven, who works at a hospital in Yorkshire. However, in his experience it was not until 2015 that the NHS went from struggling with just its usual “winter pressures” – a temporary overload in the cold months – to an “eternal winter”: the same difficulties but close to year-round. “This was evident in the number of ‘extra capacity’ beds opened across the NHS to relieve ‘winter pressures’ that were still open at Easter. This picture has continued to cause ever increasing concern and put pressure on staff and patients”, says Scriven, a former president of the Society for Acute Medicine. In other words, being overwhelmed became routine – a regular, predictable event – and has remained that way since. He was talking about England. But the trajectory of the health service in Scotland, Wales and Northern Ireland has followed the same pattern of dramatic, relentless decline. Scriven, a doctor for 32 years, says the NHS is in the worst state he has ever seen; it is in a “downward spiral”. “Care is in some respects dire. The target used to be to treat 95% of A&E patients within four hours. Now it’s just 76%. Patients face delays all year round that would have been unacceptable five to 10 years ago and until recently would have been reported to NHS England as an ‘adverse incident’. Unfortunately we are in the position where dire circumstances, such as ‘corridor care’, with the complete lack of privacy and dignity that people suffer while sat on a trolley waiting [to get a bed], have in fact been normalised.” The chief executive of one acute hospital trust in England gives an even bleaker assessment as the NHS prepares to mark the 75th anniversary of its creation on Wednesday, which will include a service of thanksgiving for 2,200 staff and volunteers at Westminster Abbey. “It feels like we are locked into a death spiral. The challenges today are far greater than anything over the last 20 years,” they say. “Waiting lists are incredibly long, with no viable solutions to reduce them. Morale is low. And people – both patients and staff – are frustrated, annoyed and angry. Financial pressures are mounting and with patients waiting far longer for their care and struggling to access care, it is likely harm is increasing. It feels like the NHS, on its 75th birthday, is in an utter mess.” How did the country’s most important public service end up in such a sorry state? Labour’s Wes Streeting, the shadow health secretary, regularly points out that when his party was in government it “delivered the shortest waiting times and the highest patient satisfaction in history”. While this is true, it would be wrong to suggest the NHS was in perfect shape under Labour. When it left office in May 2010 almost 2.6 million people were on the waiting list for hospital care and that total had been as high as 4.2 million. However, health experts point out that it took Labour time to get on top of the many problems in the NHS Tony Blair had inherited in May 1997, and that it needed years of sustained huge increases in the service’s budget and staffing to do that. It is instructive to compare the performance of the NHS’s “referral to treatment” (RTT) programme – the longstanding aspiration to treat 92% of everyone on the treatment waiting list within 18 weeks and a key metric of judging its overall ability to cope with the many pressures it is under – when Labour lost power in May 2010 and now, after 13 years of Tory-led administrations. When Gordon Brown left Downing Street the median wait for treatment under RTT was 5.5 weeks; today it is 14.1 weeks. While 2.6 million people were waiting then, today the figure is 7.33 million. Back then 92.1% of patients were seen within 18 weeks – the key 92% target was met – but NHS England’s last set of monthly performance statistics showed that now just 46% are seen within the target time. Many international studies have found that the effective performance of any health system depends primarily on two things: the money it gets and the staff it has. Analysis by the Health Foundation think tank shows that the NHS got annual budget rises of 3% during Margaret Thatcher and John Major’s Tory governments between 1979 and 1997. Under Blair and Brown between 1997 and 2010, the average soared to 6.7%. But during the Tory-Liberal Democrat coalition in 2010-15 it plummeted to 1.1% as a result of the austerity imposed on the entire public sector. David Cameron and Theresa May’s subsequent administrations from 2015 to 2018 gave the NHS only a little more – 1.7%. Funding only recovered to the 4%-a-year average that health economists say is the minimum investment to maintain a high-performing system under Boris Johnson, Liz Truss and now Sunak. The prime minister has made improving the NHS one of his five key priorities and surveys regularly remind him that it is an issue of acute concern to the public. But despite that, and despite the NHS having received an average annual increase to its income of 3.6% since its creation in 1948 and the service’s many visible problems – such as people dying of a heart attack or stroke because an ambulance took too long to reach them – the Health Foundation has found the service will receive a budget boost of just 1.2% this year. On staffing, the picture under the Tories is just as sobering. In March 2010 the NHS had 21,351 empty posts – a vacancy rate of 2.1%. At the end of March this year that had risen to 112,498 vacancies – 8% of the total workforce. In 2010 the service was short of 2,113 doctors and dentists and 8,153 nurses and midwives. Today it needs 8,549 medical staff and 40,096 nurses. In January the Care Quality Commission reported how when its inspectors visited Colchester hospital in Essex, it was so understaffed that there were too few people on duty to help some patients with their breakfasts, answer call bells promptly or clear dirty dressings from bedsides. Last Friday the government unveiled a 15-year NHS long-term workforce plan, though the planned increases in numbers of doctors and nurses will take years to start producing new recruits. Anita Charlesworth, the Health Foundation’s head of research, says the NHS’s sorry state is due to “a collision between rising demand over the long period, with the ageing population and people having more long-term health conditions, and medicine being able to do more, which is a positive thing, and constrained capacity, which was at least a decade in the making.” Covid’s arrival in early 2020 meant a system that was already “on the edge” of its ability to cope has since then in many ways fallen off a cliff, she says. “What’s striking about the current situation is that, while previously individual NHS services have struggled, now it’s every area of the NHS which is struggling at the same time as the social care system is struggling and at the same time as a cost of living crisis. It’s the combination of those factors that makes this so challenging.” She is particularly worried by several aspects of what she calls the NHS’s “managed decline”: the harm to patients who cannot get prompt care; that access to diagnostic tests such as a CT or MRI scan is too slow, delaying the start of treatment; and the fact that patients are struggling to get urgent and emergency care – to see a GP, start A&E treatment or get an ambulance after dialling 999 – not just to have planned surgery. The evidence about patient harm caused by care delays is growing. The Royal College of Emergency Medicine, which represents A&E doctors, estimates that 23,000 people – 442 a week – died during 2022 as a direct result of having to wait too long in an emergency department. Similarly, Association of Ambulance Chief Executives data shows that last December 57,000 patients were put at risk because of delays in ambulance crews handing them over to A&E staff, of whom 6,000 were exposed to “severe harm” as a result. Charlesworth denies that the NHS is slowly imploding. “I don’t think the NHS is failing. I think the NHS is being failed – failed by policy that is ineffective,” she says, referring to the neglect of the deepening workforce shortages, shortsighted approach to funding and failure to build hospitals and other new NHS buildings that have characterised all governments since 2010. The end result, she says, is that “we lack capacity. The gap between the pressures on the NHS and the resources available is as wide as it’s ever been. “In human terms that means patients aren’t getting timely care and staff are suffering the moral injury of not being able to do what they’re trained to do. So by failing to invest in the capacity the NHS needs we’re failing patients, we’re failing staff and we’re failing the taxpayer, because a productive and efficient NHS is also really important for economic growth.” In May Richard Taunt, a former deputy director at the Department of Health, published an essay setting out “the five reasons the NHS won’t live to see 100”. They included its highly centralised structures, a squeeze in the number of younger people available to become staff at a time when the ageing population is increasing demand, and the persistent mistake of treating illness but not preventing it. Back at the NHS frontline, the trust chief executive is surprisingly positive about its future. They hope that the next government quietly dismantles the 42 new “integrated care systems” – regional groupings of NHS trusts, which work with local councils and voluntary organisations to improve care – which they see as “an expensive failure”; and that ministers can somehow end the very debilitating wave of NHS pay strikes. “Whilst there are many reasons to feel anxious and the short-term future is almost certainly more challenging than the recent past, if we refocus on patient care and not just money, if we take difficult decisions and if we give people hope and belief, the NHS may survive to see its 100th birthday.” Despite laying bare the NHS’s many problems, Charlesworth, too, is hopeful. “I’m profoundly optimistic about the NHS’s future. First, public commitment to the NHS remains absolutely rock solid. Second, all the evidence is that tearing up our tax-funded free-at-the-point-of-use model of healthcare and moving wholesale to another [type of] system wouldn’t deliver benefits to patients or the taxpayer. And third, we have the fundamental building blocks of an effective healthcare system: strong primary care, a good focus on public health and a great science base. “But for the NHS to recover and survive and prosper, if we want a high-quality NHS, it has to be properly funded and have enough capacity. That is an enduring truth that no government should ignore.”	Health Policy
Electricity Saved My Brain This is the fourth part in a series on deep brain stimulation for depression. Read from the beginning. [Content note: This story contains discussion of suicide.] “The only thing I’ll slightly complain about — and it’s very vain — I only wish the batteries in your chest didn’t show up so much,” says Patient 001. There is an intense physicality to deep brain stimulation for depression. Participants have two slight bumps on their head, wires under the skin of their neck and a battery-powered control unit implanted under the skin in their chest. Because he was implanted with two sets of electrodes, Patient 001 has two battery packs, one on each side of his upper chest. He lives in a hot place near the ocean. “It just sucks I can’t take my shirt off at the beach and not be self-conscious about that.” Sometimes the devices in his chest feel alien to him when he’s going to sleep. “I put my hand on it to be comfortable,” he says. Amanda has a strained relationship with the device, too. “I don’t like the idea of it. I don’t like how it feels. Every time I accidentally touch the wire in my neck, I’m like, ‘Ugh, ugh, I don’t like it,’” she says. “It’s getting better, but sometimes I can still feel that thing in my chest just sitting there.” She also points out the annoyingly low-tech charging process, which is done with a wireless charger draped around her neck. Her charger shows only 10 percent increments, and the screen is on for only a minute before it locks up, without indicating that the charging is done. “They can get better at that part,” she says. In addition to the charging, there are lots of tasks these volunteers complete as part of the research — surveys, mood ratings, video journals. Twice daily, Amanda clicks what looks like a TV remote at home to collect brain data. “I’m Bluetooth-enabled,” she says with a laugh. “I upload from the computer to the server at the hospital.” She and others also make regular trips to the lab at Mount Sinai. These days, Jon takes the train from his house just outside Philadelphia to Mount Sinai so often that he knows exactly which crack in the sidewalk to stand by as he waits for his train at the New Jersey Transit station. On one of his visits to the lab, a mess of scalp electrodes were eavesdropping on his brain. The scientist doing the measurements, neuroscientist Allison Waters, mentioned that his electrode leads were zipping 130 pulses of electricity into his brain per second. “She just said it off the cuff,” Jon says. Later, with his daughter, Jon did the math for a full day, doubling it for each side: “22 million, 500 thousand electrical pulses to my brain,” Jon says. “That’s what has kept me alive.” During Jon’s surgery on August 22, 2022, doctors told him that his only job was to be present. After his incisions healed, he was given a new task: rehabbing his brain. Jon was initially dismissive of the new job. He already felt fantastic, cocky almost, and didn’t buy that he needed to work hard on rehab. “In the back of my head, I’m like, ‘OK, weirdos. I’m not sick. This is great. I’m good. I got this.’” But about six weeks after his surgery, everything fell apart. A malaise crept in, and Jon freaked out. “Oh my God, I feel it,” he said. “I feel it in my body.” He snapped right back into the habits that depression solidified: overeating, sleeping too much and hiding away from his family. “My wife, I’ll never forget it, was like, ‘Hey, we got an appointment at the school.’” But Jon told her he couldn’t make it; he was busy. It was a lie. “I didn’t have anything going on,” he says. Subscribe to Science News Get great science journalism, from the most trusted source, delivered to your doorstep. Jon knew that as part of the study protocol, around the sixth month, researchers would turn off his stimulation, a looming event that made him intensely anxious. His shift alarmed him so much that on the night of October 6, he sent an email to the Mount Sinai psychiatrist Martijn Figee to ask if his stimulation had been turned off earlier than planned. “Is there an earlier part of the program where it gets shut off too, such as now, and that is also part of the experiment?” Jon wrote. “Even if it was shut off, could you even tell me that?” An hour and a half later, the email back was clear: “Your device is absolutely on.” His psychologist would address it with him at their next appointment. Relearning to live with emotions As brain implants are used more and more, the risks of DBS have become somewhat clear. Regardless of why a person is getting it or where in the brain it targets,the technique can, like any medical procedure, go sideways. Electrode leads in the brain can break; the chest controller can fail; batteries can die. Infections, in both the head and chest, are a risk, as is wire tethering, a painful condition, also called bowstringing, in which scar tissue grows around the wire in the neck. DBS can also carry risks that are distinct from other surgeries. Electrical stimulation in certain parts of the brain has been linked to unwanted behavioral changes. For people receiving stimulation for Parkinson’s disease, there have been cases of gambling problems and hypersexual behavior. In one unusual case, a Dutch man treated for obsessive-compulsive disorder developed a brand-new and intense affinity for Johnny Cash hits, especially “Ring of Fire,” “Folsom Prison Blues” and “Sunday Morning Coming Down.” When his stimulations diminish or his batteries die, the man subconsciously switches back to listening to his old favorites — Dutch-language songs and classics by the Beatles and the Rolling Stones. People being treated with DBS for depression have experienced relapses when the device accidentally stops working, for instance due to a battery failure or a wire breaking. But that’s not what happened to Jon. Worries over spiraling dark moods surface among people with DBS for depression, says psychologist Shannon O’Neill, who works with Jon and other people treated with DBS at Mount Sinai. “We often talk significantly about the difference for them of how they can distinguish between depression and normal everyday sadness,” O’Neill says. This is the rehab part, she says. People who have lived with severe depression for years need to relearn how to recognize and tolerate garden-variety emotions, including sorrow. As O’Neill describes ordinary sadness, it reminds me of the analogy that emotions are like the weather. We can spend the morning under heavy cloud cover, and then maybe we luck out with a full-blast sunny afternoon. But it’s fleeting. Likewise, our feelings are impermanent, O’Neill says. “Negative emotions come and go, just like positive emotions come and go. It can be passing and not ever-present.” Emily Hollenbeck, whose DBS surgery was in 2021, says her recovery took time. “You’re letting your brain relearn how to live in the world without the constant threat of severe negativity, suicidality, all of that.” She had to learn how to cope with emotions, and trust that she’ll get through bad situations. “Basically, I’m relearning how to ride the bike, you know?” Understanding that these feelings are transitory — that ups and downs happen — is something people with severe depression haven’t practiced, because they hadn’t had to. They’ve been perpetually stuck under heavy cloud cover. Emerging into an emotional landscape with those ups and downs can be intensely unsettling. “At first it was scary,” says Amanda, who had DBS surgery last fall. “At first I felt like I was standing on the edge of a cliff.” An artist, Amanda draws her experiences to help her think them through. One of her pictures shows a cartoon Amanda wearing a rainbow shirt, standing high on a ledge of bright green grass with blue sky overhead. But she’s looking over the edge to the darkness below. “I had been pulled out of this giant pit, and I was worried that I would fall back in it again.” But she hasn’t. When people recover from depression with DBS, they generally stay well, several studies suggest. Between three and six years after surgery, about 60 percent of patients had sustained improvements, Mayberg and colleagues reported in 2011 in the American Journal of Psychiatry. In a longer-term study, most of a group of 28 people who had deep brain stimulation for major depression or a type of bipolar disorder saw benefits for more than eight years, the researchers reported in 2019 in the same journal. Does DBS make people happy? The idea of a machine forcing happiness on us or taking away sorrow — that kind of mind control is unsettling for most of us. We are fiercely protective of the idea that our feelings originate inside of ourselves, that we are in charge here. So the idea that artificial happiness can be created by a computer that controls electrodes in our brain hooked to wires that snake down our neck? No thanks. That sentiment is understandable, but it’s not what people with these implants experience. As I’ve talked with people who had lived first with devastating depression and then with these devices, I have come to think that these implants do not make a person feel artificial joy. “DBS is not going to give you happiness,” O’Neill says. Instead, “it just kind of clears the way.” Overcoming misconceptions about what this technology can and can’t do is yet another burden for Jon and others. The patients I spoke with were incredibly candid about their depression and their treatment. They graciously tolerated my questions. But being open about their medical condition and treatment can exact a steep price. If you or someone you know is facing a suicidal crisis or emotional distress, call or text the 988 Suicide & Crisis Lifeline at 988. This series was made possible with funding from the Alfred P. Sloan Foundation.	Mental Health Treatments
Scientists conducted clinical trials into the effects of an herbal extract on mild cognitive impairment (MCI) found the herbal extract improved participants’ memory in under three months. Sailuotong (SLT) is an herbal preparation containing standardized extracts of Panax ginseng, Ginkgo biloba and Crocus sativus L. The patients also performed better during executive function tasks, such as staying focused despite distractions and multitasking. The Australian research team behind the study also believes dementia—to which MCI is considered a precursor—could be warded off using SLT, and hope to conduct longer studies that might indicate that. The herbal mixture has been developed as part of a long-standing collaboration between Western Sydney University’s NICM Health Research Institute and Xiyuan Hospital and the China Academy of Chinese Medical Sciences in Beijing. SLT was already shown to be an anti-inflammatory antioxidant, with antiapoptotic, and cholinergic-enhancing properties—and the team says previous studies have demonstrated SLT’s safety and potential cognitive benefits in vascular dementia and neuro-cognition in healthy adults. However, this latest study, published in the journal Alzheimer’s & Dementia, sought to test SLT as a potential treatment for MCI, which is characterized by cognitive decline including memory and thinking difficulties, and is often viewed as a precursor to dementia, affecting 17 percent of the world population over the age of 60. The researchers conducted a 12-week trial of 78 participants aged 60 and older, all with previous diagnoses of MCI. The participants were randomly assigned either a 180mg capsule of SLT each day or a placebo. The team’s positive results showed significant improvement in the logical memory of the elderly adults who received the SLT, compared with those in the placebo group. The SLT group also exhibited improved performance in executive function tasks such as planning, exercising self-control, following multiple-step directions even when interrupted, staying focused despite distractions and multi-tasking. “People with mild cognitive impairment have an increased risk of dementia—over fivefold in some cases—and at the moment we do not have any approved medications for mild cognitive impairment,” said lead author Associate Professor Genevieve Steiner-Lim, at NICM Health Research Institute. “Our findings are very promising as they show that even after a relatively short treatment period of just 12 weeks, SLT can support important aspects of memory and thinking in people with mild cognitive impairment.” Participants also showed few incidences of any mild or moderate side effects. Although she admits that further research into the long-term benefits and the impact of the herbal extract on daily functioning and quality of life is needed, Dr. Steiner-Lim remains optimistic about SLT potentially helping to delay dementia. The team hopes to conduct another trial with a larger sample size and longer treatment period to test whether SLT can be used to treat mild cognitive impairment and potentially delay a diagnosis of dementia. A cursory search into any proven benefits of the three herbs individually shows that, for ginseng, the U.S. FDA and Federal Trade Commission have issued numerous warnings since 2019 to manufacturers of those dietary supplements for making false claims of health or anti-disease benefits. But for Ginkgo, a meta analysis of studies showed in 2017 that evidence suggested it has potentially beneficial effects over placebo on cognitive performance. The Crocus sativus flower is used in the culinary spice saffron, which has also been used for health purposes, especially in traditional Asian medicine. Its biologically active chemical compounds (mainly alkaloids, anthocyanins, carotenoids, flavonoid, phenolic, saponins, and terpenoids) can cause a mood-enhancing effect in persons with major depressive disorder, among other benefits including sleep and vision problems. DON’T FORGET to SHARE The Memory Tips On Social Media…	Disease Research
Nurse Lucy Letby became "agitated" when a team of specialists arrived to help with the treatment of a premature baby boy, her trial has heard. Ms Letby is accused of trying to kill the boy, referred to as Child N, on three occasions at the Countess of Chester Hospital in June 2016. The nurse is charged with murdering seven babies and attempting to murder 10 others between 2015 and 2016. The 33-year-old, originally from Hereford, denies 22 charges. The prosecution allege Ms Letby made her first attempt on Child N's life on 3 June, before carrying out two more attacks 12 days later. Child N's deteriorations were consistent with some kind of "inflicted injury" or him having received an injection of air, the jury has heard. Manchester Crown Court heard how doctors were called to attend the baby boy on several occasions throughout the day of 15 June. Ms Letby "called for help" after the boy's first "profound desaturation" shortly before 07:15. Nursery nurse Jennifer Jones-Key, who was working that morning, told the court how Ms Letby, who was just beginning her shift, came onto the unit to "say hello", as the pair were friends. Ms Jones-Key said: "I think the monitor then went off, so Lucy went over to see. [Child N] went quite pale, I think he'd stopped breathing." The nurse said she assisted Ms Letby with breathing support until doctors arrived. The court heard how medics struggled to fit Child N with a breathing tube due to help unexplained "swelling" in his throat. The tube was eventually fitted and the boy stabilised for several hours before crashing again that afternoon. Ms Letby's nursing note from 14:50 that day recorded that Child N "became apnoeic" and that there was "fresh blood" around his mouth. Doctors again struggled to insert a breathing tube, the court heard. At 19:40 there was a further "profound desaturation" and Child N required resuscitation and six doses of adrenaline before he stabilised. A doctor, who cannot be named for legal reasons, told the court she remembered Ms Letby being "agitated" when a team of specialists from Alder Hey Hospital arrived to help with Child N's treatment. She said: "She approached me a few times and said 'who are these people, who are these people?'. "From working alongside the nurses and doctors at Chester, I felt that it was out of character from what I'd experienced previously in a medical emergency." In a message to a colleague that evening, Ms Letby said: "[Child N] poorly, bled again and became apnoeic. Two anaesthetic consultants failed to intubate. "Sat having a quiet moment and want to cry." In a message to another colleague, Ms Letby said she was "losing the will". In his opening address last October to the jury, Ben Myers KC, defending, said Child N was another baby who received "sub-optimal care" - not from the defendant - and should have been treated elsewhere at a specialist "tertiary" unit. Questioning Ms Letby's former colleague Ms Jones-Key, Mr Myers asked if in her opinion, Ms Letby was a "capable and hard working nurse". She agreed. Mr Myers asked, to her knowledge, whether Ms Letby only gave "the highest level of care" to the babies assigned to her. Ms Jones-Key responded: "Yes, definitely." The trial continues.	Epidemics & Outbreaks
Nov. 8, 2023 â Getting COVID-19: No fun. The same is true of flu or RSV. But getting more than one of them at the same time? Now youâre talking about what could be a really dangerous situation.Â As the colder months creep up on us, so does the spread of the big three respiratory viruses: COVID, influenza, and respiratory syncytial virus. The good news is we now have an updated COVID vaccine, flu shots that protect against multiple strains of the virus, and RSV vaccines for older folks, pregnant people, and infants. Yet despite our prevention efforts, some unlucky few may contract not just one of these viruses, but two at once or in close succession during the winter season.Â While we canât predict what the season will look like this year, last yearâs data from the CDC showed that RSV, COVID, and flu didnât all peak at once â which is good news for both patients and health care systems.Â Hereâs why thatâs good news: Last winter was the first time Panagis Galiatsatos, MD, a pulmonary and critical care doctor at Johns Hopkins,Â saw patients coming in with both COVID and flu. Far more often than not, he said, patients had only one of these viruses; still, the number of those with both flu and COVID he saw last year was âalarming.âÂ âPatients that had co-infections were by far our sickest patients,â Galiatsatos said. âThis is also a clinical bias because Iâm a critical care physician, but all of the patients I met with co-infections were in the intensive care unit.â How Do You Know If You Have More Than One Virus?Â When it comes to just how many people experience co-infections like this, itâs hard to tell. Most of these diagnoses come from being hospitalized, where doctors will typically test for all three viruses. For those who donât end up in a hospital, they might not know they have more than one infection, especially because the symptoms are similar. A runny nose, cough, fever, and body aches can happen with all three viruses.Â Because of the accessibility of COVID tests, itâs more likely that if you get sick and test positive for COVID, you probably wonât seek out a flu or RSV test at a medical facility if your infection isnât dire enough to prompt a hospital visit.Â Testing for all three isnât a necessity for everyone, said Peter Chin-Hong, MD, an infectious disease expert at the University of California, San Francisco. The elderly, very young, and people with weakened immune systems should definitely seek further testing as soon as theyâre able to.Â However, those who donât fall into those categories can still get tested for all three viruses. Based on what doctors have seen in the past, thereâs a higher chance that if you have two viruses, itâs probably COVID and flu, not RSV. And early testing in these cases can save patients a lot of grief because we have antiviral treatments for flu and COVID that we donât have for RSV.Â What to Do If You Have Flu and COVIDÂ âFirst thing is, donât panic,â says Chin-Hong. If you test positive for COVID at home and you have symptoms, seek out the drug Paxlovid within 5 days of being sick. If it turns out you have the flu as well as COVID, you can get antivirals like Tamiflu within the first 48 hours of symptoms, which may shorten the illness by a day or more.Â Thereâs been some confusion around who exactly qualifies for Paxlovid. The FDA has said that it is approved for the treatment of âmild to moderate COVID-19 in adults who are at high risk of progressing to severe COVID-19,â but some may assume they arenât in the high-risk category and donât seek it out.Â There is still a reluctance to take Paxlovid, from patients who are worried about the âreboundâ and from doctors who are hesitant to prescribe it, said Bernard Camins, MD, an infectious disease expert at Mount Sinai in New York City.Â âWe need to be more willing to prescribe Paxlovid as physicians,â Camins said. âSometimes doctors will say, âOh, youâre not feeling too bad, letâs not do it.â The problem is it might be too late by the time [the patient] does get sick enough.âÂ Regarding the infamous COVID rebound -- where patients develop COVID again shortly after recovering -- that many have associated with Paxlovid use, doctors like Chin-Hong and Camins want patients to know that this rebound is pretty typical, with or without Paxlovid.Â And in the respiratory virus season in particular, Chin-Hong said, what you might think is a rebound of COVID symptoms may very well be another virus, like influenza or RSV.Â Does One Virus Make You More Susceptible to Getting Another?Â The short answer: It depends on who you are, what activities you do, and the timing of your infection.Â Studies on COVID have shown that there can be long-term damage to immune systems after recovering from an infection. Sometimes having two viruses at once can make you sicker, as was the case for Galiatsatos's patients. Researchers have also found that patients who tested positive for influenza had a decreased risk of testing positive for COVID; but for those who did have co-infections, the disease was much more severe and left even more long-term damage to the lungs.Â Having COVID is the most common denominator when it comes to people with multiple infections, Galiatsatos said, due to its ability to invade the immune cells, weakening patients and making them more vulnerable to catching other viruses.Â But there is still a lot we donât know about co-infections with COVID, flu, and RSV. According to William Schaffner, MD, an expert in preventative medicine and infectious diseases at Vanderbilt University in Nashville, a non-immunocompromised person isnât more likely to get infected with another virus if they already have one.Â âThat is, unless their behaviors lead them to greater exposure,â Schaffner said. âIf people arenât vaccinated, donât wear masks, or have a personal behavioral disposition to constantly expose themselves to vociferous crowds, well, they're more likely to pick up one or more of these infections during the course of the winter.Â âThatâs simply because they're exposing themselves. It doesn't have anything to do with their immune systems.âÂ	Epidemics & Outbreaks
More and more people are making it to the 100-year milestone. Nearly 90,000 people were at least 100 years and older in the U.S. as of 2021, almost double the amount 20 years prior, according to data from the United Nations. So — what’s their secret? The odds of being alive for a full century depend on many different factors, including genetics, location, gender and socioeconomics — but there are some healthy steps people can take to help improve their chances, experts say. "Gerontological research indicates that the pursuit of longevity is far more than wishful thinking," Melanie Avalon, a health influencer, entrepreneur and biohacker based in Los Angeles, told Fox News Digital. "Modern science has revealed several actionable, evidence-based methods that can promote longevity, even for those without the ‘perfect symphony’ of genes." Fox News Digital spoke with multiple doctors, nutritionists and other wellness experts to get their top tips for boosting longevity. Here are 10 of them. 1. Cultivate curiosity A strong sense of curiosity — a natural desire for knowledge and exploration — is seen as a key to living a long, healthy life, according to Lauren Henkin, CEO and founder of The Humane Space, a wellness company based in Maine. "Research suggests that adults with a continued desire to learn and explore tend to live longer than their less curious peers, even when accounting for other risk factors," she told Fox News Digital. Feeding our curiosity stimulates cognitive engagement and mental agility, which may help to prevent cognitive decline and neurodegenerative diseases as we age, Henkin said. "Curiosity about other people also helps us nurture meaningful relationships that provide emotional support and reduce stress, both of which are known to enhance longevity," she noted. Curiosity can also support what’s known as "adaptive aging," the expert said. "The more curious you are, the more likely you are to seek out solutions to the various problems that arise during the aging process," Henkin pointed out. "This might be one reason why studies show that curiosity in older people is associated with maintaining the health of the aging central nervous system." Living a more curious life might entail things like learning a new skill, traveling to a new place, reading a book about a subject that interests you or simply asking more questions in your conversations with people, Henkin said. 2. Stay social Experts agree that regular interaction with other people is a big longevity-booster. "Isolation is bad for brain health and increases the risk for major brain diseases, such as Alzheimer’s," Dr. Vinita Tandon, medical director at Lifeforce, a wellness and fitness company in San Francisco, told Fox News Digital. "The more curious you are, the more likely you are to seek out solutions to the various problems that arise during the aging process." "It’s important to prioritize social connectedness, and finding community and belonging can improve health and well-being," she went on. "Pets can also be a great option for introverts." Dr. Sandi Petersen, senior VP of health and wellness at Pegasus Senior Living in Dallas, Texas, backs up this theory. Among her senior patients, 15 of whom have reached the 100-year mark during her career, she identifies social engagement as the common thread. "One lady who just turned 107 goes to eat burgers with her son every week, goes to happy hour every day and has a steady stream of people in and out of her assisted living apartment — the door is propped open all the time to invite interaction," Peterson told Fox News Digital. 3. Keep moving "As we become older, we naturally become less mobile," said Lindsay Tullis, a certified health coach at Mighty Health, a wellness company in South Dakota. "That immobility can lead to larger health risks, but by staying active, you can delay and reduce the risk of things like arthritis, joint issues and chronic illness." Not only does staying active have physical benefits, it’s also great for improving mood and brain function, Tullis told Fox News Digital. "If you want to increase your longevity, keep your body moving," she said. "Even just 10 minutes of movement per day can have a major impact." Dr. Carl P. Giordano, chief science officer and orthopedic spine surgeon at Atlantic Spine Specialists in New Jersey, told Fox News Digital that exercise has been shown to facilitate DNA repair, activate antioxidant defense mechanisms, reduce inflammation, improve immune function and boost metabolic health. "Exercise — whether it’s strength training, aerobic conditioning, balance or stretching — is a form of adversity, as is a cold plunge," he said. "It will make you stronger as long as it doesn’t hurt your body." And that doesn’t always have to mean hitting the gym or pounding the pavement. "If you want to increase your longevity, keep your body moving. Even just 10 minutes of movement per day can have a major impact." As Tandon pointed out, studies have found that the longest-living people in the world don’t necessarily work out regularly or run marathons. They are the people who "move naturally in their everyday environments without thought," whether that is gardening, walking or doing work around the house. 4. Understand your health One of the first steps to age management is knowing where you are on the health continuum, according to Eric Casaburi, founder and CEO of Serotonin Centers, an anti-aging company in Orlando, Florida. "Consistently tracking the progress of your body and your health is important in order to have a clear idea of what it is you need to improve and/or watch for — such as hormone levels, dietary habits and blood work," Casaburi told Fox News Digital. "The younger a person begins to understand their personal health metrics, the better off they’ll be in the long run," he added. As biohacker Avalon pointed out, it’s particularly important to stay on top of cardiovascular health, as ischemic heart disease is the leading cause of mortality. "While interpreting conventional blood lipid panels can be complicated, a person can test for the less common but more revealing apoB and Lp(a) blood biomarkers for a more clear picture of cardiovascular risk," she told Fox News Digital. "Testing for the genetic APOE4 allele can also reveal genetic dispositions for cardiovascular disease." 5. Consider intermittent fasting Caloric restriction is the only dietary approach shown in animal studies to extend lifespan, Avalon noted. "That said, time-restricted eating, also known as intermittent fasting (IF), may be a formidable alternative, especially in humans," she told Fox News Digital. There are several types of intermittent fasting, but they all follow the same concept of alternating between fasting and eating for various windows of time. Beyond weight loss, intermittent fasting triggers a multitude of beneficial cellular processes, the expert said. "These include improved metabolic function, increased insulin sensitivity, reduced levels of inflammation, activation of the MAPK pathway (a chain of cellular proteins that regulates many biological processes) and the stimulation of autophagy (a sort of cellular cleanup process)," Avalon said. Intermittent fasting provides these health benefits without traditional calorie restriction, which can potentially cause nutrient deprivation, she added. 6. Prioritize your sleep Dave Asprey, author of "Smarter Not Harder" and founder of Upgrade Labs, the world's first biohacking gym in California, calls sleep the "ultimate longevity biohack." "When you sleep, your body repairs and rejuvenates itself," he told Fox News Digital. "Studies show that high-quality sleep promotes skin health and youthful appearance, controls insulin secretion (making you less likely to develop diabetes) and encourages healthy cell division," all of which are essential for longevity, Asprey noted. For a better night's sleep, the expert recommends getting five minutes of morning sun as soon as you wake up in the morning, eating your last meal at least three hours before bedtime and wearing blue light-blocking glasses when the sun goes down. "Artificial blue light coming from your computer screen and indoor lighting messes with your body’s natural rhythms," Asprey said. "Wearing glasses that block these junk frequencies gives your body the signal that it’s time for bed." 7. Get your minerals and fat-soluble vitamins Minerals are responsible for the chemical reactions that take place in your body, helping to convert your food into energy, Asprey said. "They work together with fat-soluble vitamins D, A, K, and E — which I like to call vitamin DAKE — to keep your immune system working right, your hormones balanced and your metabolism running properly," he told Fox News Digital. "Getting enough of these essential nutrients helps you stave off chronic diseases that accelerate aging." Most people are deficient in at least one of the fat-soluble vitamins and/or minerals, Asprey warned. "I recommend taking a vitamin DAKE supplement and a mineral supplement daily to get everything you need to support longevity," he said. 8. Consider taking cold showers Studies have linked cold therapy to increased longevity and disease prevention. With this in mind, Tandon recommends incorporating cold showers into your daily routine. "These regulate longevity biomarkers like adiponectin, which reduces inflammation and enhances insulin sensitivity, leading to longevity," she said. Research has also shown that cold therapy lowers blood pressure and improves metabolism, Tandon pointed out. "One study showed that people who regularly took cold showers saw a 29% reduction in sickness-related absences from work," she said. 9. Be mindful of what and how much you eat Diet is one of the most controllable factors of longevity, experts agree, with a wide range of options for nutrition improvements. One tip is to incorporate more fermented foods. As Tandon pointed out, research shows that people who consume low-sugar, probiotic-rich fermented foods like yogurt, kefir, kimchi and miso improved their gut microbiota diversity. "The microbiota diversity decreases inflammation markers like the C-reactive protein that is associated with heart diseases, diabetes and mental decline," she said. Many experts also agree that plant-focused diets are beneficial to longevity. "Plant-centered diets are essentially normal proteins and complex carbohydrate diets," noted Giordano. "These have been shown to maintain metabolic function, decrease inflammation and down-regulate mTOR, which promotes the recycling of misfolded proteins in the cells of the body," he added. To regulate portion sizes and prevent obesity, Tandon also recommends following the "80 rule" when eating. "In the city of Okinawa, one of the places in the world with the lowest rates of illness and longest life expectancy, they practice ‘Hara Hachi Bu,’ which translates to ‘eating only until 80% full,’" she said. "This practice has been shown to help Okinawans live healthier and longer lives." 10. Connect to your purpose Studies have shown that having a sense of purpose in life results in better cognitive function and longevity, noted Serena Poon, a nutritionist and longevity wellness expert in Los Angeles. "There's a transformative power that arises when you're aligned with your passions, when you sense that your actions are making a positive impact on the world, or when you feel a profound sense of purpose in your life," she told Fox News Digital. "These connections infuse you with a distinct vitality." This might also mean taking up a hobby or learning a new complex skill, like playing an instrument or learning a new language. "Skills that require you to be mentally and physically present help exercise your brain and create strong new neural pathways," Poon said. "This can help when you’re trying to train your brain to adopt new habits throughout your life for longevity."	Longevity
It has been over three years since Covid-19 cases were first diagnosed in the United States. And while President Joe Biden announced last week that he intends to end the state of national emergency around Covid-19, this does not mean the pandemic is over. Although much is now known about this coronavirus, many questions remain, especially as the virus continues to evolve and infect people on a large scale. There were more than 280,000 new coronavirus cases diagnosed in the last week, according to the US Centers for Disease Control and Prevention. This is almost certainly an undercount, given the many home tests not included as part of the official tally. A frequent question from CNN readers and viewers is what it means if someone has Covid-19 symptoms but tests negative for the virus, especially if they have been exposed. Why does that happen? Should they test again and when? Are there other tests they should get, including for other viruses? How can someone find out if they’ve already had Covid-19? To help us with these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.” CNN: Many people believe they have symptoms of Covid-19 but are testing negative. Why does that happen? Dr. Leana Wen: There are several possibilities. First, Covid-19 often presents like other viral illnesses. Common symptoms include a fever, cough, runny nose, headache or body aches, a sore throat and diarrhea. These are types of symptoms also seen with other viral illnesses, including influenza and adenovirus. It’s possible you may have symptoms you’re identifying as evidence of a Covid-19 infection that are actually due to another virus. Second, you may be testing too soon after being infected with Covid; there may not be enough virus present to trigger a positive result. Generally, it takes at least two days after exposure to develop symptoms and/or to have a positive result. Many times, though, there isn’t enough virus to trigger a positive test until at least five days after exposure. This is why repeated testing is important, especially if you are taking home rapid antigen tests. Third, the test may be a false negative. Home antigen tests are less accurate than PCR tests. If you have a high likelihood of contracting Covid-19 — for example, if you were exposed to someone who had the coronavirus and now you have symptoms, but you’re still testing negative from a home test — you may wish to get a PCR test. CNN: If someone were exposed to another person who has Covid-19, when should they get tested, and with what test? Wen: If you were exposed to someone with Covid-19, you should wait until it’s been at least five days after exposure to get tested, according to the CDC. Either an antigen test or a PCR test could be used at this point. But because it’s still possible to develop symptoms after five days, the CDC recommends you wear a mask when in public indoor places for a total of 10 days. You should also monitor your symptoms; if you develop any, even after five days following a potential exposure, you should get tested again. CNN: What if you’ve had direct exposure — for example, from a spouse who has Covid-19 — and have symptoms, but still get a negative test after five days? Wen: If you took a rapid antigen test, I’d recommend taking another one the next day. It’s possible your viral load was not high enough the first time around. (This is also the guidance suggested by the U.S. Food and Drug Administration.) If the repeat test is still negative, and it’s important for you to find out whether you have Covid-19, you could go take a PCR test. The PCR test is more accurate, though the caveat is that it picks up viral remnants. That means if it’s positive, it could mean you recently recovered from Covid-19. If all these tests are negative, another possibility is that you have a different viral illness, and should still continue to wear a mask in public until 10 days after your exposure. Also, be careful around vulnerable individuals while you are symptomatic, even if it’s not from Covid-19. If you have a trip to a nursing home planned to visit your elderly aunt, for example, or you’re planning to host dinner with an immunocompromised guest, you should postpone until your symptoms are gone and your 10-day quarantine period has completed. CNN: If your Covid-19 test is negative, should you get tested for other viruses? Wen: It depends. If you are a generally healthy person and have mild symptoms, testing is probably not required. You should use symptomatic management, meaning to drink lots of fluids, rest and take over-the-counter analgesics like acetaminophen or ibuprofen as needed. If you have underlying medical conditions, you might be particularly concerned about influenza. There are antiviral treatments available, and you should consider speaking with your doctor about flu testing and if you are eligible for them. Some physicians’ practices are now routinely testing for Covid-19, influenza and respiratory syncytial virus (RSV). When in doubt, speak with your doctor. And make sure to call your doctor if you develop worsening or particularly concerning symptoms, such as shortness of breath, chest pain or an inability to keep down fluids. CNN: How can someone find out if they’ve already had Covid-19? Wen: There is an antibody blood test to the SARS-CoV-2 Nucleocapsid available from commercial laboratories like Quest Diagnostics and Labcorp. This specifically looks for prior infection. If it comes back positive, it means that you had Covid-19 at some point. It does not tell you when. So if you want to find out if a particular bout of recent symptoms was from the coronavirus, this test wouldn’t help. And remember, having had Covid-19 in the past doesn’t mean that you can’t get sick from it again.	Epidemics & Outbreaks
America’s pharmaceutical giants are suing this summer to block the federal government’s first effort at drug price regulation. Last year’s Inflation Reduction Act included what on its face seems a modest proposal: The federal government would for the first time be empowered to negotiate prices Medicare pays for drugs — but only for 10 very expensive medicines beginning in 2026 (an additional 15 in 2027 and 2028, with more added in later years). Another provision would require manufacturers to pay rebates to Medicare for drug prices that increased faster than inflation. Those provisions alone could reduce the federal deficit by $237 billion over 10 years, the Congressional Budget Office has calculated. That enormous savings would come from tamping down drug prices, which are costing an average of 3.44 times — sometimes 10 times — what the same brand-name drugs cost in other developed countries, where governments already negotiate prices. These small steps were an attempt to rein in the only significant type of Medicare health spending — the cost of prescription drugs — that has not been controlled or limited by the government. But they were a call to arms for the pharmaceutical industry in a battle it assumed it had won: When Congress passed the Medicare prescription drug coverage benefit (Part D) in 2003, intense industry lobbying resulted in a last-minute insertion prohibiting Medicare from negotiating those prices. Without any guardrails, prices for some existing drugs have soared, even as they have fallen sharply in other countries. New drugs — some with minimal benefit — have enormous price tags, buttressed by lobbying and marketing. AZT, the first drug to successfully treat HIV/AIDS, was labeled “the most expensive drug in history” in the late 1980s. Its $8,000-a-year cost was derided as “inhuman” in a New York Times op-ed. Now, scores of drugs, many with much less benefit, cost more than $50,000 a year. Ten drugs, mostly used to treat rare diseases, cost over $700,000 annually. Pharmaceutical manufacturers say high U.S. prices support research and development and point out that Americans tend to get new treatments first. But recent research has shown that the price of a drug is related neither to the amount of research and development required to bring it to market nor its therapeutic value. And selling drugs first in the U.S. is a good business strategy. By introducing a drug in a developed country with limited scrutiny on price, manufacturers can set the bar high for negotiating with other nations. Here are just a few of the many examples of drug pricing practices that have driven consumers to demand change. Exhibit A is Humira, the best-selling drug in history, earning AbbVie $200 billion over two decades. Effective in the treatment of various autoimmune diseases, its core patent — the one on the biologic itself — expired in 2016. But for business purposes, the “controlling patent,” the last to expire, is far more important since it allows an ongoing monopoly. AbbVie blanketed Humira with 165 peripheral patents, covering things like a manufacturing step or slightly new formulation, creating a so-called patent thicket, making it challenging for generics makers to make lower-cost copycats. (When they threatened to do so, AbbVie often offered them valuable deals not to enter the market.) Meanwhile, it continued to raise the price of the drug, most recently to $88,000 a year. This year, Humira-like generics (called biosimilars for its type of molecule) are entering the U.S. market; they have been available for a fraction of the price in Europe for five years. Or take Revlimid, a drug by Celgene (now part of Bristol Myers Squibb), which treats multiple myeloma. It won FDA approval to treat that previously deadly disease in 2006 at about $4,500 a month; today it retails at triple that. Why? The company’s CEO explained price hikes were simply a “legitimate opportunity” to improve financial “performance.” Since it must be taken for life to keep that cancer in check, patients who want to live (or their insurers) have had no choice but to pay. Though Revlimid’s patent protection ran out in 2022, Celgene avoided meaningful price-cutting competition by offering generic competitors “volume-limited licenses” to its patents so long as they agreed to initially produce a small share of the drug’s $12 billion monopoly market. Par Pharmaceutical, another drugmaker, maneuvered to create a blockbuster market out of a centuries-old drug, isoproterenol, through a well-meaning FDA program that gave companies a three-year monopoly in exchange for performing formal testing on drugs in use before the agency was formed. During those three years, Par wrapped its branded product, Vasostrict, used to maintain blood pressure in critically ill patients, with patents — including one on the compound’s pH level — extending its monopoly eight additional years. Par raised the price by 5,400% between 2010 and 2020. When the covid-19 pandemic filled intensive care units with severely ill patients, that hike cost Americans $600 million to $900 million in the first year. And then there is AZT and its successors, which offer a full life to HIV-positive people. Pills today contain a combination of two or three medicines, the vast majority including one similar to AZT, tenofovir, made by Gilead Sciences. The individual medicines are old, off-patent. Why then do these combination pills, taken for life, sometimes cost $4,000 monthly? It’s partly because many manufacturers of the combination pills have agreements with Gilead that they will use its expensive branded version of tenofovir in exchange for various business favors. Peter Staley, an activist with HIV, has been spearheading a class-action suit against Gilead, alleging “collusion.” The negotiated price for these pills is hundreds of dollars a month in the United Kingdom, not the thousands charged in the U.S. Faced with such tactics, 8 in 10 Americans now support drug price negotiation, giving Congress and the Biden administration the impetus to act and to resist Big Pharma’s legal challenges, which many legal experts view as a desperate attempt to stave off the inevitable. “I don’t think they have a good legal case,” said Aaron Kesselheim, who studies drug pricing at Harvard Medical School. “But it can delay things if they can find a judge to issue an injunction.” And even a year’s delay could translate into big money. Yes, American patients are lucky to have first access to innovative drugs. And, sadly, patients in countries that refuse to pay up once in a while go without the latest treatment. But more sadly, polling shows, large numbers of Americans are forgoing prescribed medicines because they can’t afford them.	Health Policy
Bacterial diversity in the gut plays an important role in human health. The crucial question, however, is where are the sources of this diversity? It is known that an important part of the maternal microbiome is transferred to the baby at birth, and the same happens during the breastfeeding period via breast milk. Further sources were yet to be discovered. However, a team led by Wisnu Adi Wicaksono and Gabriele Berg from the Institute of Environmental Biotechnology at Graz University of Technology (TU Graz) has now succeeded in proving that plant microorganisms from fruit and vegetables contribute to the human microbiome. They report this in a study published in the journal Gut Microbes. You are what you eat The authors were able to demonstrate that the frequency of fruit and vegetable consumption and the variety of plants consumed influences the amount of fruit- and vegetable-associated bacteria in the human gut. Early childhood in particular represents a window of opportunity for colonisation with plant-associated bacteria. It was also demonstrated that the microorganisms of plant origin have probiotic and health-promoting properties. A microbiome is the totality of all microorganisms that colonise a macroorganism (human, animal, plant) or a part of it, for example the intestine or a fruit. While the individual microbiomes are becoming better understood, little is known about their connections. “The proof that microorganisms from fruits and vegetables can colonise the human gut has now been established for the first time,” explains first author Wisnu Adi Wicaksono. This suggests that the consumption of fruit and vegetables, especially in infancy, has a positive influence on the development of the immune system in the first three or so years of life, as the intestinal microbiome develops during this time. But even after that, a good diversity of gut bacteria is beneficial for health and resilience. “It simply influences everything. Diversity influences the resilience of the whole organism; higher diversity conveys more resilience,” says Institute head Gabriele Berg. Several billion sequences In order to be able to determine that the consumption of fruits and vegetables and their microbiomes actually leads to changes in the intestinal microbiome, the team first created a catalogue of microbiome data from fruits and vegetables which enabled them to assign their bacteria. They compared these with publicly available data from two studies on intestinal flora. The TEDDY project looked at the development of babies in a long-term study and the American Gut Project studied the intestinal microbiome of adults – both projects also collected data on the food intake of the test persons. In total, the researchers had metagenome data from around 2500 stool samples at their disposal, each of which contained between one and ten million sequences – several billion sequences were thus evaluated. Using this extensive data set, the presence of fruit and vegetable microflora in the gut could be demonstrated. This evidence is a crucial building block in proving the WHO’s One Health concept, which closely links human, animal and environmental health. Follow-up study on three continents To further explore this connection, together with international colleagues and within the EU-funded HEDIMED project (www.hedimed.eu) Gabriele Berg at the Institute of Environmental Biotechnology is already working on an intervention study in which people on three continents eat exactly the same things for a certain period of time, following which their excretions are analysed. But even beyond that, Gabriele Berg sees many areas that could be influenced on the basis of the study’s findings. This starts with food production, as soil, fertiliser and pesticides affect the plant microbiome. “Fresh fruit and vegetables will always have the best microbiome; agriculture or processing companies already have a major influence here. And the storage and processing of food must also be critically reconsidered,” explains Berg. Depending on the findings of the planned study, there could also be exciting applications for individuals. “Every fruit and vegetable has a unique microbiome. So maybe at some point a personalised diet can be put together based on that.” This research is anchored in the Field of Expertise "Human & Biotechnology", one of five strategic foci of TU Graz. Would you like to receive the latest stories, news, research stories, interviews or blog posts from TU Graz directly on your smartphone or in your email inbox? Subscribe to the TU Graz Telegram newsletter free of charge.	Nutrition Research
In a discreet corner of a cafe in Chester, Dr Stephen Brearey recalls the exact moment he first connected Lucy Letby to a series of unusual baby deaths on the neonatal unit where they worked. It was in a meeting with the hospital’s head of nursing and two other colleagues on Thursday, 2 July 2015. “It can’t be Lucy. Not nice Lucy,” he told them. More than eight years later, 33-year-old “nice Lucy” faces the rest of her life in prison after being found guilty of murdering seven babies and attempting to kill another six in crimes without parallel in modern Britain. Through exclusive interviews, the uncovering of internal confidential documents, and months of reporting from Manchester crown court, the Observer can today tell the full story of how concerns were raised about Letby for months before she was eventually removed from frontline care in July 2016. The failure of hospital executives to take urgent action cost the lives of at least two babies – two triplet brothers, murdered within 24 hours of each other – and prolonged Letby’s attacks on other newborns at the Countess of Chester hospital in north-west England, senior doctors believe. The decisions of executives will now be investigated as part of a non-statutory public inquiry that will scrutinise what they knew and when and, crucially, why no investigation was ordered into the mounting death toll until July 2016 – more than a year after Letby’s presence at a series of unexplained deaths was known. It will also examine why it took almost another year before executives spoke to the police. Following Letby’s conviction on Friday, the Observer can today reveal that detectives have begun contacting more families whose children they believe may have been harmed by the nurse. The investigation is examining the records of more than 4,000 babies born at the Countess of Chester hospital and Liverpool Women’s hospital in the six years to mid-2016. One family, whose child was born at the Liverpool hospital when Letby worked there as a trainee, was told by police earlier this year that their case was being investigated as part of the multi-million pound inquiry, Operation Hummingbird. Dozens more potential victims’ families are expected to be contacted in the coming months. The story of how Letby was finally stopped begins in June 2015. Three newborn babies had died on the neonatal unit in the space of just 14 days. It was a year’s worth of deaths in two weeks. Brearey, the head consultant paediatrician on the unit, carried out an urgent review. Each of the infants – two boys and a girl, each less than a week old – had been healthy, despite their prematurity. A fourth baby – the twin sister of one of the boys – had almost died after deteriorating suddenly during this two-week period. There was no obvious cause for the deaths, so Brearey called a meeting with Alison Kelly, the hospital’s head of nursing, and Eirian Powell, the manager of the neonatal unit, on 2 July. There had been only one nurse on duty for each of the four unexplained incidents, the meeting was told. Her name was Lucy Letby. Letby, then 25, had worked on the neonatal unit for five years by that point. She was well-liked, particularly by Powell and the nurses, and had become an integral part of the team, in part because she was qualified to care for the most unwell babies – those in intensive care – and often volunteered to work extra shifts. Until April 2016, she lived in staff digs a short walk from the unit, which was handy because she liked to work the night shift, which started at 7.30pm and finished at 8am. It gave her cover for her crimes, as there were fewer staff and parents on the unit overnight. But no one, at this time, was prepared to think the unthinkable. Letby carried out many of her attacks just moments after the babies’ parents or nurses had stepped out of the nursery. But on one occasion, she was almost caught in the act. A mother arrived on the neonatal unit at about 9pm with breast milk for her twin boys when she saw Letby standing over one of their incubators. There was fresh blood around his mouth and he was screaming in agony. When the mother asked Letby what was happening to her days-old son, the nurse tried to assure her that he was fine and said words to the effect of: “Trust me. I’m a nurse”. By the end of October 2015, five months after Letby was first connected to the unexplained deaths, seven babies had died in unusual circumstances – more than double the mortality rate for an average year. Letby was found guilty of murdering five of those children. The other two cases were investigated by police, the Observer has been told, but they were not brought to trial. Another review, in October 2015, again found that Letby was the only staff member present at each of the unexplained deaths. Powell is understood to have raised the mortality rate again with Kelly and another senior manager, but the connection to Letby was felt to be just coincidence, according to Brearey. Letby, who had by now murdered five babies and attempted to kill another three, was allowed to remain on the unit. But senior doctors, who had been prepared to give the young nurse the benefit of the doubt, were now becoming increasingly concerned. They asked an independent expert, Dr Nimish Subhedar, to carry out a review of the unusual deaths to find any common themes. He found that the babies had been otherwise stable when they suddenly deteriorated and that all had, unusually, failed to respond to life-saving treatment. Further, their collapses had all happened in the middle of the night. Letby was again noted to be on shift in each case. Brearey sent the report to the hospital’s medical director, Ian Harvey, in early February 2016 and requested an urgent meeting. Yet despite the rising death toll, no such meeting took place for another three months. This, according to Brearey and other senior doctors, is the point when action should have been taken. Letby’s connection to the deaths was now more than just a coincidence. And no examination so far had found any innocent explanation for them. But yet again, nothing appears to have been done. In May 2016, by which time Letby had murdered five babies, a hospital manager produced a two-page document responding to the concerns of Brearey and his fellow consultant paediatricians. It was the first time anyone beyond the senior doctors had initiated a formal review of the concerns, despite their gravity. It began: “There is no evidence whatsoever against LL [Lucy Letby] other than coincidence.” It was not until June 2016 that Letby was removed from the neonatal unit, after murdering two otherwise-healthy triplet brothers within 24 hours of each other. They were her 12th and 13th victims. It was, said Dr John Gibbs, another consultant paediatrician on the unit, the “tipping point” that prompted senior doctors to demand the Hereford-born nurse be taken away from their newborn patients. But this was a year after an executive first learned of her association with unusual fatalities. By this time, she had murdered seven infants and attempted to kill another six, making her the worst child serial killer in modern British history. What came next is described by the senior doctors as a Kafkaesque nightmare, in which they felt their concerns were not only dismissed, but they were treated with as much suspicion as Letby. This attitude came from the top down, starting with the hospital’s then-chief executive Tony Chambers, according to Brearey. “I was talking about all of [the concerns] in one of our meetings with [the executives] in early July [2016] and Chambers’s response was: ‘Well that would be very convenient’,” said Brearey. A second senior doctor corroborated Brearey’s recollection of the meeting, on 4 July 2016. According to the doctors, Chambers was implying that the deaths and unusual collapses were a result of poor care rather than deliberate harm. “It just astonished me, that attitude, which I think was shared with most of the other execs and probably stemmed from the sort of culture that he gave to the trust as a chief exec,” said Brearey. Chambers told the Observer that this was a “one-sided account of the meeting where what I said has been taken out of context”. He added: “I also said that there were a significant number of factors to consider, including demand, acuity, clinical care, staffing and environment.” Despite the concerns about Letby, she was moved to the hospital’s risk and patient safety office. It can now be revealed that she was involved with raising serious incident investigation reports to NHS England – a role that would have given her sensitive access at a time when she was effectively under suspicion of murdering infants. It is not clear who took the decision to move her to the office, nor how long she was there. But the fact she was moved there at all proves, say the senior doctors, that their concerns about Letby were treated “with contempt”. “It was just unfathomable really. You couldn’t make it up,” said Brearey. Executives eventually ordered two further reviews in July 2016, yet neither was asked to look specifically at the concerns about Letby. Both concluded that a number of the deaths needed further forensic investigation. Harvey, the medical director, and Chambers, the chief executive, said in a January 2017 meeting with senior doctors that Letby had been proved innocent – and would be returning to the neonatal unit within weeks. Brearey and his consultant colleagues were stunned. Not only was Letby being allowed to return to the unit, but the senior doctors were ordered to apologise to her for raising the concerns. Two consultants, Brearey and Dr Ravi Jayaram, were told to enter a mediation process with the nurse. Her father, they were told, had threatened to refer them to the General Medical Council unless they withdrew their allegations and welcomed her back. Faced with the threat of disciplinary action, the doctors sent Letby a carefully worded apology on 28 February 2017. Their letter, which has been seen by the Observer, reads: “Dear Lucy. The increased mortality on the neonatal unit and subsequent reviews and re-designation of the neonatal unit has been very stressful time for all staff and parents. We understand that it has been an exceptionally stressful time for you. “We would like to apologise for any inappropriate comments that may have been made during this difficult period. As you will be aware, emotions have run high. We are very sorry for the stress and upset that you have experienced in the last year. Please be reassured that patient safety has been our absolute priority during this difficult time.” Less than three months later, after weeks of anguished meetings about how to prevent Letby from returning to work, Brearey and his colleagues contacted Cheshire police. It was that meeting, on 27 April 2017, that triggered one of the biggest and most complex murder investigations of recent times in Britain. Brearey’s colleague Jayaram said he “could have punched the air” when the now-retired detective chief superintendent, Nigel Wenham, listened to the consultants and said that their concerns were “something that [the police] have to be involved with”. Letby had been just six days from returning to work on the neonatal unit at this point. Instead, she never set foot on the ward again. The next time senior doctors would see her was when her picture appeared on the television news, after her arrest more than a year later, in July 2018. DS Paul Hughes, who led the investigation, told the Observer the information provided by Brearey and his colleagues had been “the golden thread” for their inquiry. “They have been very brave in coming forward and they’ve put this ahead of their careers, in my view,” he said. “If it wasn’t for their ongoing determination, would there have been more [murders]? I don’t know. It’s difficult to answer or speculate on the future. But they’ve done well.” If there was a smoking gun in this medically complex case, it was uncovered by one of Letby’s colleagues. On the night before Valentine’s Day in February 2018, nearly a year after police launched their investigation, Brearey was hunched over his computer screen when he spotted something unusual. He had been asked by detectives to review the care of siblings and twins on the unit and was looking at the records of a seven-day-old boy. The infant, known as Child F, had suffered a serious collapse on the unit in August 2015, a day after his twin brother had died unexpectedly. In the very last paragraph of Child F’s discharge letter was a line about his insulin level and the level of another hormone called C-peptide. In normal readings, the insulin level would be between 200 and 300. For Child F it was 4,657. The results also showed a very low C-peptide level. It was conclusive proof that he had been poisoned. Letby had laced his feeding bag with insulin a day after fatally injecting air into the bloodstream of his six-day-old twin brother. It was a miracle that Child F had survived. “I just had this gut-wrenching moment: ‘What the fuck is this?!,’” said Brearey. “It was a smoking gun. You saw it there, in plain sight. If there was any iota of doubt [about her guilt], it was removed then.” It was, said DCI Nicola Evans, a “real milestone” in the investigation. “We were shocked to the core,” she said. Letby was arrested five months later, at 6am on 4 July 2018. Her father, John, had stayed the night, and watched as his daughter was led out of her three-bedroom house, where she lived alone with her two cats, Tigger and Smudge, in her nightie and a blue Lee Cooper tracksuit. Within weeks of her arrest, two of the senior executives involved – Chambers and Harvey – had left the hospital. Kelly, the first to be told of Letby’s connection to unusual deaths, departed soon after. None of the hospital’s leadership was required to give evidence at the 10-month trial at Manchester crown court, yet they will all be expected to cooperate with the inquiry that will follow. Gibbs, a consultant paediatrician who gave evidence 13 times to Letby’s trial, said the executives must explain why they failed to take action sooner. “Things could have been done differently and probably should have been done differently,” he said. Gibbs, who has since retired, said he did not know what information hospital leaders had at the time but that more “decisive action” should have been taken in February 2016, five months before Letby was eventually removed, following the murder of the two triplets. “The only people that can tell you that are the managers themselves, so it has to be looked into,” he said. “Why did the trust manage it the way they did? What information were they getting? And if this sort of concern arose again, in any department in any hospital, how could it be managed differently?” Letby is expected to become only the third woman in Britain to be given a whole-life prison term, meaning that she will never be released, when she is sentenced on Monday. She was found guilty of seven charges of murder and seven of attempted murder. The attempted murders relate to six babies, as several charges apply to some of the infants. She was found not guilty of two charges of attempted murder. The jury was unable to reach verdicts on six further charges of attempted murder, which related to five babies. The Crown Prosecution Service is considering whether to seek a retrial on those charges. Harvey, the hospital’s former medical director, said he would help the inquiry “in whatever way I can”. He added: “As medical director, I was determined to keep the baby unit safe and support our staff. I wanted the reviews and investigations carried out, so that we could tell the parents what had happened to their children.” Kelly, the hospital’s former head of nursing, said she too would fully cooperate with the inquiry. She added: “It is impossible to imagine the heartache suffered by the families involved and my thoughts are very much with them. These are truly terrible crimes and I am deeply sorry that this happened to them. We owe it to the babies and their families to learn lessons and I will fully cooperate with the independent inquiry announced.” Chambers, the former chief executive, said: “All my thoughts are with the children at the heart of this case and their families and loved ones at this incredibly difficult time. I am truly sorry for what all the families have gone through. “The crimes that have been committed are appalling and I am deeply saddened by what has come to light. “The trial, and the lengthy police investigation, have shown the complex nature of the issues raised. I will cooperate fully and openly with any post-trial inquiry.”	Epidemics & Outbreaks
Fruit flavours may be banned and extra taxes applied to e-cigarettes, in a crackdown on vaping aimed at children. Legislation to allow tighter restrictions was promised in the King's Speech, earlier on Tuesday. The move, which could apply to the whole of the UK, could also see vapes having to be hidden from view in shops and plain packaging introduced. And, as promised last month, ministers will also be looking to raise the age of sale for smoking. The idea is to raise the age at which tobacco products can be bought by a year every year from 2027. It would mean those currently aged under 15 could never buy cigarettes or tobacco legally. Prime Minister Rishi Sunak announced the policy a month ago - but he has promised MPs a free vote on the issue. The proportion of 11- to 17-year-olds who vape has doubled in the past two years, to 7.6%. And the government is currently consulting on measures to tackle the rise in youth vaping. But the King's Speech, setting out the government's priorities for the next year, revealed legislation would be brought forward to push through a tightening of the rules once the consultation had finished. Measures being considered include: - restricting how vapes are described - limiting flavours to tobacco or tobacco and mint only - banning displays in shops, so vapes remain hidden, as is the case for cigarettes - introducing plain packaging, to stop the use of cartoons and animal characters - banning the use of disposable vapes Introducing a new tax on e-cigarettes is also proposed - value added tax (VAT) is already applied - to make vapes more expensive. It is currently three times cheaper to vape than smoke - although, the consultation has urged careful consideration as vapes are also an important tool to help smokers quit, as they carry a fraction of the risk. Hazel Cheeseman, from the Action on Smoking and Health campaign group, welcomed the move. "Vapes have been a valuable aid to help smokers quit - but vaping has been growing among teens," she said. "Further regulations are needed to ensure products are not promoted or sold to teens." Ms Cheeseman also backed the idea of an extra tax on vapes, to reduce their affordability for teenagers, but added it was important they remained "cheaper than lethal tobacco products".	Health Policy
Worried parents protested in Iran’s capital Tehran and other cities on Saturday over a wave of suspected poison attacks that have affected schoolgirls in dozens of schools, according to Iranian news agencies and social media videos. The so-far unexplained illnesses have affected hundreds of schoolgirls in recent months. Iranian officials believe the girls may have been poisoned and have blamed Tehran’s enemies. The country’s health minister has said the girls have suffered “mild poison” attacks and some politicians have suggested the girls could have been targeted by hard line Islamist groups opposed to girls’ education. Iran’s interior minister said on Saturday investigators had found “suspicious samples” that were being studied. “In field studies, suspicious samples have been found, which are being investigated … to identify the causes of the students’ illness, and the results will be published as soon as possible,” the minister, Abdolreza Rahmani Fazli, said in a statement carried by the official news agency IRNA. Sickness affected more than 30 schools in at least 10 of Iran’s 31 provinces on Saturday. Videos posted on social media showed parents gathered at schools to take their children home and some students being taken to hospitals by ambulance or buses. A gathering of parents outside an Education Ministry building in western Tehran on Saturday to protest over the illnesses turned into an anti-government demonstration, according to a video verified by Reuters. “Basij, Guards, you are our Daesh,” protesters chanted, likening the Revolutionary Guards and other security forces to the Islamic State group. Similar protests were held in two other areas in Tehran and other cities including Isfahan and Rasht, according to unverified videos. The outbreak of schoolgirl sickness comes at a critical time for Iran’s clerical rulers, who have faced months of anti-government protests sparked by the death of a young Iranian woman in the custody of the morality police who enforce strict dress codes. Social media posts in recent days have shown photos and videos of girls who have fallen ill, feeling nauseous or suffering heart palpitations. Others complained of headaches. Reuters could not verify the posts. The United Nations human rights office in Geneva called on Friday for a transparent investigation into the suspected attacks and countries including Germany and the United States have voiced concern. Iran rejected what it views as foreign meddling and “hasty reactions” and said on Friday it was investigating the causes of the incidents. “It is one of the immediate priorities of Iran’s government to pursue this issue as quickly as possible and provide documented information to resolve the families’ concerns and to hold accountable the perpetrators and the causes,” Foreign Ministry spokesperson Nasser Kanaani told state media. Schoolgirls were active in the anti-government protests that began in September. They have removed their mandatory head scarves in classrooms, torn up pictures of Supreme Leader Ayatollah Ali Khamenei and called for his death.	Epidemics & Outbreaks
News Sad Girl Playlists Aren’t Just Trendy—Study Finds Sad Music Can Boost Your Mental Health By Alyssa Hui Updated on June 20, 2023 Fact checked by Nick Blackmer Fact checked by Nick Blackmer Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years of experience in consumer-facing health and wellness content. health's fact checking process Share this page on Facebook Share this page on Twitter Share this page on Pinterest Email this page New research suggests that listening to sad music can positively impact a person’s mood based on the sense of connectedness it provides.Experts cite three responses to sad music: grief, melancholia, and sweet sorrow.Experts agree that music of all kinds can play a role in people’s mental health and mood, but music is a personal, unique experience for each listener. A new study found that listening to sad music can impact a person’s mood positively, based on a revived sense of connectedness. When you’re at a party or social gathering you may queue an upbeat song, such as “That’s What I Like” by Bruno Mars. On other days, you might just want to listen to something that’s a bit more gloomy and relatable like Taylor Swift’s “Anti-Hero.” Whatever music you enjoy listening to most, whether that be hip-hop, country, rock, or jazz, it can oftentimes influence your mood and feelings. This is especially true when it comes to sad music. Various features of a song, including tempo, mode, instrument choice, and dynamics, can prompt negative emotions in listeners, Tara Venkatesan, PhD, a cognitive scientist at Oxford University and an operatic soprano, told Health. However, a new study published in the Journal of Aesthetic Education, which Venkatesan was a part of, suggests that while listening to sad music can certainly make people feel sad, doing so may also impact a person’s mood positively and allow them to feel a sense of connectedness. “Our main point is that the value of sad music lies in its ability to create a sense of connection, regardless of whether it actually evokes sadness in the listener,” Venkatesan clarified. “And it’s that sense of connection, not necessarily the experience of sadness itself, which is what makes listening to sad music really great!” Getty Images / Westend61 Why Do People Love Sad Music? The researchers hypothesized that people value sad music for the same reasons they might value sad conversations—a sense of genuine connection. For example, when someone tells you about their horrible break up, you might feel sad yourself because of how genuinely devastated and lonely they are feeling, Venkatesan explained. However, as you continue talking, you might feel like there’s something meaningful about that interaction and connected with this person in a unique way. The research team demonstrated sad music’s ability to provide a sense of connection in two parts. In the first part, the researchers wanted to show that emotional expression is a characteristic value of what music is all about. They gave nearly 400 participants a description of four different songs including: A song that “conveys deep and complex emotions” but is “technically very flawed”A song that is “technically flawless” but “does not convey deep or complex emotions”A song that is “deeply emotional” and “technically flawless”A song that is both unemotional and “technically flawed” Participants were asked to rank songs based on which pieces embodied “what music is all about.” They found that participants valued emotional expression more than technical proficiency when reviewing their song choices. Highly emotional songs, even of lesser technical value, were chosen at a much higher rate. For the second part of their experiment, the authors asked 450 new participants to rate how connected they felt when listening to music or participating in conversations that expressed 72 different emotions, including inspiration, love, sadness, contempt, etc. They found that the emotions that make people feel connected in conversation are also the emotions whose expression in music matched the “what music is all about” highly rated songs: sadness, love, joy, loneliness, and sorrow. Furthermore, participants said that songs expressing sad emotions like suffering and despair are unpleasant to listen to but still capture the essence of what music is all about and make for high-connection conversations. “In other words, regardless of whether we enjoy sad music, we value sad music because it creates a sense of connection,” Venkatesan explained. Other research has suggested that people listen to sad music for no particular motivation other than the fact that they like this music or band. In fact, a 2014 study highlights that nearly a third of participants listened to sad music when they were in a positive mood. Does Listening to Sad Music Evoke Sadness? Whether or not sad music makes a person feel sad depends on each individual and their experience, Shannon Bennett, PhD, site clinical director for NewYork-Presbyterian’s Center for Youth Mental Health, told Health. For example, a person might feel sad when they hear a certain song because that song might be connected to a particular memory. Since our emotions and memories are very connected, when we listen to a song that evokes a certain memory, it can cause us to feel sad. “If a piece of music is connected to either of those experiences that could then bring on a real feeling of sadness,” Bennett explained. “But that to me is a more personal experience in terms of how intense that feeling is, how long it lasts, and then importantly what we do with it.” This aligns with a 2016 study that found people who listen to sad music can perpetuate cycles of negative thinking and often prompts them to think about sad memories or negative thoughts. Music, and our response to it, is a unique and personal experience. While sad music can generally make people feel sad, depending on the mental health state of an individual, it can evoke other emotions as well, added Venkatesan. She cited previous research on people’s experience of sad music and noted three main categories expressed: grief, melancholia, and sweet sorrow. “While grief consisted mainly of negative emotions like despair, both melancholia and sweet sorrow consisted of more mixed emotions like longing and nostalgia and even positive emotions like comfort and pleasure,” she said. Music and Mental Health Bennett clarified that sad music does not automatically indicate sad emotion for the listener—it can actually impact the listener’s mental health positively. “Music can be a way to practice just sitting with a feeling that sometimes is harder to sit with and that is actually emotionally very helpful,” she added. “We call that an emotional exposure that in fact is used in some very well-researched therapy protocols to help us to sit with emotions that we sometimes don’t want to sit with.” Sad music can also make people feel connected in the same way a heartfelt conversation makes us feel connected, said Venkatesan. “It is very likely that the sense of connection we experience when listening to sad music has positive health benefits.” Some studies suggest that listening to sad music creates a feeling of “emotional communion” where you share feelings of sadness with the singer or composer. Venkatesan explained that in this case, listening to sad songs may act as a form of virtual contact which can help people feel accepted, understood, and less lonely. She added that other studies suggest that listening to sad songs allows us to connect with ourselves and reflect on our own emotional experiences which can help with mood regulation. Venkatesan noted that music, in general, has a profound effect on our brains and physiology and therefore can also impact our mood. For example, some research suggests that relaxing music can decrease levels of salivary cortisol and psychological stress, which is an indicator of decreased stress and better regulation when responding to a stressor. Bennett noted in the same way that a sad song might evoke a sad emotional state, there are ways to use music to evoke a positive emotional state. There are also ways that people can choose positive behaviors that might move them in the direction of positive emotion. Bennett concluded, “My hope is that this research will help people just recognize that feeling sad is okay and also that there are things that we can do to help us move out of that feeling.” Was this page helpful? Thanks for your feedback! Tell us why! Other Submit 6 Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Attie-Picker M, Venkatesan T, Newman GE, Knobe J. On the value of sad music. J Aesthet Educ. Published online April 18, 2023. Tallahassee Memorial Healthcare. How music affects your mind, mood and body. Taruffi L, Koelsch S. The paradox of music-evoked sadness: an online survey. PLoS One. 2014;9(10):e110490. doi:10.1371/journal.pone.0110490 Garrido S, Schubert E, Bangert D. Musical prescriptions for mood improvement: an experimental study. Arts Psychother. 2016;51:46-53. doi:10.1016/j.aip.2016.09.002 Van den Tol AJM, Edwards J, Heflick NA. Sad music as a means for acceptance-based coping. Music Sci. 2016;20(1):68-83. doi:10.1177/1029864915627844 Ooishi Y, Mukai H, Watanabe K, Kawato S, Kashino M. Increase in salivary oxytocin and decrease in salivary cortisol after listening to relaxing slow-tempo and exciting fast-tempo music. PLoS One. 2017;12(12):e0189075. doi:10.1371/journal.pone.0189075	Mental Health Treatments
DEA chief grilled on Biden’s plans to deschedule marijuana Rep. Matt Gaetz (R-Fla.) and Rep. Steve Cohen (D-Tenn.) demanded further information from the Drug Enforcement Administration (DEA) about its plan to remove marijuana from the list of schedule one drugs during a House Judiciary hearing Thursday. DEA Administrator Anne Milgram testified before the House Judiciary Subcommittee on Crime and Federal Government Surveillance during which she informed committee members that the agency has “not been given a specific timeline” to review and reevaluate marijuana’s classification. President Biden put out a marijuana reform statement in October 2022 that called on the Department of Health and Human Services (HHS) and the attorney general to reevaluate the federal law’s scheduling of marijuana. The DEA must receive HHS’s review and recommendation to conduct its own evaluation process before coming to a scheduling decision, according to Milgram. To Gaetz’s dismay, the DEA has yet to receive any such materials from HHS. “That’s unsettling, isn’t it? When you don’t even know a timeline, it doesn’t really make it seem like something’s front of mind,” Gaetz said to Milgram after she disclosed the status of this procedure. Cohen supported Gaetz’s stance on the matter, forming a rare bipartisan agreement in the House. Cohen claimed that the federal discourse around marijuana has always been “governmental gibberish,” and that “the government has messed this up forever.” Drug scheduling is used by the DEA to create lists of substances ranked by their acceptable medical use and the level of use considered abusive. Marijuana currently stands on the schedule one list, the classification meant for the world’s most dangerous drugs. Other substances on this list include heroin, LSD and ecstasy. “What I will say to you, not specific to marijuana, but just overall, is that I am committed on trying to move things as quickly as we can,” Milgram said in response to Cohen’s question whether the department can do anything to speed up the process. After hearing Milgram’s answer, Cohen told the administrator that he would help her out by calling his former colleague, the HHS secretary, today. “We’re going to get this moving,” he added. Gaetz also mentioned that marijuana’s current status provokes opioid dependencies and accidental fentanyl overdoses. The Florida Republican explained that without medical marijuana, patients with chronic pain are more likely to turn to opioids to manage their symptoms, which is often the gateway to an addiction. Fentanyl, which Milgram said is one of the deadliest drugs to exist, was not classified as a schedule one substance when Biden put out his marijuana reform statement in 2022. Fentanyl related substances were moved to the schedule one list in 2018, but fentanyl itself remains under a schedule two classification on account of its medical value. “I really hope we get this done,” Gaetz told Milgram. “We’re two years into the Biden administration. And I honestly had hoped that by now, we would have already descheduled marijuana from the schedule one list.” Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.	Drug Discoveries
CNN — A rough respiratory virus season in the US appears to be easing, as three major respiratory viruses that have battered the country for the past few months are finally all trending down at the same time. A new dataset from the US Centers for Disease Control and Prevention shows that the number of emergency department visits for the three viruses combined – flu, Covid-19 and RSV – have dropped to the lowest they’ve been in three months. The decline is apparent across all age groups. Measuring virus transmission levels can be challenging; health officials agree that Covid-19 cases are vastly undercounted, and surveillance systems used for flu and RSV capture a substantial, but incomplete picture. But experts say that tracking emergency department visits can be a good indicator of how widespread – and severe – the respiratory virus season is. “There’s the chief complaint. When you show up to the emergency room, you complain about something,” said Janet Hamilton, executive director at Council of State and Territorial Epidemiologists. “Being able to look at the proportion of individuals that seek care at an emergency department for these respiratory illness concerns is a really good measure of the respiratory disease season.” In the week following Thanksgiving, emergency department visits for respiratory viruses topped 235,000 – matching rates from last January, according to the CDC data. While the surge in emergency department visits early in the year was due almost entirely to Omicron, the most recent spike was much more varied. In the week ending December 3, about two-thirds of visits were for flu, about a quarter were for Covid-19 and about 10% were for RSV. Grouping the impact of all respiratory viruses together in this way offers an important perspective. “There’s a strong interest in thinking about respiratory diseases in a more holistic way,” Hamilton said. “Transmission is the same. And there are certain types of measures that are good protection against all respiratory diseases. So that could really help people understand that when we are in high circulation for respiratory diseases, there are steps that you can take – just in general.” Now, Covid-19 again accounts for most emergency department visits but flu and RSV are still the reason behind about a third of visits – and they’re all trending down for the first time since the respiratory virus season started picking up in September. More new data from the CDC shows that overall respiratory virus activity continues to decline across the country. Only four states, along with New York City and Washington, DC, had “high” levels of influenza-like illness. Nearly all states were in this category less than a month ago. Whether that pattern will hold is still up in the air, as vaccination rates for flu and Covid-19 are lagging and respiratory viruses can be quite fickle. Also, while the level of respiratory virus activity is lower than it’s been, it’s still above baseline in most places and hospitals nationwide are still about 80% full. RSV activity started to pick up in September, reaching a peak in mid-November when 5 out of every 100,000 people – and 13 times as many children younger than five – were hospitalized in a single week. RSV particularly affects children, and sales for over-the-counter children’s pain- and fever-reducing medication were 65% higher in November than they were a year before, according to the Consumer Healthcare Products Association. While “the worst may be over,” demand is still elevated, CHPA spokesperson Logan Ramsey Tucker told CNN in an email – sales were up 30% year-over-year in December. But this RSV season has been significantly more severe than recent years, according to CDC data. The weekly RSV hospitalization rate has dropped to about a fifth of what it was two months ago, but it is still higher than it’s been in previous seasons. Flu activity ramped up earlier than typical, but seems to have already reached a peak. Flu hospitalizations – about 6,000 new admissions last week – have dropped to a quarter of what they were at their peak a month and a half ago, and CDC estimates for total illnesses, hospitalizations and deaths from flu so far this season have stayed within the bounds of what can be expected. It appears the US has avoided the post-holiday spike that some experts cautioned against, but the flu is notoriously unpredictable and it’s not uncommon to see a second bump later in season. The Covid-19 spike has not been as pronounced as flu, but hospitalizations did surpass levels from the summer. However, the rise in hospitalizations that started in November has started to tick down in recent weeks and CDC data shows that the share of the population living in a county with a “high” Covid-19 community level has dropped from 22% to about 6% over the past two weeks. Still, the XBB.1.5 variant – which has key mutations that experts believe may be helping it to be more infectious – continues to gain ground in the US, causing about half of all infections last week. Vaccination rates continue to lag, with just 15% of the eligible population getting their updated booster and nearly one in five people remain completely unvaccinated. Ensemble forecasts published by the CDC are hazy, predicting a “stable or uncertain trend” in Covid-19 hospitalizations and deaths over the next month. And three years after the first Covid-19 case was confirmed in the US, the virus has not settled into a predictable pattern, according to Dr. Maria Van Kerkhove, the World Health Organization’s technical lead for the Covid-19 response. “We didn’t need to have this level of death and devastation, but we’re dealing with it, and we are doing our best to minimize the impact going forward,” Van Kerkhove told the Conversations on Healthcare podcast this week. Van Kerkhove says she does believe 2023 could be the year in which Covid-19 would no longer be deemed a public health emergency in the US and across the world, but more work needs to be done in order to make that happen and transitioning to longer-term respiratory disease management of the outbreak will take more time. “We’re just not utilizing [vaccines] most effectively around the world. I mean 30% of the world still has not received a single vaccine,” she said. “In every country in the world, including in the US, we’re missing key demographics.” CNN Health’s Carma Hassan, Brenda Goodman and Amanda Musa contributed to this report	Epidemics & Outbreaks
Low-grade intestinal inflammation a long time after radiotherapy Patients who have undergone pelvic radiotherapy may live with low-grade chronic inflammation of the lower intestine 20 years after the treatment. This has been shown in a study by researchers at the University of Gothenburg. Radiotherapy is often necessary to cure or slow down a cancer. Even though today’s radiotherapies feature a high level of precision, healthy tissue in and around the radiation field is still affected. This study highlights a previously unknown side effect of radiotherapy to the lower abdomen. The mucous membrane of the large intestine is normally protected against contact with bacteria in feces by a thin barrier of mucus. In the current study, researchers at the University of Gothenburg have shown that radiotherapy to the pelvic area affects this thin layer of mucus, allowing bacteria to come into contact with cells on the surface of the intestine. This could be a reason for the low-grade inflammation that the researchers also found in intestines that had been exposed to radiotherapy several years previously. “It can be hard to detect low-grade inflammation,” says Sravani Devarakonda, a researcher at the University of Gothenburg’s Sahlgrenska Academy and lead author of the study. “This is the first time researchers have been able to show with certainty that this is happening in cancer survivors, a long time after pelvic radiotherapy has ended. We saw signs of low-grade inflammation as late as twenty years after radiotherapy.” Common intestinal problems It is common for those who have received radiotherapy for cancer of the cervix, prostate, or rectum, for example, to experience intestinal symptoms many years after completing their treatment. The severity ranges from tenesmus (a feeling of not having emptied the bowels properly despite multiple toilet visits), to very frequent diarrhea (fifteen times a day or more). The study is based on samples from 28 people, including 24 cancer survivors. Four of the subjects had not undergone radiotherapy and served as a control group. Among the subjects, the shortest time since radiotherapy was two years and the longest time was twenty years. The median was five years between the end of radiotherapy and intestinal biopsy. The study, published in the journal eBioMedicine, was carried out in broad collaboration between clinical and basic science researchers at the University of Gothenburg, Sahlgrenska University Hospital and Karolinska Institutet. Responsible for the research cooperation is Cecilia Bull, an associate professor at the University of Gothenburg’s Sahlgrenska Academy. Long-term changes “Our study subjects included both patients who had received traditional radiotherapy and those who had the more targeted form, IMRT. We saw low-grade inflammation in both groups. The damage to the surrounding tissue can be limited by IMRT, but there are still long-term inflammatory changes,” she says. The next step for the researchers will involve finding out whether this low-grade inflammation after radiotherapy causes some of the intestinal symptoms often seen in these cancer survivors and, if so, which symptoms are due to the inflammation. Research is already being carried out to find ways of strengthening the intestines’ resistance to radiotherapy, so that long-term symptoms which affect quality of life can be alleviated or even prevented entirely. In an extensive study involving more than 300 patients, researchers are trying to strengthen the protective mucosal barrier by adding extra dietary fiber to the diet before beginning radiotherapy. ,	Disease Research
Winter can be a bleak period. The crisp brown leaves have fallen from the trees; the flowers have wilted; everything is freezing – especially amidst a cost-of-living crisis – and there’s little to no sunshine. Joy can be sparse, and amidst all the gloom, your sex life can take a hit. Often termed "winter depression," Seasonal Affective Disorder (SAD) is a form of depression that comes and goes in a seasonal pattern. Symptoms can include persistent low mood, irritability, sleeping for longer than usual, feeling lethargic, and, importantly, a decreased libido. In the UK, SAD impacts around 2 million people. It’s little surprise: during the winter, we're plunged into darkness for months on end, and sadly, sunshine can be a rarity. Each year, around 5 percent of the U.S. population experiences SAD, and four out of five of these people are women. Mental health and sex are completely intertwined, and like regular depression, SAD can impact intimacy and facilitate sexual dysfunction. The National Institute of Mental Health finds that SAD is diagnosed four times more often in women than in men. Elsewhere, one 2018 study concluded that women experienced seasonal variations in symptoms of depression alongside tiredness and anhedonia, or the loss of ability to feel pleasure. And that pleasure extends to the bedroom. How does SAD affect your sex life? So, how does SAD impact sex? Per the NHS, depression can result in women finding it more difficult to orgasm, and a loss of sex drive. Men with depression often experience these symptoms too, alongside erectile dysfunction or problems getting and maintaining an erection. Depression can impact self-esteem and body image, which in turn, can affect our desire to be intimate with partners. Sex releases three feel-good hormones that can temporarily aid the symptoms of SAD: dopamine, endorphins and oxytocin, all of which facilitate pleasure, emotional regulation, and one-to-one bonding with a partner. Pre-bedtime sex – whether solo or partnered – can release prolactin, aiding feelings of rest and relaxation and inducing REM sleep. With all these sex-related benefits in mind, SAD’s infringement on sexual pleasure can be frustrating. Ness, 33, has recognised her symptoms of SAD since she was a teenager. She’s always struggled with the darker periods of the year, suffering from low mood and tiredness. She’s tried everything from St. John’s Wort (a herbal medicine some people take for mental health conditions) to SAD lamps and has even had her rheumatologist recommend that she just "needs to go somewhere sunny" during winter. "I don’t want to be close to anyone – it’s like the darkness engulfs me. I find orgasms less pleasurable, too," Ness recalls. "My sex life becomes more active during the spring and summer. I feel more connected with myself – I’m happier, and that makes it easier for me to connect sexually." "My sex life becomes more active during the spring and summer. I feel more connected with myself – I’m happier, and that makes it easier for me to connect sexually." In relationships, Ness’s SAD has been noticeable. She hasn’t always felt supported. "Past partners have often let me dwell in the sadness," she explains. "My current partner supports me through and understands that I find everyday activity harder during the winter months, not just relationship-related matters." What to do when mental health is impacting your sex life Dr. Caroline West — who has a PhD in Sexuality Studies and currently works as a consent educator — explains that our sex lives and our mental health are intrinsically linked. "If we feel depressed, that can lead to poorer physical health which can in turn lead to decreased desire and positivity towards sex and our bodies," West says. "When our mental health is overwhelmed, it can be a drain on energy levels which makes people not want to engage in sex as they see it as too much work. When we feel down about ourselves, sex can be the last thing on our minds, and our thoughts towards our bodies may not be very sex-positive," West explains. "A lack of intimacy can in turn make us feel even more frustrated and depressed." So, how can SAD sufferers alleviate its impact on sex? Taking time out for self-care, reconnecting with the body through masturbation and allocating time for physical connection with a partner can help to alleviate the symptoms, facilitating happier, more pleasurable sex during the winter months. "When our mental health is overwhelmed, it can be a drain on energy levels which makes people not want to engage in sex as they see it as too much work." Dr. Hana Patel is a GP specialist in mental health and a GP Expert Witness, issuing specialist information, guidance and opinion on the medical care provided by GPs. "Mental health problems can affect our sexual health. People suffering from depression describe symptoms of feeling tired, having low self-esteem, having less energy, feeling a reduction in sexual desire and finding it difficult to find pleasure in things they used to enjoy," Patel tells Mashable. As she explains, low levels of vitamin D can also impact the likelihood of developing SAD, as can a family history of depression. "To increase your vitamin D, go out as much as possible during the day, sit near the window at work, increase your exercise levels, eat a varied, balanced diet, and avoid stress as much as possible. Consider mindfulness and stress management techniques," Patel advises. "Some people prefer to take vitamin D supplements over the winter months, and may want to try an SAD lamp." Want more sex and dating stories in your inbox? Sign up for Mashable's new weekly After Dark newsletter. Likewise, mindful sex can help. According to meditation app Headspace, incorporating mindfulness into sexual experiences — whether partnered or solo — can alleviate the experience. One study conducted amongst women at the University of British Columbia involved taking part in three mindfulness meditation sessions spaced two weeks apart alongside mindfulness meditation at home. This period of meditation increased desire, arousal, lubrication, and overall sexual satisfaction. Jasmine Eskenzi is the Founder and CEO of The Zensory, a mindful productivity app. "Being mindful during sex can increase your self-esteem, self-acceptance and self-compassion," Jasmine notes. "Try some mindful breathing before you head to the bedroom – breathe in for four seconds, hold your breath for seven seconds and breathe out for eight. Repeat this until you feel calmer." Try not to think of sex – whether partnered or solo – as a one-time event. Spend some time laying the foundations, whether that involves reading an erotic book, masturbating, or watching a sexy movie. If you are in a relationship – whatever that may look like – investing in that can be equally impactful. Prioritise regular date nights, whether that involves turning off the TV and cooking a nice meal together or ordering a takeaway. Creating these intimate memories can help to strengthen your bond both emotionally and sexually. Communicate with your partner Taking time to communicate is fundamental, so check in with your partner regularly, too. You can also practise this in your relationship with yourself – and better your solo pleasure – by examining what turns you on. "Ask your partner what they find sexy about you," Pippa Murphy – sex and relationship expert at condoms.uk — advises. "Not only will this give you both a confidence boost, but it could also lead to better sex as you can accentuate or focus on these things in bed. The more confident you feel, the better sex you’re likely to have." Keeping the boudoir a no-phone zone can also have a poignant impact, as Murphy believes. "If you scroll on your phone before bed, you’re not only impacting your ability to build a deep connection with your partner, but chances are you’re decreasing your ability to get horny by being greeted with a social feed of negative news," Pippa says. "Keep your phone outside the bedroom and spend the last 10 minutes before bed getting intimate with your partner, whether that’s through sex or a conversation." Remember: sex can be whatever you want it to be. As West reminds us, "sex doesn’t have to be a big production or involve penetration. Intimacy can be defined however you want." Explore what works for you: consider keeping a SAD sex diary, noting down how you’re feeling each day mood-wise and libido-wise. That way, you’ll be able to spot patterns and develop self-tailored coping mechanisms for making your boudoir as spicy and depression-friendly as possible. Sex and SAD needn’t be enemies. If you're feeling suicidal or experiencing a mental health crisis, please talk to somebody. If you're in the U.S., text "START" to Crisis Text Line at 741-741. You can reach the 988 Suicide and Crisis Lifeline at 988; the Trans Lifeline at 877-565-8860; or the Trevor Project at 866-488-7386. Text "START" to Crisis Text Line at 741-741. Contact the NAMI HelpLine at 1-800-950-NAMI, Monday through Friday from 10:00 a.m. – 10:00 p.m. ET, or email [email protected]. If you don't like the phone, consider using the 988 Suicide and Crisis Lifeline Chat at crisischat.org. Here is a list of international resources. If you're in the UK, call the Samaritans on 116 123 or contact Shout, a 24/7 free mental health service in the UK (Text SHOUT to 85258).	Mental Health Treatments
Isaiah Jarrett, from Birmingham, had been suffering from what doctors believed was gastroenteritis, it is claimed, but eventually a CT scan was done and it was found he had a brain tumourIsaiah Jarrett died from an aggressive brain tumourAn eight-year-old boy who was diagnosed by doctors as having a stomach bug, died after it was later found he had an aggressive brain tumour, it is claimed. Isaiah Jarrett, from Castle Vale, Birmingham, died just eight months after being diagnosed with medulloblastoma, a type of brain tumour, following bouts of extreme vomiting. It is claimed doctors initially thought Isaiah's illness could've been gastroenteritis, and when he later began to vomit blood, suffer with a stiff neck and had headaches, they were put down to long episodes of sickness. But after five weeks of no improvement, Isiah's concerned mum, Dena Allen, 36, demanded answers and Isiah underwent a CT scan at Birmingham Children's Hospital where it was revealed he had a golf ball sized mass on his brain. He had a 15 hour surgery, after which he was told the tumour was an aggressive cancer, and he lost use of his voice instantly after the op, due to the position of the lump. It was originally thought that Isiah was suffering from a stomach bug ( Image: Brain Tumour Research SWNS) Isiah underwent intensive chemotherapy and radiotherapy to try and tackle the cancer ( Image: Brain Tumour Research SWNS) The schoolboy underwent intense chemotherapy and radiotherapy treatment but the cancer had spread and Isiah died on July 20 last year. Following her tragic loss, Dena, joined the charity Brain Tumour Research as a campaigner and is aiming to complete 10,000 Steps a Day in February to fundraise. Speaking of hearing the news he had a tumour, Dena, a mum-of-seven, said: "My mind went blank and I fell to my knees. I thought it could have been something to do with his belly, never in a million years did I expect to be told my little boy had a brain tumour. "After his first surgery on 20 December I never heard Isaiah’s voice again. He eventually learned to communicate though gestures and murmurs. Everything that could possibly go wrong went wrong." Due to the location, Isaiah lost his speech instantly and spent five weeks in the intensive care unit (ICU) where he was fitted with a tracheostomy. Dena said: "Isaiah suffered with swelling and a build-up of fluid which meant he had seven surgeries in total, all of which I was told could kill him. You’re faced with an impossible decision as a parent who wants the best for their child.” The cancer also affected Isaiah's ability to speak ( Image: Brain Tumour Research SWNS) Dena was forced to give up her full-time work as a carer to look after her son and after gruelling chemotherapy and radiotherapy, an MRI scan showed the cancer had spread to his brain stem and spine. Dena was then told no treatment could save her son and Isaiah died at home surrounded by his family. Statistics provided by Brain Tumour Research show brain tumours kill more children and adults under 40 than any other cancer, yet historically just 1% of the national spend on cancer research has been allocated to brain tumours. Mel Tiley, community, and development manager at Brain Tumour Research, said: “We’re heartbroken for Dena and her family on the loss of little Isaiah. "His story reminds us that brain tumours are indiscriminate, and Dena’s generosity in sharing her son’s story will help us raise awareness of this horrific disease. We wish her the best of luck as her challenge begins on 1 February.” Through her campaigning and sharing Isiah's heartbreaking story, Dena is determined to continuing raising awareness and help in the fight against brain tumours. "By taking part in this event and sharing Isaiah’s story I hope to help put an end to brain tumours taking the lives of everyone, especially young children," Dena said. "No other family should have to go through the heartache and pain of losing a loved one." She added: "My main aim this year is to fight to get brain tumours out there and spoken about. We need to fully understand them to be able to provide better treatment and eventually a cure to stop anyone else from suffering from this cruel disease.” Read More Read More Read More Read More Read More	Disease Research
Police investigating the deaths of a man and a woman in their 40s have issued a warning after a potentially deadly synthetic opioid was identified at the scene. Essex Police said a man and a woman were found dead at an address in Basildon on Tuesday. Officers identified the presence of etonitazene at the scene. Etonitazene is a synthetic opioid that is 40 times more potent than fentanyl and at least 1,000 times more potent than morphine. Known by its street name Pyro, it is usually used on animals for addiction studies. Essex Police said: "This substance may pose a high risk to users and anyone handling it. "Synthetic opioids are occasionally added to illicit drugs like heroin to enhance the potency, but they substantially increase the risk of respiratory arrest in users. "Our officers are working hard to investigate this incident and, crucially, prevent any further deaths." Police advised people to not use any illegal substances at this time in particular. Detective Inspector Kevin Hughes of Essex Police said: "We strongly advise anyone using drugs not to use alone. Immediate advice is to avoid using heroin altogether." But he said anyone choosing to take heroin should ensure there is someone who is not under the influence to watch out for them. The detective also said heroin users should take less than they normally would and wait before continuing, and have the opioid antidote, naloxone, to hand. "Current advice is that naloxone should work to counteract the effects of nitazine-type drugs. Click to subscribe to the Sky News Daily wherever you get your podcasts "Be ready to call for help - urgent medical intervention may make all the difference. "Don't use with other depressants - particularly avoid consuming other depressants such as alcohol, pregabalin, gabapentin or other opiates - these can amplify the risk of respiratory arrest. "People need to look out for each other and be alert to any signs of an opioid overdose, such as shallow breathing, loss of consciousness and blue lips or fingertips. Read more: The million dollar streets strewn with bodies contorted by the effects of fentanyl "If someone does overdose it's vital to act fast. Call for an ambulance immediately." Opioids, in particular fentanyl, have caused drug-related deaths to surge across the US in recent years. The number of opioid-related deaths in the UK is the highest in Europe.	Drug Discoveries
One of the UK's most secretive centres of scientific research - Porton Down - is aiming to stop the next pandemic "in its tracks". I have passed through the incredibly tight security at this remote facility to get rare access to its scientists. They are based in the shiny new Vaccine Development and Evaluation Centre. Their work builds on the response to Covid, and aims to save lives and minimise the need for lockdowns when a new disease next emerges. "Covid, of course, is not a one-off," says Prof Dame Jenny Harries, chief executive of the UK Health Security Agency (UKHSA), which runs these laboratories. "We say it [Covid] was the biggest public health incident for a century, but I don't think any of us think it'll be a century before the next," she adds. The combination of climate change, urbanisation and people living closer to animals - the source of many new diseases which transfer to people - means we're facing a "rising tide of risk", she says. Porton Down - located in the tranquil Wiltshire countryside, near Salisbury - is one of the few places in the world equipped to research some of the nastiest viruses and bacteria you could imagine. The freezers here contain the likes of Ebola. Neighbouring buildings include the Defence Science and Technology Laboratory (part of the Ministry of Defence), where it was confirmed the nerve agent Novichok has been used in the Salisbury poisonings. The vaccine laboratories - housed in dark green buildings - were hastily constructed as part of the emergency response to Covid. But, as the intense demands of the pandemic have waned, the focus has shifted. The new vaccine research centre is concentrating on three types of threat: - known infections that are getting harder to deal with, such as antibiotic-resistant superbugs - potential threats that might cause a problem, including bird flu and new Covid variants - and "Disease X" - something unforeseen, like Covid, which takes the world by complete surprise The aim is to work with the pharmaceutical industry, scientists and doctors to support all stages of vaccine development. Porton Down scientists are working on the first vaccine against Crimean-Congo Haemorrhagic Fever, which is spread by ticks and kills around a third of those infected. The disease is found in Africa, the Balkans, the Middle East and in Asia - and could spread further with climate change. At the other end of the process, vaccine effectiveness is evaluated. It was scientists here who spotted that the Omicron variant could bypass some of the protection afforded by Covid vaccines. And they are still monitoring new Covid variants by growing them in the laboratory, exposing them to antibodies in taken from blood samples and seeing if new variants are still able to infect. Meanwhile machines - unofficially named Qui-Gon, Obi-Wan, BB8 and Palpatine - are part of the front line monitoring the threat posed by the world's largest flu outbreak in birds. The H5N1 avian flu virus has devastated bird populations, and routine testing of farmworkers has found the first, symptomless, cases in people in the UK. The difference is, before the pandemic the teams here were able to test just 100 samples a week - now it's more than 3,000. Faster vaccines The work here feeds into the "100 Days Mission" - a hugely ambitious vision to develop a vaccine against a new threat in 100 days. Historically, it has taken a decade to design and test new vaccines. The unique circumstances of the pandemic meant the first Covid vaccines were produced within a year, with the vaccine rollout starting in December 2020. Estimates suggest Covid vaccines saved more than 14 million lives in just the first 12 months they were used. "Imagine if those vaccines had been available just a bit earlier," said Prof Isabel Oliver, chief scientific officer for UKHSA. "They were available more rapidly than ever before in history, [but] we could have saved many more lives and we could have returned to greater normality much more quickly." The hope here is the lessons of the Covid pandemic will be mean we are better prepared next time. Prof Harries says in the past we have been simply reacting to events, but in the future we need to be on the front foot and "try and stop" any pandemic before it even begins. And if a new disease does occur, she adds, we need to "stop it in its tracks" in its earliest stage. Follow Jameson Twitter Photos: Emma Lynch/BBC	Vaccine Development
EcoHealth Alliance, a New York City-based nonprofit that works internationally to prevent emerging diseases, has been scrutinized by Republican politicians for its relationship with the Wuhan Institute of Virology in Wuhan, China, and research money in the years leading up to the COVID-19 outbreak. EcoHealth is now back in the spotlight following a CBS News report stating they may have double billed for Wuhan projects through the National Institutes of Health (NIH) and the U.S. Agency for International Development (USAID). "What I've found so far is evidence that points to double billing, potential theft of government funds. It is concerning, especially since it involves dangerous pathogens and risky research," Diane Cutler, a former federal investigator hired by Kansas Republican Sen. Roger Marshall, told the outlet. Cutler said she discovered after reviewing thousands of documents that the federal government may have made duplicate disbursements for possible medical supplies, equipment, travel and salaries. Sources further told the publication, "tens of millions of dollars could be involved." EcoHealth pointed Fox News Digital to a PDF version of a press release posted on their website following the report, which vehemently denies the allegations. "CBS News was correct in noting that both USAID and NIH funded work in China via EcoHealth Alliance," the release states. "But the conclusions they drew were incorrect. The group says that NIH and USAID "supported two different projects that are complementary, but distinct, and do not involve duplication of effort." EcoHealth also says the "story fails in the way it reports the science being conducted" and that an upcoming Government Accountability Office report will show "the total amount of grant funding from NIH and USAID to the Wuhan Institute of Virology for the projects in question from 2014 to 2021 amounted to less than $1.3 million." The NIH has pushed grants to EcoHealth for bat-related research, including funding that made its way to the Wuhan Institute of Virology, or the "Wuhan lab." An NIH grant that began in 2014 ultimately pushed $3.7 million to EcoHealth and included more than $600,000 in sub-awards to the Wuhan Institute of Virology to study bat coronaviruses between 2015 and 2019, according to federal records. USAID has also reported grants to EcoHealth, including nearly $2.5 million between 2013 and 2019 for "land use change & disease emergence," records show. A recent investigation found that NIH did not properly oversee EcoHealth and its federal research grants for its bat coronavirus research in China. In a January report, the Department of Health and Human Services inspector general said NIH "did not effectively monitor or take timely action" to ensure that EcoHealth complied with the terms of its grant awards and sub-awards. EcoHealth, meanwhile, is propelled almost entirely by government money. Between July 1, 2013, and June 30, 2020, $78 million of the $87.5 million in contributions and grants EcoHealth received - or nearly 90% - came from government sources, according to a Fox News Digital review of its tax forms. EcoHealth did not address Fox News Digital's questions on the sub-awards that made their way to the Wuhan Institute of Virology and its money primarily originating from government sources. EcoHealth originated from a merger of the Wildlife Trust and the Consortium for Conservation Medicine. The group identifies its mission as integrating "innovative science-based solutions and partnerships that increase capacity to achieve two interrelated goals: protecting global health by preventing the outbreak of emerging diseases and safeguarding ecosystems by promoting conservation," according to its financial audit. The nonprofit counts several corporate and academic partners, including Johnson & Johnson and East China Normal University, a Shanghai-based public university under the auspices of the Chinese Communist Party-controlled Ministry of Education. The group also partners with United States government agencies, including NIH, the Centers for Disease Control and Prevention, the New York City Department of Health, and the New York State Department of Environmental Conservation, its website states. They also list Malaysia's Ministry of Health and Department of Veterinary Services as partners. During the onset of the pandemic, Arkansas Republican Sen. Tom Cotton raised questions about the Wuhan Institute of Virology, which ignited condemnation from Democrats and many media outlets, who chalked them up as "fringe conspiracy theories." Then-President Trump also consistently questioned whether the virus had leaked from the lab, igniting media and political figures to paint the lab leak as a fringe theory. Weeks ago, an Energy Department assessment found that COVID-19 "likely" originated from a lab leak, and Federal Bureau of Investigation chief Christopher Wray said during a Fox News interview that the "FBI has for quite some time now assessed that the origins of the pandemic are most likely a potential lab incident in Wuhan." Peter Daszak, EcoHealth's president, has maintained that the COVID-19 outbreak emerged naturally and did not originate as an accidental leak from the Wuhan Institute of Virology. In 2020, he even privately thanked former National Institute of Allergy and Infectious Diseases Director Anthony Fauci for his public Wuhan lab messaging. "I just wanted to say a personal thank you on behalf of our staff and collaborators, for publicly standing up and stating that the scientific evidence supports a natural origin for COVID-19 from a bat-to-human spillover, not a lab release from the Wuhan Institute of Virology," Daszak wrote to Fauci in April 2020, according to previously uncovered emails. "From my perspective, your comments are brave, and coming from your trusted voice, will help dispel the myths being spun around the virus's origins," Daszak said. And in the press's broad dismissal of the "lab leak" theory, major fact-checkers often included Daszak in attempts to squash it. The British scientist appeared in a Washington Post fact-check video published in May 2020, where he discussed his work with the Wuhan Institute researching viruses in bats that could cause "the next pandemic." The video outlined circumstantial evidence around the leak, such as its proximity to the outbreak, its work with coronaviruses, and its known security concerns, but still concluded it likely didn't happen. After the narrator repeated the lab's denial that it was the source of the virus, Daszak said, "China's been incredibly open, and I believe it's because it's been a scientific collaboration." At the time, The Washington Post's Glenn Kessler taunted Texas Republican Sen. Ted Cruz after he had criticized the Post's video, saying it showed it was "virtually impossible" the virus jumped from a lab. A little over a year later, Kessler published a timeline about how the lab-leak theory "suddenly" became credible. Facebook fact-checking partner Science Feedback cited Daszak in a February 2020 post headlined, "Scientific evidence indicates virus that causes COVID-19 infection is of natural origin, not the result of human engineering." Daszak also penned a June 2020 Guardian op-ed assailing "conspiracy theorists" for blaming a lab leak. An April 2020 CNN article headlined, "How did coronavirus break out? Theories abound as researchers race to solve genetic detective story," also cited Daszak, who said he was "very confident" that the virus originated naturally. An NBC News story about "conspiracy theories" involving the lab also quoted the British scientist. "The fact that they published the sequence so quickly suggests to me that they weren't trying to cover up anything," he told NBC News. Additionally, a Chinese state media outlet cited him saying there was "absolutely no evidence" for the lab theory. Fox News Digital's Chris Pandolfo and David Rutz contributed reporting.	Epidemics & Outbreaks
International Yoga Day 2023: 5 Ways How Yoga Can Improve Your Sleep On International Yoga Day 2023, here are a few yoga asanas that can be a help you to improve your sleep quality. If you are unable to get enough good sleep, yoga can help. Regular practice of yoga is known to help alleviate several ailments, including insomnia and abnormal sleeping habits. On International Yoga Day 2023, here's how yoga can be a helpful way to improve your sleep quality. Yoga Asanas for better sleep Mansi Gulati International face yoga expert recommends these yogasana for better sleep: Balasana Rest your chest and belly on one or two stacked pillows with knees wide apart and big toes touching. Rest an ear on the pillow, eyes closed, and jaw and belly relaxed. Your arms can rest on the sides of the pillow or underneath. Focus your attention on the nostrils and enjoy the sensation of breath flowing in and out. Pawanmuktasana Lying flat on your back with an optional pillow behind your head. Straighten and extend one leg long in front of you and bend the other leg, hugging it in toward your side body as if your knee could touch your armpit. Interlace fingers around your shin or behind the knee of your bent leg. With closed eyes and a relaxed jaw, breathe into your belly. Stay for as long as you’d like and then switch sides. Halasana It is recommended that by staying in the plow pose for about 1 to 5 minutes will help in falling asleep easily. All you need to do is lie down on your back and gently lift your legs above your head and then to the flat surface behind you. While you do so, your hands must either be on your back for support or on the floor. By turning around the blood flow, you bring new vivacity into the body. Bhramari Kriya Deep inhale and exhale with bee sound Bee Breath resonates as a hymn of profound serenity at bedtime. This practice gently leads the weary mind away from the chaos of the world. As one harmoniously emulates the drone of a bee, the vibrations drown out the cacophony of disquieting thoughts. Tips for practicing yoga for sleep: If you are looking for ways to improve your sleep, yoga is a great option. There are many different yoga poses and styles that can help you to relax and sleep better. You can find yoga classes at your local gym or yoga studio, or you can practice yoga at home. Here are some tips for practicing yoga for sleep: Practice yoga in a quiet, dimly lit room. Wear comfortable clothing that you can move around in freely. Start with a few simple poses and gradually increase the length of your practice. Focus on your breath and allow yourself to relax into the poses. End your practice with a few minutes of Savasana (corpse pose). This article is for informational purposes only and is not intended to be a substitute for professional medical advice. Please consult your doctor or other health care provider before starting any new exercise program, especially if you have any underlying health conditions.	Stress and Wellness
People line up to enter a branch of China Construction Bank, after the lockdown placed to curb the coronavirus disease (COVID-19) outbreak was lifted in Shanghai, China June 6, 2022. REUTERS/Aly Song/File PhotoRegister now for FREE unlimited access to Reuters.comSHANGHAI, June 14 (Reuters) - A protest planned by hundreds of bank depositors in central China seeking access to their frozen funds has been thwarted because the authorities have turned their health code apps red, several depositors told Reuters.The depositors were planning to travel to the central province of Henan this week from across China to protest against an almost two-month block on accessing at least $178 million of deposits, which has left companies unable to pay workers and individuals unable to access savings. read more Rights groups have warned China could use its vast COVID surveillance infrastructure to stifle dissent. Without a green code on their smartphone app, citizens lose access to public transport and spaces such as restaurants and malls, as well as the right to travel across the country.Register now for FREE unlimited access to Reuters.com"They are putting digital handcuffs on us," said a depositor from Sichuan province surnamed Chen, who declined to use his full name for fear of government retribution.The Henan provincial government, the National Health Commission and the Ministry of Public Security did not respond to requests for comment.After recent COVID outbreaks, some regions in China have asked travellers to register their plans online.A man surnamed Liu, who lives in Hubei province, found that his health code turned red on the morning of June 12 after he registered the day before to travel to Henan.Liu had planned to travel to a protest planned for Monday in the Henan provincial capital Zhengzhou, where he had hoped to get his money back. The protest would have been the latest among numerous such demonstrations in Henan in recent months.More than 200 depositors were similarly blocked when their health codes turned red, according to members of a WeChat group.It could not be ascertained if the change in code was intended to block the protesters or for another reason, but three depositors told Reuters they knew people who had registered to travel to Henan, who were not connected to the frozen funds, whose codes did not turn red.Yu Zhou Xin Min Sheng Village Bank, Shangcai Huimin Country Bank and Zhecheng Huanghuai Community Bank froze deposits on April 18, with all three telling customers they were upgrading internal systems. read more Liu, who declined to give his full name for fear of government repercussions, said his child may not be able to go to school if his code does not soon revert to green."I can't do anything, I can't go anywhere. You're treated as though you're a criminal. It infringes on my human rights," said Liu.Wang Qiong, who lives in the central city of Wuhan, found her health code had turned red after she registered to travel to Henan on June 11."The police had my identity details from the last time I went to protest in April," said Wang, who said she has lost access to 2.3 million yuan ($341,550).Other depositors told Reuters they were able to arrive in Zhengzhou by train and car but their codes turned red as soon as they scanned city health codes.($1 = 6.7340 Chinese yuan renminbi)Register now for FREE unlimited access to Reuters.comReporting by Engen Tham Additional reporting by Martin Quin Pollard Editing by Tony Munroe and Mark PotterOur Standards: The Thomson Reuters Trust Principles.	Epidemics & Outbreaks
When you pick up a prescription of Viagra, Lunesta, Advair, or Paxlovid, you might wonder how drugs get their mystifying brand names. Do pharmaceutical executives sit around a conference table and blurt out sounds or syllables or scribble them down until they conjure a unique name that suits the drug they’ve developed? The reality is not that simple.Even though people enjoy poking fun at pharmaceutical brand names, says Scott Piergrossi, president of Creative at the Brand Institute, a name-development firm based in Miami, they should understand that drug brand names incorporate safeguards that minimize medication errors caused by name confusion. “The names are very well thought out in a hugely iterative process,” he says.Although the naming of a drug may appear whimsical, “it’s a very regimented process,” says Suzanne Martinez, a Chicago-based strategist at Intouch, a pharmaceutical marketing agency.There is a steady demand for snappy new drug names. “There are 30,000 drugs on the market in the U.S., and the U.S. Food and Drug Administration approves 50 novel brand names every year,” says Todd Bridges, global president of the Drug Safety Institute, the regulatory arm of the Brand Institute, and former director of the Division of Medication Error and Prevention Analysis at the FDA. Every year, he adds, it becomes more challenging to get new brand names approved.Playing the name gameIn broad strokes, the drug-naming process includes a creative phase, involving an agency or firm that specializes in brand strategy and marketing to develop potential names; an assessment phase involving professionals from the drugmaker’s commercial, regulatory, and legal departments; and regulatory procedures involving legal reviews and approval by the FDA.“Naming is an art and a science,” says Martinez. “Both sides of the brain go into it.”On the creative side, brand strategists and other imaginative types try to come up with names that are appealing and will resonate with the consumer in both messaging and tone. This involves linguistic, legal, and written challenges. At the same time, they want to avoid any prefixes or suffixes that may have negative, derogatory, or offensive connotations.That can be complicated because the pharmaceutical business crosses borders and “most of the time [drug companies] are looking for one name that can work globally,” Martinez says. After all, a name or syllable that might make sense in the U.S. may be a no-go in a European market. For example, “mist” has positive connotations in English, but it means manure in German.In the naming business, “we call these permavoids—roots to permanently avoid,” Piergrossi says.To develop a name that’s likely to satisfy all parties—including the decision-makers at the pharmaceutical company and regulatory bodies in multiple countries—the agency’s strategic and creative team spend months brainstorming hundreds of possible names for one drug. Then that list is gradually whittled down and presented to decision-makers at the pharmaceutical company, and finally the FDA.“On average, pharmaceutical companies spend hundreds of thousands of dollars developing a drug name,” Piergrossi says, and the whole process typically takes two to three years, though it was faster for COVID-19 drugs.When developing names, sometimes strategists will try to embed a reference to the biology behind the drug. For example, the cancer drug Xalkori is an ALK—short for anaplastic lymphoma kinase—inhibitor, while Zelboraf, used to treat melanoma, is a molecule that inhibits the BRAF gene.“They sound like alien names, but they can cue physicians to their mechanisms of action,” says R. John Fidelino, head of innovation and impact at The Development, a brand strategy and marketing consulting firm in New York City.An emotional touchSometimes companies want the name to stir up an emotion or be more aspirational—as was the case with Advair, which suggests an advantage when it comes to air and breathing. Fidelino participated in the naming of Viagra, which was the first pill that worked to address erectile dysfunction. The name was chosen because “it expresses vim, vigor, and vitality that a man was looking to experience and achieve in overcoming erectile dysfunction,” says Fidelino.But there’s a fine line because the name can’t make an exaggerated claim, be promotional, or overstate the drug’s efficacy—suggesting a cure, for example.As part of the drug-naming process, pharmaceutical companies often want to highlight what’s unique about a particular medication. “Every drug that comes to market has an aspect of innovation—many times it’s unprecedented in terms of the disease it treats or it uses a mechanism of action that’s completely new,” explains Fidelino.Piergrossi was involved in the naming of Latisse, a prescription treatment to help people with thin, or too few, eyelashes grow more. The “La” alludes to the word “lash” and the “tisse” evokes the French impressionist, Henri Matisse. As a result, Piergrossi explains, Latisse “almost has a styling effect associated with it.”In creating the name Lunesta, for insomnia, Piergrossi and his team wanted to include the word “lune,” to evoke a feeling of lunar influences and a sense of restoration and sleep, he explains.By contrast, generic drug names are based upon specific syllables—called stems—that are strung together to convey information about the chemical structure or action of a medication. For example, bebtelovimab is a newly approved monoclonal antibody drug that can be used to treat COVID-19; like other monoclonal antibodies, the name ends in -mab. In the U.S., these are assigned by the United States Adopted Names Council as a prerequisite to marketing a drug. “The stem at the end of the drug indicates the class of medicine,” Martinez says. “It is like a mini scientific formula in a name.”Who makes the final choice On the regulatory side, the drug maker’s attorneys evaluate legal and regulatory issues behind potential names. Part of the evaluation considers whether the name makes exaggerated claims or misstates the efficacy. Which is why we don’t see drug brand names with the word “cure” or “remedy” in them.Ultimately, the FDA gives final approval of a drug’s brand name. To determine whether to approve a proposed name, one of the steps the FDA employs is a software program commonly referred to as POCA, which is short for: Phonetic and Orthographic Computerized Analysis. It uses an advanced algorithm to identify similarities between drug names, both when they’re spoken and written as a prescription.This includes letters that are similar in cursive writing—such as L, T, and K that have an upstroke, explains John Breen, executive director of health strategy for the kyu Collective, a marketing services organization, in New York City.In addition, the FDA’s name-approval process includes database searches for medication errors related to active ingredients in the drug, simulation studies with FDA-employed healthcare providers to test their response to proposed names, and consideration of possible failures, errors, or name confusion when it comes to prescribing, ordering, dispensing or administering the drug.“There’s a reason why there’s a bit of wackiness when it comes to drug names,” Breen says. That’s because “it has become almost a survival of the fittest not necessarily from brand-building or commercial potential but from surviving the [name] approval process.”Cases of mistaken identityAccording to a 2018 report by the Institute for Safe Medication Practices, of the 6,206 medication-related errors reported to the ISMP between 2012 and 2016, nearly 10 percent were related to drug name confusion. That was a significant improvement from reports submitted between 2000 and 2004 in which 20 percent of medication errors were related to drug name confusion. These errors can occur as a doctor writes a prescription, as a pharmacist dispenses a drug, when a nurse administers, or when a patient takes medications—if they have two with similar-sounding names, for instance.Among the examples of look-alike, sound-alike drug names that are often confused for each other are: Adderall and Inderal; Celebrex, Celexa, and Cerebyx; Paxil and Taxol; Zyrtec and Zantac. These are just a few examples from the Institute for Safe Medication Practices’ lengthy list of drug names that are frequently confused.Between 2000 and 2009, the FDA’s Center for Drug Evaluation and Research (CDER) received approximately 126,000 reports of medication errors, “some of which are directly related to the similar sound and appearance of drug name pairs.” When name-related drug errors come to light, the FDA will sometimes ask a company to rename a medicine. This happened in 1990, in the case of Losec (for heartburn) and Lasix (a diuretic); subsequently, Losec was renamed Prilosec. In 2010, after reports of dispensing errors were made to the FDA, Kapidex (a heartburn drug) was renamed Dexilant to avoid confusion with Casodex (a cancer drug) and Kadian (a narcotic). And in 2016 the FDA approved a name change for Brintellix (an antidepressant) to Trintellix, in order to reduce the risk of confusion with Brilinta (a blood-thinning drug).How does the FDA decide which drug’s name should be changed? “The one that was approved last has to change its name,” Bridges says. “You can imagine how this would affect a company—after spending all that money developing and marketing a name, then they have to change it.”Meanwhile, the FDA continues to update its guidelines and standards for evaluating drug name safety, Martinez says. “The regulatory landscape is always evolving,” she adds, in an effort to avoid brand names that are potentially problematic. The FDA has a monitoring system called MedWatch to track both adverse effects from drugs as well as medication errors, including name confusion, Bridges notes.Seeking brand names with staying power Just as brands like Kleenex and Xerox became synonymous with their products, a similar phenomenon sometimes happens with drugs. Over time, some drug brand names—such as Viagra, Xanax, Botox, and Lipitor—have become leaders in their categories, household words, and linked with their intended purpose. “People use them more often in their everyday vernacular than most other drugs,” Martinez says.Sometimes brand names stick in the public’s mind and sometimes they don’t. Take the vaccines for COVID-19 as an example: Most people know if they received the Pfizer or the Moderna vaccine and were able to request subsequent vaccines or boosters accordingly. However, most people don’t ask for the Pfizer vaccine by its brand name, Comirnaty, or the Moderna vaccine by its marketed name, Spikevax, after these drugs earned full approval from the FDA.To their credit, the names do evoke associations with how the vaccines work: COVID and mRNA for COMIRNATY; and the mechanism of action, using an mRNA vaccine to trigger production of the spike protein, for Spikevax.The take-home messageBesides being intriguing, understanding what goes into naming a drug and how it might relate to the actual product may help you avoid your own name-confusion at the drugstore. If you start to think of Zantac as a drug that combats stomach acid—hence, the -ac at the end—you’ll be less likely to confuse it with the antihistamine Zyrtec (a look-alike name) or the benzodiazepine Xanax (a sound-alike name).“We often try to build in layers of meaning to drug brand names,” Piergrossi says. “The more we can encode multiple concepts that relate to the product’s attributes or benefits without sounding forced or contrived, that’s the ideal scenario.” It’s true for pharmaceutical companies, health-care professionals, and consumers, alike.	Drug Discoveries
SAN JACINTO, Calif. — Teresa Johnson can’t escape the pain. It’s as if she’s getting pierced by needles all over her body, all at once. At night, she sometimes jolts out of sleep thinking bedbugs are attacking her. But it’s just the unfailing pain — day in and day out. Johnson, 58, said her ordeal started in September 2022, when she went for a CT scan of her abdomen after a bout of covid-19. Though Johnson warned the lab she was allergic to iodine, she believes the lab tech used it in an injection, triggering an allergic reaction. She spent the next three weeks in the hospital, feeling as if her body was on fire. When she was discharged to her home at the base of the San Jacinto Mountains in Riverside County, Johnson said, her quality of life deteriorated and her frustration mounted as she waited for her Medi-Cal plan to get her assessed by a specialist. She could barely walk or stand, she could no longer cook for herself, and sometimes she couldn’t even lift her leg high enough to step into the tub. “I would never wish this on anybody,” Johnson said while rocking back and forth on the couch to still the pain. “You don’t know if you should cry, or just say OK, I can make it through this. It messes with you mentally.” Johnson said her primary care doctor told her he wasn’t sure what triggered the pain but suspects it was compounded by the lingering effects of covid. Johnson, who is diabetic, developed neuropathy, a type of nerve damage, possibly after the allergic reaction caused her blood sugar levels to skyrocket, her doctor told her. He referred Johnson, who receives care through California’s Medicaid program for low-income people, to an endocrinologist in March. But Johnson said she was not offered timely appointments, and it took more than six months, four referrals, multiple complaints to her health plan, and a legal aid group’s help to finally snag a phone call with an endocrinologist in mid-September. Access to specialists — from gastroenterologists to cardiologists — has been a long-standing challenge for many Medi-Cal patients, especially those in rural areas or regions facing staff shortages. The Inland Empire, where Johnson lives, has the second-lowest supply of specialists in the state, according to the California Health Care Foundation. (KFF Health News is the publisher of California Healthline, an editorially independent service of the California Health Care Foundation.) The state Department of Managed Health Care, which regulates most Medi-Cal health plans, requires plans to get patients in to see specialists within 15 business days, unless a longer waiting time would not harm the patient’s health. But the timeline often looks very different in reality. “It’s hard to get a specialist to contract for Medi-Cal patients. Period,” said Amanda Simmons, executive vice president of Integrated Health Partners of Southern California, a nonprofit organization that represents community health clinics. “Specialists don’t want to do it because reimbursement rates are so low.” Johnson said she made her first call in March to the endocrinologist assigned by her Medi-Cal insurer, Inland Empire Health Plan, and that the office offered her an appointment several months out. Over the next four months, she received three more referrals, but she said she got a similar response each time she called. When Johnson objected to the lengthy wait times, requesting earlier appointments, she was told there was no availability and that her condition wasn’t urgent. “They told me it wasn’t important,” Johnson said. “And I asked, ‘How would you know? You’ve never seen me.’” Esther Iverson, director of provider communications for the plan, declined to speak about Johnson’s case but said the plan makes every effort to meet the 15-day requirement. It can be challenging to meet the standard, she said, due to a lack of available physicians — especially for certain specialties, such as endocrinology and pain management. She pointed to the nationwide physician shortage, which is more pronounced in rural areas, including parts of San Bernardino and Riverside counties, where the plan operates. She also noted that many physicians decided to leave the field or retire early due to burnout from the covid pandemic. “The highest priority for us is timely access to quality care,” Iverson said. During her quest, Johnson enlisted the help of Inland Counties Legal Services, which provides free legal representation to low-income residents. They called the plan multiple times to request earlier appointments but got mired in bureaucratic delays and waiting periods. In one instance in August, after the insurer told Johnson it couldn’t meet the 15-day time frame, her legal representative, Mariane Gantino, filed an appeal, arguing that Johnson’s request was urgent. The insurer’s medical director responded within a few hours denying the claim, saying the plan concluded that her case was not urgent and that a delay would not cause a serious threat to her health. “I’m so burned out after dealing with this for so long,” Johnson said in mid-September. “Why do they have the 15-day law if there aren’t going to be any consequences?” A few days later, Johnson finally received the call she had been waiting for: an offer of a phone appointment with an endocrinologist, on Sept. 18. During the appointment, the doctor adjusted her diabetes and other medications but didn’t directly address her pain, she said. “I’m in the same position,” Johnson said. “I’m still in pain. What’s next?” Over the years, Johnson has worked a variety of jobs — from driving eighteen-wheelers cross-country to weaving hair — but her most consistent work was as a caregiver, including to her six children, 21 grandchildren, and three great-grandkids, with another great-grandchild on the way. Now, because of her extreme pain, the roles have been reversed. A daughter and granddaughter who live with her have become her full-time caregivers. “I can’t do nothing. I can’t take care of my grandkids like I used to,” said Johnson, who sleeps most of the day and wakes up only when her pain medication wears off. “I was planning to take care of the new baby that’s coming. I probably can’t even hold her now.” This article is part of “Faces of Medi-Cal,” a California Healthline series exploring the impact of the state’s safety-net health program on enrollees.	Health Policy
BRENTWOOD — Crazy how your life can change in a matter of hours. That’s how Cassie Smith describes what happened the day she found out her toddler son had leukemia. Since then, the Brentwood mother of three and her husband David, a Brentwood police officer, have been on a roller coaster as they navigate their son’s health and try to figure out how they will meet all the expenses. Cassie Smith was packing her bags for a weekend trip on June 5 when her 4-year-old son, Luca, woke up with a black eye and puffy face. A trip to the emergency room revealed what no parent wants to hear. “The last 48 hours have been an absolute nightmare,” Cassie wrote on Facebook and later on an online fundraiser page. “Our baby boy has cancer.” Within hours he was taken via ambulance to Kaiser Permanente Childrens Hospital and Research Center at Oakland, followed by more scans, an MRI, “lots of blood work.” Soon began the beginning of what will likely be six months of chemotherapy. Though no one could ease the pain of the news, a little financial help soon came through an online campaign arranged by the Brentwood Police Activities League and the Wall of Heroes through the Fund the First program to help first responders in need. Chris Bollinger, executive officer of Brentwood PAL and a school resource officer, made the referral, knowing that his friend and colleague would never ask for help himself. “He is very well-liked,” Bollinger said of beat cop David Smith. “He’s an amazing guy and has a great family.” Based in Brentwood, the Wall of Heroes program supports first responders or their family members as well as those in the military and veterans who have medical crises, can no longer work or are deployed away from home, such as during some wildland fires, hurricanes and other emergencies. The group partners with the Fund the First crowdfunding platform to offer a secure online method to donate. All of their recipients have been referred through employers or colleagues, according to spokeswoman Jessie LaChance-Mellan. With the Wall of Heroes, 100% of what is donated goes back to the family. So far, the campaign has raised $64,000. LaChance-Mellan said the fundraisers hope to reach the goal of $75,000 by July 6 to get the Smiths through the first rough patch, after which family and friends may be able to help with meals, housecleaning, child care and household tasks so the parents can focus on Luca. “I know that with chemotherapy, this initial set is going to be six months, and Luca will go back and forth four to five times a week,” LaChance-Mellan said. “And you can kind of do the math. And that’s just the first six months. Health insurance won’t cover gas, meals or medical co-payments, she said, noting the family has two other young children. Luca has been diagnosed with B-ALL leukemia, and it’s unclear what treatment might be on tap after six months, LaChance-Mellan added. Luca’s father has taken off work to be with his family, but offered to cover two shifts a week, though his colleagues disagreed. Some have even offered to donate their sick time to him. “He was talking about coming in and we’re like ‘no,’ you need to worry about your family,” Bollinger said. “He doesn’t want to take charity and all that stuff. And he’s extremely overwhelmed with the amount of support that he has in this community.” Even so, Brentwood PAL is planning a cornhole tournament and poker fundraiser for Smith’s family this summer. It also donated two air purifiers, because Luca will be immunocompromised and the family must keep their home extremely clean to keep him healthy, Bollinger said. “I think there’s a lot of uncertainty right now because it’s so fresh and so new,” he said. Once the six months of initial treatment are completed, Luca will be evaluated to see where he is and “what the game plan is, but we have been advised this will be at least a two-year ride,” Luca’s mother said in a recent update on Fund the First campaign page. “We are devastated, confused, broken, and trying to muster the strength through these days and hopefully see our boy turn around for the better soon,” she added, noting that the family is “camped out at Kaiser” for his initial chemotherapy. With no history of cancer in their families or their environment, Cassie Smith said it’s something she never imagined would happen to her family. For his part, Bollinger said he just wants to do all he can to alleviate any unnecessary stress during this difficult time. “He served his country (in the Navy) and now he’s serving his community that he grew up in,” Bollinger said about David Smith. “I don’t want them to have to worry about financial stuff or anything like that. We just want to help them out as much as we can.” To donate, go to the Fund the First online campaign at https://bit.ly/3xRYdo1.	Disease Research
Hundreds of wild sea lions in South America, a farm of minks in Europe, and more than 58 million poultry birds have died. All of these animals fell victim to the impact of avian influenza — a virus rapidly circulating the globe, killing wild and domesticated animals, disrupting ecologies and hampering the food supply. Human health is inextricably linked to animal health, and these events are spooky reminders that a widespread outbreak in animals has potential consequences for humans. In the U.S., the most recent wave of bird flu has struck in 17 mammals and more than 160 birds. It’s the broadest outbreak of H5N1 since it surfaced as a concern in China in 1996. The virus has been under close watch by scientists, even more so now that it has spread far and wide. “This is the number one potential pandemic virus everyone has been interested in for a long time,” said Richard Webby, an infectious disease researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, and the director of the World Health Organization Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds. Tedros Adhanom Ghebreyesus, the World Health Organization’s director-general, said on Wednesday that avian influenza’s spillover to mammal species must be monitored closely, and that risk to humans remained low for the moment. “But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he said. The sheer amount of H5N1 circulating has heightened the risk the virus could spill over into other species, develop the ability to transmit among people and become a pandemic. But the virus has yet to unlock a complicated string of mutations or genetic changes that would allow it to spread more rapidly in people. “It’s a series of events, each of which is fairly improbable. This is why I say the risk to humans is presently low. The evolutionary barriers are high,” said Anice Lowen, a virologist and associate professor at Emory University School of Medicine. “It is a numbers game. So that’s one reason why the scale of the current avian outbreak is concerning.” Researchers are particularly concerned about this version of avian influenza, H5N1, because most humans haven’t dealt with it before. “We don’t have an immune response against H5. That’s why the virus has pandemic potential,” Lowen said. Scientists have also observed high death rates and severe disease in chickens and mammals that have contracted H5N1, which has made them concerned the virus could cause severe sickness in people, too. The U.S. has counted a single human case of H5N1 in the United States — a prison inmate in Colorado culling infected birds on a farm. Previous spillovers to humans, mostly in people in Southeast Asia and North Africa who likely handled infected birds directly, had high death rates, though those numbers could be biased by limited reporting of mild cases. H5N1 has long been a top pandemic concern. The version that’s been circulating in ducks and other wild birds has evolved and adapted for efficient spread. As those animals travel, the virus does too, through droppings, saliva and nasal secretions. Wild birds are shedding virus and infecting animals “over a larger amount and a larger geographic footprint than ever before,” said Bryan Richards, the emerging disease coordinator at the United States Geological Survey National Wildlife Health Center. More than 6,100 wild birds have tested positive for the virus in the U.S. Poultry farm birds likely become infected from contact with wild bird feces or other secretions. Scavengers like bears, raccoons and foxes have also been infected, likely after eating a dead or diseased bird, Richards said. Marine mammals — including dolphins — have tested positive, too. Recently, more than 500 sea lions were found dead with H5N1 in Peru. It’s not clear if the virus was spreading among these species or if animals were infected through food. The virus is poorly adapted for spread in people. “The avian virus is not as good at attaching to human cells as they are in the birds airways. They’re just not adapted to humans,” said Dr. Helen Chu, an infectious disease physician and influenza expert at UW Medicine in Seattle. To spread effectively in humans, the virus would need to make several genetic changes. That process would likely take place in other mammals. Webby and Lowen said there were two main processes the virus could undertake to evolve a better bind with receptors in human respiratory cells. The first would be for the virus to change rapidly through reassortment, an “evolutionary shortcut” in which an animal becomes infected with both an avian influenza virus and a human virus, Lowen said. During the coinfection, the two segmented influenza viruses could exchange bits of genetic code and combine to create a chimeric virus. That virus would then likely need more replication to fix mismatched genes and develop traits that would allow it to flourish in humans. “Reassortments would be very concerning to see, but probably they still wouldn’t be able to transmit in humans,” Lowen said. “Likely what would be needed is more evolution to fix the mismatches.” Previous avian influenza pandemics — which began in 1957 and 1968 — required both reassortment and additional mutations before they were able to spread widely among humans, Webby said. Each of these pandemics killed about 1 million people worldwide and about 100,000 people in the U.S. The second option is for the virus to mutate within a dense group of animals. Researchers grew concerned after an apparent outbreak of H5N1 on a mink farm in Spain. “They’re in small cages very close together. There’s a level of efficiency of transmission,” Chu said of the mink. Studies more than a decade ago showed that ferrets could pick up mutations for airborne transmission of H5N1 after serial infections. In the recent mink farm outbreak, the virus likely spread from mink to mink, Webby said. Although it picked up one mutation of concern, it largely remained adapted for birds. The mink were culled. “Luckily it was stamped out,” Webby said. The virus faces steep genetic hurdles, but the more it spreads in animals, the more chances it has to surmount those barriers. Lowen said governments should invest further in surveillance of potential hosts that could help the virus leap to humans, consider measures like vaccination to limit the spread in poultry and invest in science that will help determine what genetic changes could be worrisome for people.	Epidemics & Outbreaks
Mia Catharine Mattioli/CDC toggle caption EIS officer Arran Hamlet walks into the Government Meadows site to conduct environmental sampling for norovirus. Mia Catharine Mattioli/CDC EIS officer Arran Hamlet walks into the Government Meadows site to conduct environmental sampling for norovirus. Mia Catharine Mattioli/CDC Last September, Kevin Quinn was trekking through a remote, mountainous region in central Washington state, when he started feeling sick. "At first, I thought it was just a stomachache," he says, "But when we got to the campsite I started throwing up, and it started coming out the other end as well." He was hiking north on the Pacific Crest Trail – a five-month, 2600–mile trek from the Mexican border up to Canada that's gotten popular in the last ten years thanks to the memoir Wild, by Cheryl Strayed, which became a movie in 2014. Quinn was on the trail with his daughter, who had left her job so they could hike together. After months of hiking, he found himself wiped out at a campsite in the middle of nowhere. "I had heard about the norovirus for years, but it was always in the context of 'Oh, there's a cruise ship in the Caribbean,'" he says, "You don't think about this being an issue when you're out on the Pacific Crest Trail." Norovirus is a highly contagious virus that can cause serious gastrointestinal distress for several days. It's often associated with enclosed, crowded settings like cruise ships, health care facilities and childcare centers. But it also crops up in the wilderness – like in an outbreak among hikers like Quinn last year which was documented in a recent investigation by the Centers for Disease Control and Prevention. Call in the disease detectives After a stream of sick Pacific Crest Trail hikers came through the Washington Alpine Club Lodge near Snoqualmie Pass last summer, a volunteer named Robert Henry closed the dorm-style lodge and emailed health authorities. "My concern at the time was to make sure that the hikers on the trail didn't get any worse, and to make sure that the volunteers at the Washington Alpine Club didn't contract whatever it was they were bringing in," Henry ways. He also worked to warn other hikers about the threat. One of Henry's alert messages reached Arran Hamlet, a disease detective with the CDC's Epidemic Intelligence Service, based at the Washington State Department of Health. When Hamlet heard about the outbreak, he made a survey for hikers to fill out. He heard from some two dozen hikers who experienced symptoms of gastrointestinal illness – and says social media reports indicate there were many more. Michelle Holshue toggle caption EIS officer Dr. Arran Hamlet observes a water source being tested for environmental contamination of fecal waste and norovirus. Michelle Holshue EIS officer Dr. Arran Hamlet observes a water source being tested for environmental contamination of fecal waste and norovirus. Michelle Holshue Hamlet focused on a 70-mile stretch of trail south of the Lodge, where ill hikers were coming from. One common rest stop, he learned, was a remote log cabin in the meadows, with a pit latrine and a stream that's used for drinking water. Hamlet and his team hiked out to the cabin and tested water from the stream. They also swabbed the toilets, the door handles, the tabletops, the poker chips – anything people were touching. While the water samples came back clean, "every single [surface] swab tested positive for fecal contamination," he says. "This doesn't mean that we can see human feces on things," he adds, "but at some point in time, there was transmission of human fecal contamination onto every surface in the cabin we swabbed, and also everywhere in the latrine." The results of the investigation were published this month in the CDC's Morbidity and Mortality Weekly Report. Investigators concluded that there was an outbreak of norovirus on the trail last summer that was spreading between hikers and that "exposure to contaminated surfaces within the cabin and ... latrines likely amplified transmission." Surface transmission is one easy way the disease could spread among hikers: Someone who is infected could contaminate their hands or clothing when they defecate or vomit. They may spread the virus onto shared surfaces that other hikers touch, such as a latrine door handle, or a shared utensil at the campsite. Those hikers could touch their mouths, ingesting virus particles and becoming sick. They could also get it from eating food or drinking water that's been contaminated. Michelle Holshue toggle caption EIS officer Dr. Arran Hamlet swabs a backcountry pit latrine for norovirus sampling during an investigation for an outbreak of gastrointestinal illness among Pacific Crest Trail Hikers in 2022. Michelle Holshue Shanna Miko, a nurse epidemiologist at CDC, was part of the field team on the Pacific Crest Trail study — and it wasn't her first norovirus-in-the-woods investigation. Last year, she traced an outbreak at the Grand Canyon, among people who were backcountry hiking and whitewater rafting. "These are very well-planned trips. For many people, they're once-in-a-lifetime," she says. Travelers often read books and blogs in preparation, and get advice from others who have done the trip before them, accumulating trail wisdom – "places where people frequently stop, or places that have shelters where people frequently sleep over," good places to get water, or use the bathroom, she says. These hubs, which seem so remote, see thousands of people – in varying levels of wellness – pass through in a season. They may not leave visible traces but some may leave germs, like norovirus, that can live on environmental surfaces for a long time, Miko says. (According to the CDC, this hardy virus can stay alive on surfaces for "days or weeks.") Hand sanitizer doesn't cut and other advice for staying well With norovirus, hand sanitizer and common water filters don't work. The virus is small, and "extra sticky" on skin, Miko says. And it takes just a few dozen viral particles to make a person very ill. Miko says there are ways that hikers can cut their risks. Always wash your hands with soap and water after you have a bowel movement – and wash them again before you eat. "The soap is a great detergent to remove the virus from your hands," she says. While any soap and water will work, she recommends biodegradable soaps in protected national parks and backcountry woods to reduce the impact on the environment. Make sure to drink and cook with good, clean water. Pay attention to where the water comes from, and treat it properly. "Boiling for at least three minutes is the best way to kill everything you would typically come across," Miko says. And note: Most water filters are good at removing bacteria and common parasites but they don't cut it when it comes to norovirus. You'll need to layer on either chemical treatment or UV light treatment to kill the virus. (Here's the CDC's breakdown of what works for which pathogens.) If you do fall ill, shelter in place if you can. This is for your own safety, and for the sake of others, "so you aren't seeding norovirus particles along the trail and putting others at risk," Miko says. This is not the time to try to push ahead but to rest and hydrate. "If possible, try to keep your defecation far from the trail and bury it, and don't prepare food anywhere near where you're using the restroom or vomiting," she says. The worst of the symptoms usually passes in two to three days, though "you can still spread norovirus after you feel better," Miko says. She recommends waiting at least two days after symptoms have resolved before continuing on. Norovirus was the last straw Kevin Quinn thinks he got norovirus because he broke his own rule. "We were told not to drink from standing water, and I did the one time," he says. It was a dry year, and the streams in the section he was hiking had run out. Kevin Quinn toggle caption Kevin Quinn set out to hike the Pacific Crest Trail with his daughter, Katie, who had left her job so they could hike together. Norovirus derailed their plans. Kevin Quinn He was thirsty, he was really tired – and while he filtered the water, he skipped the additional, chemical treatment. Soon, he knew he'd made a mistake. "I was completely debilitated. I didn't have the energy to set my tent up," he recalls, "All I was doing was, like, every 15 minutes, going off into the woods and either throwing up or having diarrhea." After a night of being very ill, Quinn and his daughter made a long, slow trek out of the woods. "We never made the whole trail," he says, "We just decided to call it quits." Earlier in the summer, he caught COVID, which derailed his trail plans for a month. Up ahead, there were wildfires and trail closures. For Quinn, getting norovirus was the last straw. A year later, he still regrets that he didn't take the time to treat the water properly. To other hikers – he says: heed the signs, wash your hands and make sure your water is clean. In his experience, it's not worth the risk. The story was edited for web by Carmel Wroth and for air by Scott Hensley.	Epidemics & Outbreaks
Treating psoriatic arthritis (PsA) isn't like treating strep throat. You don't just take one medicine for a few days and feel better. PsA is a complex, chronic disease that stays with you and affects many parts of your body -- skin, joints, nails, heart, and lungs. Many medications slow PsA and relieve symptoms, but the first treatment you try won't always be the right one for you. "There is no one-size-fits-all, and there is no one medication for psoriatic arthritis," says Saakshi Khattri, MD, assistant professor of dermatology and rheumatology at the Icahn School of Medicine at Mount Sinai in New York. âSo often there are patients who do not respond to their medication.â There are a couple of reasons you might need to switch to a new treatment, says Ethan Craig, MD, assistant professor of clinical medicine at the University of Pennsylvania and rheumatologist at the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. âOne is intolerance -- the patient has a side effect of some sort. The second is ineffectiveness. Either the medication doesn't work in the first place, or it works for a period of time and then it stops working," he says. When your medicine doesn't tame your symptoms, it's time to regroup with your rheumatologist or dermatologist and talk about other treatment options. Signs That It's Time to Change The clearest signs that you need a medication switch is a new flare-up of symptoms. Worsening joint pain and stiffness, increased fatigue, and sudden trouble doing activities that were easy for you are some of the most obvious symptoms. More subtle signs like difficulty sleeping and mood changes also suggest the medication you're on isn't controlling your PsA well enough. If you've just started on a treatment, you do need to give it time.Â Sometimes you can have a partial response -- maybe the swelling comes down in some of your joints but not in others. Then your doctor might suggest that you wait it out for 4 to 6 months to give the drug more time to work. During that time, steroids or nonsteroidal anti-inflammatory drugs (NSAIDs) can help bridge the gap until your medication kicks in. Once you've been on a treatment for several months with no improvement, or if you're no longer getting relief from a drug you've been taking for a while, "that's often an indication that we need to think about switching things up," Craig says. Advice for Switching Meds PsA treatment comes in many forms. Often anti-inflammatories and conventional disease modifying drugs are used (DMARDS). Biologic DMARDS are also often used; they target different pathways in the immune system. There are other options for treatment as well, including targeted synthetic DMARDS and newer oral agents. Your doctor will take a few factors into consideration when recommending your next step, including: Your symptoms. PsA causes a variety of symptoms. Your choice of medication may hinge on the type of symptoms you have, how much they bother you, and which drug targets them best. For example, one of Craig's patients worked at a ticket window. "Because he had to hand out tickets, he was very self-conscious about the appearance of his nails," Craig says. "He was willing to be on a drug that helped his nails, even if it didn't help his arthritis." The drugâs side effects. Each type of medication comes with a set of side effects, which you need to balance against its benefits. For example, methotrexate can irritate your stomach, while biologics increase the risk for infections. Itâs important to think about which side effects you can tolerate and which ones you definitely don't want. How you take the drug. Many PsA meds come as an infusion or an injection. If you're not a fan of needles, you might prefer a pill. What other conditions you have. Methotrexate can damage your liver. NSAIDs are linked to heart problems. So if you already have liver or heart disease, these medications may not be safe for you. Your insurance coverage. Ultimately, your insurance company could decide which treatment you get next. "The sad fact of the matter is that our choice of medication is often substantially constrained by insurance approval," Craig says. Some insurance companies will expect you to try a certain drug first and prove it doesn't work before theyâll let you switch to the medication that you and your doctor want to use. How to Ask Your Doctor for a New Treatment You might already see your doctor every 3 to 4 months if you take medication. During those visits, the doctor can examine your joints, do imaging tests, and check your lab test results to see whether your PsA is under good control. But tests donât always tell the whole story. Your point of view is important, too.Â Let the doctor know if you're having any problems with your medications, including side effects or breakthrough symptoms. If you're not due for a visit yet, call the office or send your doctor an email about your concerns through the patient portal. Donât be afraid to speak up. "A lot of patients are hesitant. They don't want to take up the doctor's time," Craig says. "It's helpful for us if they come in. I hate to see someone suffer for months. And it's often easier to intervene earlier in the course of the disease, when things are less active." If your doctor isn't on board with you switching medications, don't be afraid to push back to get on the right treatment. "Sometimes it's a matter of miscommunication," he adds. "We need to be on the same page as to what the expectations are, what we're treating, and what effect we expect." Show Sources Photo Credit: smartstock / Getty Images SOURCES: Arthritis Foundation: "Beyond Joints: How Psoriatic Arthritis Affects the Body." Mayo Clinic: "Psoriatic Arthritis." Ethan Craig, MD, assistant professor, clinical medicine, University of Pennsylvania, rheumatologist, Corporal Michael J. Crescenz VA Medical Center, Philadelphia. Saakshi Khattri, MD, assistant professor, dermatology and rheumatology, Icahn School of Medicine at Mount Sinai, New York.	Disease Research
Amoxicillin penicillin antibiotics are seen in the pharmacy at a medical and dental health clinic in Los Angeles, California, U.S., April 27, 2016. REUTERS/Lucy NicholsonRegister now for FREE unlimited access to Reuters.comLONDON, June 14 (Reuters) - In the absence of global standards limiting toxic emissions produced by antibiotics at the point of manufacture, the pharmaceutical industry has come up with its own standard.The AMR Industry Alliance - a coalition of drugmakers, biotech, diagnostic and other companies involved in the field of antimicrobials - said on Tuesday it was adopting its own standards to ensure the responsible manufacture of antibiotics.Antibiotics seeping into the environment during the manufacturing process aren't just toxic to the soil, water and living organisms but can also spur the emergence of drug-resistant bacteria.Register now for FREE unlimited access to Reuters.comAntibiotics can also contaminate the environment through excretions by humans and animals that consume them, via fertilisers used on crops, and the improper disposal of medicinal products into sewage systems.But manufacturing as a source of emissions can be controlled, and as such the Alliance has developed its own so-called 'safe-level' of antibiotic seepage into the environment at the point of manufacture, taking into account ecological toxicity.Although there have been proposals for such regulations to be imposed in some countries - including India, a key global antibiotic supplier that has come under fire for lax regulations - not much has come to pass."The challenge of regulation is - on the environmental side, it's country by country, so it's very difficult to set international environmental regulation," Steve Brooks, the Alliance's manufacturing work group lead, told Reuters.The Alliance, which accounts for about a third of the antibiotic manufacturing supply chain, has been urging members in recent years to self-regulate."We're not here to say all members across all our supply chains are meeting all aspects of the standard today. But we do know we've made great progress," said Brooks.In 2018, the Alliance put together a framework to control antibiotic manufacturing waste streams and encouraged members to adopt it. Alongside the British Standards Institution (BSI), it is now formalising the framework.A 2021 progress report showed that some 85% of sites owned by Alliance members had been assessed, of which just over three quarters fully met the standards set under the framework.FRAGMENTED SUPPLY CHAINInterventions are often simple, for example, a waste stream could be collected and treated separately with chemicals or incinerated instead of being released into the aquatic environment, said Brooks."It's not forcing industry to implement massively expensive controls, unless of course, those ultimately are required," he said.But ensuring these standards are implemented far and wide, in the absence of legal ramifications remains to be seen.It will be complicated by a fragmented global supply chain for antibiotics, in which various manufacturing stages are often outsourced and the industry is particularly reliant on China and India.British pharma giant GSK (GSK.L), a key maker of antibiotics, says its own sites are fully compliant with the manufacturing standards, and expects to have third party sites fully onboard by the end of 2022."Contracts with suppliers are discontinued if a supplier was unable or unwilling to meet the discharge limit," a GSK spokesperson told Reuters.Procurers of antibiotics are beginning to ask for products that are responsibly manufactured, said Brooks. To that end, the Alliance expects to have some sort of certification process in place that will be mediated by an independent third party in the coming year.If there's a will to adopt these standards, there's a way, a spokesperson from Netherlands-based antimicrobial drug manufacturer Centrient Pharmaceuticals said."I think we're very optimistic that it's possible, should companies choose to do so."Register now for FREE unlimited access to Reuters.comReporting by Natalie Grover; Editing by Susan FentonOur Standards: The Thomson Reuters Trust Principles.	Drug Discoveries
Queen Maxima of the Netherlands looked effortlessly elegant in a chic camel cape as she returned to a cancer hospital in Utrecht five years after she opened it. The Argentine-born royal, 51, paired her camel cape with a jumper dress in a similar shade and belted it at the waist as she met with children who have received treatment at the ward. Mother-of-three Máxima accessorised the jumper dress with a belt at the waist and a pair of knee-length boots in a tan shade. The Queen's chic camel cape, which is a break from her tradition of wearing bold colours, has had another outing to the ward after she also stepped out in the layer at the end of January with her husband, King Willem-Alexander, at the Royal Palace. Today Máxima's visit was a poignant one as she returned to the Princess Máxima Centre, which has become a hub for research into childhood cancers since the royal first opened it in 2018. All children with cancer in the Netherlands are treated at the paediatric oncology ward, which it claims makes it the largest paediatric centre in Europe. According to the centre's website, its mission is: 'To cure every child with cancer, with optimal quality of life.' Last year, after the Russian invasion of Ukraine, 63 Ukrainian children moved to The Netherlands so they could receive cancer treatment at the centre. While the treatment at the centre is funded in part by the health ministry in The Netherlands and also by health insurance, its research relies heavily on donations. Today, as she returned to the health centre, Máxima was pictured meeting with children who have been diagnosed with cancer. She was pictured smiling with some children and chatting to others, showing her affinity with little ones as she walked around the centre. At one point, she was pictured exclaiming something as she chatted with a child, whom it appears she may have first met several years ago. The Queen was presented with a photo on an easel of herself in a previous visit, leaning down to speak to a young child in a wheelchair at the centre. She was visibly moved looking at the photo, in what appeared to be a realisation that she is now posing for a photo with the same child, who is grown up and looking well. During her visit, Máxima will also meet with oncologists and other staff members at the centre, with an aim of discussing how research into childhood cancers can help bring children for treatment earlier on to increase their chances of survival and living a healthy life after recovery. To mark World Child Cancer Day tomorrow, she will also write the first message in a 'Heart under the belt' card on display at the hospital.	Disease Research
The NHS warned yesterday it faces the most severe disruption yet as tens of thousands of doctors began a strike over pay. Around 60,000 junior doctors were eligible to join a three-day strike which began yesterday. The British Medical Association says they are walking out for “pay restoration” after a real-terms cut of 26% since the Tories came to power. NHS national medical director Prof Sir Stephen Powis said patients would face significant disruption. He said: “This is likely to be the most disruptive industrial action that we’ve seen all winter.” Consultants and other medics have been drafted in to provide cover in areas such as A&E. Speaking outside University College London Hospitals in Central London, Dr Phoebe Verbeeten, 28, said: “The NHS has become an increasingly negative place to work and it’s run on goodwill and caffeine at the moment.” Dr Sara Cooke, 33, paediatric registrar in cardiology, said: “I have been in medicine for about 10 years now and have definitely seen the impact that not only pay but conditions have had on team morale, and the effects on the profession as a whole.” The NHS already has a record 7.2 million elective procedure backlog and many more operations are likely to be axed. Newly qualified medics earn £14.09 an hour which they are asking to be increased to £19 an hour. Union leaders want that backdated for 2022/23, and agreed pay progression for the 2023/24 financial year – due to start next month. Junior doctors received a 2% rise during 2022/23, despite inflation now running at well over 10%. Health Secretary Steve Barclay said yesterday: “I urge junior doctors to come and have discussions, as other health unions have been doing, so we can pause the strikes and discuss the issues.” PM Rishi Sunak said: “I don’t think it’s right there’s so much disruption being caused to families’ lives.”	Health Policy
The "potentially massive impact" of lockdowns on society was not thought through in 2020, the lead lawyer for the Covid inquiry has said. As the probe into the government's handling of the pandemic began hearing evidence, Hugo Keith KC said the UK may not have been well prepared "at all". It was "extraordinary" that lockdowns had received little thought, he said. Government figures show 227,321 people have died in the UK with Covid mentioned on their death certificate. Mr Keith told the first public hearing that the virus had caused "death, misery, and incalculable loss". He said while Covid could not have been avoided, the key issue was whether its impact on the UK was inevitable. There was "very little debate" about whether a national lockdown could be needed ahead of the pandemic or whether it could be avoided, Mr Keith told the inquiry, adding that there was a failure to think through the consequences for education and the economy. On Tuesday, Mr Keith was addressing the inquiry as it prepares to take oral evidence from its first witnesses later in the week. Its first topic - or module - will examine how well prepared the UK was for Covid up to January 2020. Mr Keith said: "Even at this stage, before hearing the evidence, it is apparent that we might not have been very well prepared at all." What is the UK Covid-19 inquiry? - It is about going through what happened and learning lessons - No-one will be found guilty or innocent - Any recommendations made do not have to be adopted by governments - The inquiry has no formal deadline but is due to hold public hearings until 2026 - Scotland is holding a separate inquiry in addition to the wider UK one Chair Baroness Hallett pledged that the inquiry into the handling of the coronavirus pandemic would be the "thorough investigation" that the public deserves. The former High Court judge paid tribute to a "dignified vigil" of bereaved family members holding a silent protest outside of the building. Lady Hallett said there were three key questions to be answered for the "millions of people who have suffered and continue to suffer": - Was the UK properly prepared for a pandemic? - Was the response to it appropriate? - And can we learn lessons for the future? This first part of the inquiry will hear from key politicians, civil servants, scientists, unions, health and care organisations, groups representing victims and their relatives and more. The Covid-19 Bereaved Families for Justice group has criticised the inquiry's timetable and says people have been "excluded from sharing key evidence". They branded the inquiry's Every Story Matters project - where members of the public can share their experience with the inquiry through a website - an "inadequate" process because stories will be anonymised and summarised and possibly "open to bias and interpretation by third parties". Addressing critics of the inquiry, Lady Hallett said she hoped they would understand the difficult balance she has had to strike. "I am listening to them, their loss will be recognised, they will be able to contribute to the inquiry." Mr Keith, counsel to the inquiry, said UK was "taken by surprise" over "significant aspects" of the pandemic, including lockdowns. "Extraordinary though it may seem, given that it's a word that's forever seared in the nation's consciousness, there was very little debate pre-pandemic of whether a lockdown might prove to be necessary in the event of a runaway virus, let alone how a lockdown could be avoided. "Very little thought was given to how, if it proved to be necessary, how something as complex, difficult and damaging as a national lockdown could be put in place at all. "Equally, there appears to have been a failure to think through the potentially massive impact on education and on the economy." He said the UK had been preparing for an outbreak more similar to flu, and questioned how well placed and funded the NHS was to cope. "No amount of foresight or planning can guarantee that a country will not make mistakes when a disease strikes, but that does not mean that we should not strive to be as ready as we sensibly can be," Mr Keith said. "No country can be perfectly prepared, but it can certainly be underprepared." Mr Keith highlighted "shocking" data showing that Covid mortality was two-and-a-half times higher in some of the most deprived parts of the UK than the richest, with people in some ethnic minority groups or with a disability far more likely to be infected or die of the disease. To what extent those outcomes could and should have been foreseen and mitigated would be a "big question" in module one, he said. The wider political environment will also be considered including the possible impact of Brexit on emergency planning. "Did the attention paid to the risks of a no-deal Brexit - Operation Yellowhammer as it was known - drain resources and capacity that should have been continuing the fight against the next pandemic?" Mr Keith asked. "Or did that generic and operational planning, in fact, lead to people being better trained and well-marshalled, and in fact better prepared to deal with Covid? "On the evidence so far... we very much fear that it was the former." The inquiry will also examine if the collapse of the power-sharing agreement in Northern Ireland damaged the ability of authorities to plan and respond to the pandemic. Mr Keith said it was unlikely we will ever know how Covid started - whether it emerged from a lab leak or from farmed wild animals that were sold in Wuhan. Nor when the first human infection happened, he said. "For this inquiry's purposes, this knowledge does not matter." In his opening remarks, Pete Weatherby KC, counsel for the Covid-19 Bereaved Families for Justice group, said the "closest to an overall plan" to deal with Covid in 2020 was a 2011 document drawn up to protect the UK from an outbreak of influenza. "With a pandemic, time is of the essence and lost time is measured in lives," he said. "The families expect the evidence will showâ¦ little or no ministerial leadership and the chaos of committees which led to poor planning and ultimately a reactive rather than a proactive response to the virus." In response to the Brexit claims, a spokesperson for the prime minister said the government would not be responding to every issue raised in the inquiry. He added that it would be up to the government to respond at the appropriate stage. WhatsApp Messages Lady Hallett has asked to see ex-prime minister Boris Johnson's unredacted WhatsApp messages between him and around 40 politicians and officials, but this is being challenged by his successor, Rishi Sunak. The Cabinet Office launched a legal challenge against the request, arguing some of the messages were irrelevant. This is thought to be the first time a government has taken legal action against its own public inquiry. Mr Johnson said he was "perfectly content" for the inquiry to have WhatsApp messages sent after May 2021. Earlier messages are not available because his mobile phone was involved in a security breach and has not been used since. Former Health Secretary Matt Hancock also said he was happy to share his messages, although many of these have already been leaked by the journalist Isabel Oakeshott, who helped Mr Hancock write his book, Pandemic Diaries. In a statement about the back-and-forth over the messages, Rishi Sunak's spokesperson said it "is still ongoing" and will "obviously... be resolved through the normal process". "Broadly, we continue to provide tens of thousands of pieces of information to the inquiry, 55,000 documents over the past 11 months and we will do so in the spirit of transparency and candour." How many Covid deaths have there been? The UK saw one of the worst first waves of Covid in Europe in spring 2020. In April and May that year, about 160,000 deaths were registered: 60,000 more than you'd expect based on the years just before the pandemic. But by that winter the UK had been overtaken by many countries in eastern Europe who had seemed to escape the first wave. The UK's Office for National Statistics has continued to analyse these figures for Europe and, as of July last year, put the UK in the middle of the pack. According to Department of Health figures, 227,321 people died across the UK with Covid recorded on their death certificate. Covid vaccines have prevented many deaths and serious illness from the virus - more than 151m doses have been given in the UK.	Epidemics & Outbreaks
Tens of thousands of Americans have reported a COVID-19 test result to the National Institutes of Health's website that launched in November.The site, MakeMyTestCount.org, allows people to anonymously report the results of any brand of at-home COVID-19 test.In updated data exclusively provided to ABC News, 24,000 people have reported a test result to the site. Additionally, three-fourths of the results are a positive test and women were more likely to report a test result than men."I think there's a greater number of people who are testing for COVID at this time than are being reported on this website. So, this is just sort of a small raindrop in a huge storm," Dr. Sarah Elisabeth Waldman, an associate professor in the division of infectious diseases at UC Davis Medical Center, told ABC News.When asked about the discrepancy in women- and men-reporting levels, "I don't think it's specific to COVID. I think this is more specific to women in general, having higher rates of self-reporting on voluntary websites and other programs," she added.Photo illustration of a government issued COVID-19 at home test kit.Michael Bocchieri/Getty Images, FILEPublic health experts said it's great that there is a place for people to import test results and that more people are doing so than expected – but questions remain about self reported data that could give scientists a better idea of where the virus is spreading and who is most affected.They also warned that there may be a bias in who is inclined to report test results."The fact that we're seeing three out of four reported tests as positive definitely doesn't mean that three out of four people are actually positive. Likely, it means that people are more inclined to report a positive than a negative result," Andrew Weitz, Ph.D., a program director at the NIH and co-lead of the project, told ABC News.But that doesn't mean reporting of at-home test results is not beneficial to health officials. In fact, the more results that are provided, the clearer their understanding of COVID in the community is."The absolute numbers may or may not tell the whole story, but what I think the public health community is going to start getting a better handle on is how the trends can help us understand that story," Dr. Krishna Juluru, a presidential innovation fellow at the NIH and co-lead of the project, told ABC News.Experts also urged the public to report their at-home test results regardless of whether positive or negative to provide health officials with a better sense of what is going on in the community."Without the negatives, we don't have a good idea of what the overall positivity rate might be, and where we're seeing real significant increases," Matthew Binnicker, Ph.D., director of the clinical virology laboratory at Mayo Clinic, told ABC News. "We need to be able to determine where COVID is most prevalent, where we're experiencing a surge [and] we need to have the total number of tested including positive and negatives to really get a good sense of that."The NIH is also launching a pilot program in one county in Pennsylvania that will provide free COVID-19 health services entirely virtually. Up to 8,000 eligible residents are anticipated to participate in the program.Under the program, a patient sick with COVID-19 could receive at-home rapid tests, telehealth sessions, and at-home treatments like Paxlovid without leaving their house."It's largely focused on a home setting, but we also allow individuals to have options so if they want to pick up a test at a local community center, after a telehealth consultation if they want to go pick up their medications at a local pharmacy, we allow that as well," said Juluru.A woman placing swab into the antigen test extraction tubeCris Cantã³n/Getty Images, FILESince anti-viral drugs, such as Paxlovid, cannot be taken with some other medications, so patients must meet with a clinician before any therapeutics are sent to their home.There are plans to expand the program to multiple other sites throughout the year."This is a pilot program, so we're kind of doing it in the spirit of learning as much as possible," said Weitz. A main goal for the scientists at the NIH is, "to understand what's working, what's not and how can we improve things if there were to be a larger scale rollout of this program," he added.	Epidemics & Outbreaks
The use of gas and air in maternity wards is being suspended amid midwife safety fears. The nitrous oxide levels have been recorded at 50 times the safety limit with concerns raised about staff being exposed to fumes on a regular basis. The Princess Alexandra Hospital Trust, which operates hospitals in Essex, is among those to axe Entonox gas last month. They have ordered new machines which break the gas down - though can only get three. It comes as the Royal College of Midwives has said too many of the buildings housing maternity services are "simply not fit for purpose". The union claims the issue has arisen from "poor ventilation" in delivery suites and labour wards, which it describes as "the tip of the iceberg". Have you been affected by this story? Let us know at webnews@mirror.co.uk Amy Fantis is due to have her baby at Princess Alexandra and said taking away gas and air is "madness". She told the Times: "It’s not available to everyone and I might not get it. It is a stress that you don’t need. "I understand they have to keep midwives safe but to just take it away seems madness. "It is the poor mums who are paying the price." Joanna Keable, head of midwifery at the Trust, said the issue is solely about the risks of prolonged exposure. She said gas and air will not bring any risk to expectant mums or their babies. She said: "Please be reassured that there is no risk to mothers, birthing people, their partners and babies. "The use of Entonox was temporarily suspended to protect our midwifery and medical teams from prolonged exposure to nitrous oxide in the atmosphere arising from the patient use of gas and air." Ms Keable added: “There continues to be a range of other pain relief options that our maternity and medical team are discussing with women and pregnant people on an individual basis. "We have also ordered and are awaiting delivery and installation of permanent extraction/gas and air kits to support us to be able to offer gas and air in all areas of our Maternity Unit as soon as possible." Ipswich Hospital temporarily suspended its use of the pain relief last year but re-introduced it after new ventilation units were installed. Dr Suzanne Tyler, the RCM’s Executive Director, Trade Union, said: “Too many of the buildings that house maternity services are simply not fit for purpose. This issue has arisen because of poor ventilation in delivery suites and labour wards – but this is just the tip of the iceberg. "We know of crumbling walls, ceilings being held up by props and even sewage flowing onto wards. "During COVID, a lack of decent ventilation and appointments taking place in tiny rooms meant that birth partners were unable to attend scans. "These aren’t cosmetic issues. "We need to see proper investment in maternity services, including the bricks and mortar.”	Women’s Health
- Summary - Companies - Women's rights campaigner serving 12 years' jail - Norwegian Nobel committee lauds Iranian protesters - Tehran says award is 'biased and politically motivated' - Biden praises Mohammadi and calls for immediate release OSLO, Oct 6 (Reuters) - Imprisoned Iranian women's rights advocate Narges Mohammadi won the Nobel Peace Prize on Friday in a rebuke to Tehran's theocratic leaders and boost for anti-government protesters, prompting the Islamic Republic's condemnation. The award-making committee said the prize honoured those behind recent unprecedented demonstrations in Iran and called for the release of Mohammadi, 51, who has campaigned for three decades for women's rights and abolition of the death penalty. "We hope to send the message to women all around the world that are living in conditions where they are systematically discriminated: 'Have the courage, keep on going'," Berit Reiss-Andersen, head of the Norwegian Nobel Committee, told Reuters. "We want to give the prize to encourage Narges Mohammadi and the hundreds of thousands of people who have been crying for exactly 'Woman, Life, Freedom' in Iran," she added, referring to the protest movement's main slogan. Tehran, which has called the protests Western-led subversion, accused the Nobel committee of meddling and politicizing the issue of human rights. "The action of the Nobel Peace Committee is political move in line with the interventionist and anti-Iranian policies of some European governments," Nasser Kanaani, a spokesperson for Iran's Foreign Ministry, said. "The Nobel Peace committee has awarded a prize to a person convicted of repeated law violations and criminal acts, and we condemn this as biased and politically motivated," he added in the statement carried by state media. Mohammadi was quoted by the New York Times as saying she would never stop striving for democracy and equality, even if that meant staying in prison. "I will continue to fight against the relentless discrimination, tyranny and gender-based oppression by the oppressive religious government until the liberation of women," the newspaper quoted her as saying in a statement, which it said was issued after the Nobel announcement. Mohammadi is serving multiple sentences in Tehran's Evin Prison amounting to about 12 years imprisonment, one of the many periods she has been detained behind bars, according to the Front Line Defenders rights organisation. Charges include spreading propaganda against the state. She is the deputy head of the Defenders of Human Rights Center, a non-governmental organisation led by Shirin Ebadi, the 2003 Nobel Peace Prize laureate who lives in exile. "I congratulate Narges Mohammadi and all Iranian women for this prize," Ebadi told Reuters. "This prize will shed light on violation of women's rights in the Islamic Republic ... which unfortunately has proven that it cannot be reformed." 'EMBOLDEN NARGES' FIGHT' Mohammadi is the 19th woman to win the 122-year-old prize and the first one since Maria Ressa of the Philippines garnered the award in 2021 jointly with Russia's Dmitry Muratov. Mohammadi's husband Taghi Rahmani applauded as he watched the announcement on TV at his home in Paris. "This Nobel Prize will embolden Narges' fight for human rights, but more importantly, this is in fact a prize for the 'woman, life and freedom' movement," he told Reuters. Her brother, Hamidreza Mohammadi, said he was "overwhelmed" when watching the announcement and that the prize would strengthen the work of his sister and other activists. "She will feel much stronger in her endeavours for human rights in Iran and for everyone who hopes for a better situation in Iran," he told Reuters in Oslo. Arrested more than a dozen times in her life, and held three times in Evin prison since 2012, Mohammadi has been unable to see her husband for 15 years and her children for seven. Her prize, worth 11 million Swedish crowns, or around $1 million, will be presented in Oslo on Dec. 10, the anniversary of the death of Swedish industrialist Alfred Nobel, who founded the awards in his 1895 will. Past winners include Martin Luther King and Nelson Mandela. Mohammadi's award came as rights groups reported that an Iranian teenage girl was hospitalised in a coma after a confrontation on the Tehran metro for not wearing a hijab. Iranian authorities deny the reports. U.S. President Joe Biden praised Mohammadi and called for her immediate release, while lamenting the reported assault of the hospitalized teenager. "The United States will continue working to support Iranians’ ability to advocate for their own future, for freedom of expression, for gender equality, and to end gender-based violence against women and girls everywhere," Biden said in a statement. GLOBAL TRIBUTES The Nobel Committee's honouring of Mohammadi also came just over a year after the death of 22-year-old Mahsa Amini in the custody of Iranian morality police for allegedly flouting the Islamic Republic's dress code for women. That provoked months of nationwide protests that posed the biggest challenge to Shi'ite clerical rule in years, and was met with a deadly security crackdown costing several hundred lives. Among a stream of tributes from major global bodies, U.N. Secretary-General Antonio Guterres said the Nobel award was "a tribute to all those women who are fighting for their rights at the risk of their freedom, their health and even their lives" . Dan Smith, head of the Stockholm International Peace Research Institute think tank, said that while the prize could help ease pressure on Iranian dissidents, it would be unlikely to bring about Mohammadi's release. Reporting by Gwladys Fouche, Nerijus Adomaitis, Terje Solsvik and Tom Little in Oslo, Ilze Filks in Stockholm, Parisa Hafezi in Dubai, Anthony Paone in Paris, Charlotte Van Campenhout in Brussels, Michelle Nichols at the United Nations, John Davison, Gabrielle Tetrault-Farber and Cecile Mantovani in Geneva; Writing by Gwladys Fouche, Andrew Cawthorne and Susan Heavey; Editing by William Maclean and Andrew Heavens Our Standards: The Thomson Reuters Trust Principles.	Women’s Health
A GP surgery has closed its doors for the final time because it cannot recruit enough staff. Patients of Springmead Surgery in Chard will be moved to another practice. The closure is part of a national trend as fewer GPs take on more complex and heavier workloads. Dr Bernie Marden, Chief Medical Officer, NHS Somerset, said: "the practice has relied on extra locums for some time, adding, "Ultimately this is not sustainable for the long term." "Springmead Surgery has been experiencing challenges due to a variety of difficulties, including GP partnership and staff changes, over a few years." He added: "This issue is not unique to Somerset. Across the country we have GP workforce challenges and ever-increasing demands on services from an ageing, more clinically complex population. Many people in Chard are angry at what they see as a loss of an essential service. Sharon Vaux told BBC West: "You physically can't talk to a doctor, so you can't really get ill, because there's nobody to talk to," she said. "Sometimes people need to talk to someone in a medical profession". Springmead patient Richard Kilde said: "To have 6,000 patients move to a smaller surgery when we already have a three week waiting time, how on earth are they going to deal with it?" Dr Lucy-Jane Davis, from the British Medical Association, South West, said there are now fewer GPs that at any other time in the history of the NHS. "What we're seeing (in Chard) is a broad trend that we're seeing played out in real time in a specific community which is really concerning," she said.	Health Policy
An "amazing" schoolboy has died after a long battle with illness as his devastated family have paid tribute. Edward Hunstone, from Moreton, was just three when he was diagnosed with grade two pilomyxoid astrocytoma - a type of brain tumour. The 12-year-old was diagnosed after he started being "randomly sick", his nan Tracy said doctors initially put this down to an intolerance to certain foods and told the family "to keep a diary". The brave youngster endured eight years of chemotherapy, which he "took all in his stride", his family said. The chemotherapy went on until January 2021 and Edward also lost his vision in his right eye and in 2020 needed a shunt due to fluid on his brain, this also needed to be fixed four times. While on a break at Center Parcs in January this year, the family got a call from doctors to say Edward needed to have a bone marrow biopsy. Edward had the procedure on January 18 and a day later the family were told Edward had acute myeloid leukaemia. Tracy said: "They did another [bone marrow biopsy] in January, I can’t remember the exact date but it was a Wednesday, and by the Thursday he was in hospital and never left.” Edward's family said this treatment caused him to be "very, very poorly" and tragically the schoolboy lost his fight on February 22. Paying tribute to her son mum Sam Hunstone, 40, described him as "amazing" and said she was so proud of him. She said: “Edward was a little nutter, he really was, but he was so sweet as well. Say if he had pocket money, the others would just spend theirs, but he would sit and think. “Say there were two things he wanted, he would take about an hour to decide which one he wanted. He wouldn’t just go ‘mum get me the other one’. “He was also the first person to offer you money if you needed it. He would say ‘oh I have my pocket money if you need it’. He was so sweet. We are all so proud of him.” His nan Tracy also said: “Edward had no filter, he would say it exactly how it was. He was amazing. He loved arts, he loved crafts, he loved going out for night drives. Especially through covid because he couldn’t mix with other people." She added: “He was a right little character and said exactly what he thought. He was amazing. He had such a fight.” The family now want to give Edward "the best send off he deserves" and have set up a GoFundMe page to help with fundraising. Writing on the page, Tracy said: We are absolutely devastated Edward lost his fight on February 22 at 9am, our hearts are broken, and we want to give Edward the send off he absolutely deserves. He was 12-years-old and absolutely touched so many hearts. "He was one of a kind and never, ever should this have happened to him. He was amazing fighter and fought right to the end, everybody loved him who met him. Please if you can help Edward get the send off he deserves." To donate to the GoFundMe, please click here.	Disease Research
SHREVEPORT, La. -- The U.S. Drug Enforcement Administration has allowed one of the nation’s largest wholesale drug distributors to keep shipping addictive painkillers for nearly four years despite a judge’s recommendation to strip its license for turning a blind eye to thousands of suspicious opioid orders. The case has drawn attention to the involvement of a high-profile consultant the company had hired to stave off punishment and who is now DEA Administrator Anne Milgram’s top deputy. Here are the key takeaways: WHAT’S AT STAKE? A federal administrative law judge in August 2019 found that Morris & Dickson failed to flag thousands of suspicious, high-volume orders from pharmacies and recommended that it lose its license. Failure to follow DEA rules by Morris & Dickson and other major distributors has been blamed for leading to more than 700,000 American overdose deaths in the past two decades.. The company said it overhauled its compliance system, canceled suspicious orders and sent daily emails to the DEA spelling out its actions. But Judge Charles W. Dorman said it was too little, too late, and issued a ruling to deter similar actions by other companies. “Acceptance of responsibility and evidence of remediation are not get-out-of-jail-free cards that erase the harm caused by years of cavalier disregard,” Dorman wrote in a 159-page ruling obtained by The Associated Press. WHO IS MORRIS & DICKSON? Shreveport, Louisiana-based Morris & Dickson is the U.S.' fourth-largest drug distributor, with annual sales of more than $4 billion. But it trails a trio of pharmaceutical distributors known as the Big Three, all of whom agreed to pay the federal government more than $1 billion in fines and penalties for similar violations. Morris & Dickson officials have repeatedly said in court filings that the loss of its license would be a “virtual death sentence.” Among the more than 12,000 suspicious orders that Dorman said Morris & Dickson should have reported to the DEA were several placed by the Wilkinson Family Pharmacy in suburban New Orleans. In one month, March 2014, 42% of all prescriptions filled by Wilkinson were for controlled substances such as painkillers and 38% of those were paid for in cash. “Anybody with half a brain could’ve seen something wasn’t right,” said Dan Schneider, a retired pharmacist whose fight to hold drug companies accountable for the opioid crisis was featured in a Netflix documentary series. WHO IS LOUIS MILIONE? Louis Milione was named DEA’s principal deputy administrator in 2021. He had previously retired from the agency in 2017 after a storied 21-year career that included two years leading the division that controls the sale of highly addictive narcotics. Among his earlier achievements was running the overseas sting that in 2008 nabbed Russia’s notorious arms trafficker Viktor Bout. Morris & Dickson brought Milione as part of a $3 million contract after the DEA accused the company in 2018 of failing to flag thousands of suspicious, high-volume orders. Testifying in 2019 before federal Administrative Law Judge Charles W. Dorman, Milione argued that Morris & Dickson deserved to keep its license because it “spared no expense” to overhaul its compliance systems. WHAT DOES DEA SAY? The DEA did not respond to repeated requests to explain its handling of the case and whether Milione recused himself from any involvement in the matter. But neither Milgram nor two DEA administrators who preceded her have taken any regulatory action since Dorman’s 2019 recommendation. Former DEA officials told the AP that a nearly four-year delay is highly unusual, and that most such cases are resolved in half the time.	Drug Discoveries
Breakups are not much fun. Whether it's your first time through it or an unfortunate familiarity, there are few more agonising gut punches. Doubts and insecurities aplenty; wondering where, how and why things changed; and like an agonising Lionesses World Cup run, an overwhelming sense of "what if". Being a "science and tech journalist" has given me a fresh perspective on how it can impact us physically. Where's that headache come from? What about a sudden lack of energy? And why does eating anything, even a normal favourite, feel like an I'm A Celebrity challenge? For when pictures of wistful poetry on Instagram just don't cut it, it turns out science has some answers. As neuroscientist Dr Lucy Brown puts it, "we're all miserable when we've been dumped" - and there's a potent chemical cocktail that helps explain why. Serotonin is the brain chemical associated with happiness, oxytocin with bonding, and dopamine gets pumped out whenever your mind's reward system kicks in. No surprise then that you feel good when that holy trinity is high and rough when it's low. The key chemical is dopamine: the ultimate natural drug. 'It's like we're addicted' Brown was one of a team of researchers who conducted a study into the impact of heartbreak, scanning the brain activity of 15 young adults who were going through unwanted breakups. They were shown photos of their ex-partners, and the scans showed parts of the brain that power our sense of motivation and reward - where our dopaminergic neurons live - went into overdrive. It's an "overactivity" Brown compares to what you'd see in a cocaine addict trying to wean themselves off. "It's like we're addicted to each other," she says. "When we lose someone, we've lost a very rewarding part of our lives and sense of self. They've provided novelty in your life that now isn't there, so we need some other rewards." And like rewatching goals we may have thought had put the Lionesses' name on the title, looking back at texts and holiday photos won't do the trick. Florence Williams had found herself intrigued by the pain her heartbreak caused. Having seen her 25-year marriage suddenly fall apart, trauma was expected. But feeling physically sick and totally overwhelmed took her by surprise. "I was of course stunned by the event itself, but then I was really confused and surprised by how different I felt physically going through it," she says. "That feeling of being plugged into a faulty electrical socket; this buzzing sense of background anxiety and hypervigilance and an inability to sleep well; the weight loss and general confusion. Williams's experience and sense of confusion sent her on a global quest for answers documented in her book, Heartbreak: A Personal And Scientific Journey. She found while everyone's personal heartbreak is different, the bodily response is much the same: it's time for that holy trinity of hormones to take a battering. And it's not just emotional pain you may struggle with. In Brown's study, brain areas associated with physical pain were also activated. She explains rejection triggers a part of the brain called the insular cortex - the same part that responds to distress around pain, like when panic sets in after an already painful bee sting. When emotional stress causes physical symptoms, like headaches and nausea, its medical term is somatisation. "If you've ever had butterflies when you've been nervous, you've experienced this," explains Dr Abishek Rolands. "The most important thing to remember is even though there is no physical cause, the symptoms are very real - they are not made up or 'all in the head'." During her research, Williams, who has two adult children with her ex-husband, was particularly fascinated by the impact loss can have on our immune system. "It's important for our nervous systems that we feel safe," she says. "If we have people in our lives triggering cascades of healthy hormones, it's really protective against illness. Our cells actually listen to our mental state." Indeed, previous studies have stressed the importance of meaningful social relationships to stay healthy. And in 2021, US researchers suggested our immune system takes cues from our nervous system if it's struggling - effectively making decisions that could make us sick. In rare cases, this kind of emotional distress - especially when delivered suddenly - can even lead to the fittingly nicknamed "broken heart syndrome" - or takotsubo cardiomyopathy. Sindy Jodar, a senior cardiac nurse at the British Heart Foundation, says the symptoms - chiefly shortness of breath and chest pain - are consistent with a heart attack. "Most people have either been under a lot of physical or emotional stress, like losing a loved one," she says. "The only explanation we have at the moment is when the body is stressed, it releases a lot of catecholamines (adrenaline), and when lots of that is around in the body it can impact the heart." Unlike a heart attack, the condition does not cause blockages in the coronary arteries - but does totally change the shape of the heart's left ventricle, which pumps oxygenated blood through the body. It's this which gives the condition its actual Japanese name, as the shape of the ventricle becomes reminiscent of a trap fishermen use to catch octopus: narrow at the top, larger at the bottom. The condition only impacts around 5,000 people a year in the UK, and is more common in menopausal women, with most recovering after a few weeks. Just as science can explain why heartbreak, rejection, and loss makes us feel the way we do, it also offers solutions. Brown says heartbreak should be treated like "having to give up an addiction", though she admits the "craving is stronger when we've lost someone". But there are plenty of roads to go down without gorging ice cream while watching La La Land. Williams stresses the importance of working to activate the parasympathetic part of your nervous system by doing things that make you feel calm. The other part of our autonomic nervous system, sympathetic, is what causes anxiety and hypervigilance. "Connection to nature is really calming," she says, likewise to friends and family. "And there's lots of data showing the more meaning you derive from work, the more purpose you feel, the happier you'll be." Williams says such lessons apply to anyone "going through an emotional life quake". "People who end a relationship also face big emotions - guilt, sadness, loneliness," she adds. And as Brown says, there's novelty - that sense of excitement that needs refreshing in a healthy, sustainable way. Ice cream makes a compelling dinner once, but you'd probably best hope it wears off. "A good strategy is beginning things you didn't do during a relationship, like running or travelling," says Brown. "People always remember a heartbreak - it's very painful. But you do change, and can for the better."	Mental Health Treatments
Anti-rheumatic drugs could prevent thyroid disease Anti-rheumatic drugs used for rheumatoid arthritis might prevent the development of autoimmune thyroid disease, according to a new observational study by researchers from Karolinska Institutet published in the Journal of Internal Medicine. It is well known that patients with rheumatoid arthritis (RA) are at increased risk of autoimmune thyroid diseases such as Hashimoto's disease and Graves' disease. While patients with RA are usually treated with immunomodulatory drugs that affect the immune system, such drugs are rarely used in autoimmune thyroid diseases. Instead, such patients are treated with thyroid hormone to compensate for the changes in normal thyroid function that accompany autoimmune thyroid disease. The researchers in the current study wanted to investigate whether immunomodulatory drugs that reduce inflammation in the joints of patients with RA might also reduce the risk of these patients developing autoimmune thyroid disease. Previous studies in mice suggest that so-called DMARDs, a type of immune-modulatory drugs used to treat rheumatoid arthritis, can reduce inflammation in the thyroid gland. Still, knowledge of whether this effect also applies to humans is limited, according to the research team. 46 per cent lower risk with DMARD The researchers used data between 2006 and 2018 on over 13,000 patients with rheumatoid arthritis and their treatment, as well as data from over 63,000 individuals in a matched control group without rheumatoid arthritis. The researchers found that the risk of developing an autoimmune thyroid disease among RA patients was lower after their onset of the rheumatic disease than before diagnosis. The most pronounced reduction in the risk of autoimmune thyroid disease was seen in patients with rheumatoid arthritis treated with immunomodulatory drugs or "biological DMARDs". In these patients, the risk of autoimmune thyroid disease was 46 per cent lower than in the control group without rheumatoid arthritis. "These results support the hypothesis that certain types of immunomodulatory drugs could have a preventive effect on autoimmune thyroid disease," says Kristin Waldenlind, researcher at the Department of Medicine, Solna, Division of Clinical Epidemiology, Karolinska Institutet, specialist in rheumatology at Karolinska University Hospital and first author of the study. She continues: "Our results do not prove that it is the treatment with immunomodulatory drugs that led to the reduced risk of autoimmune thyroid disease, but provide support for this hypothesis. The results, if they can be replicated in further studies, open up the possibility of studying more directly in clinical trials whether the immunomodulatory drugs currently used for rheumatoid arthritis could also be used for the early treatment of autoimmune thyroid disease, i.e. for new areas of use of these drugs, known as drug repurposing." The Swedish Research Council, the Swedish Heart-Lung Foundation and Vinnova mainly financed the study. Publication "Disease-modifying antirheumatic drugs and risk of thyroxine-treated autoimmune thyroid disease in patients with rheumatoid arthritis", Kristin Waldenlind, Bénédicte Delcoigne, Saedis Saevarsdottir, Johan Askling, Journal of Internal Medicine, online November 27, 2023, doi: 10.1111/joim.13743.	Disease Research
On the advice of his doctor, legendary singer/songwriter Bruce Springsteen, who recently turned 74, postponed his worldwide tour to continue recovering from a digestive condition that many people born in the U.S.A. can relate to: peptic ulcer disease. "Thanks to all my friends and fans for your good wishes, encouragement and support," he posted on Instagram on Sept 27. "I'm on the mend and can't wait to see you all next year." TKTKTKTKKTTK A statement shared on his Instagram reads, "Bruce Springsteen has continued to recover steadily from peptic ulcer disease over the past few weeks and will continue treatment through the rest of the year on doctor's advice." Starting this February, the tour was his first since 2017 with the E Street Band. It originally began in the United States, then continued through Britain and Europe before the band returned to the U.S. in August. Springsteen previously canceled eight shows earlier this month in hopes of resuming his tour in Canada starting in November. But he later posted on social media that "out of an abundance of caution" all 2023 shows are canceled. What is peptic ulcer disease? After we place food into our mouths, our teeth combined with enzymes in our mouth help break down the food before it winds down the esophagus into our stomach. This triggers the stomach to produce acid as well as special enzymes to break down the food into even smaller particles, so that nutrients can be absorbed later in the small intestine. "Peptic ulcer disease is essentially the wearing away of the lining of the stomach and/or the small intestine." The stomach doesn’t digest itself because it has a special protective mucus lining. As long as the special factors that line the stomach and the digestive acidic juices meant to break up food are in balance with each other, the stomach acid doesn’t damage its own protective coating. "Peptic ulcer disease is essentially the wearing away of the lining of the stomach and/or the small intestine," Dr. Arnab Ray, section head of General Gastroenterology at Ochsner Health in New Orleans, Louisiana, told Fox News Digital in an email. "The disease is most commonly associated with a bacterial infection called helicobacter pylori [H. pylori], which causes inflammation in the stomach." Many people have this bacteria in their body without ever developing an ulcer, according to Penn Medicine. NSAIDS may cause ulcers "You can also develop peptic ulcer disease from the use of NSAIDs (non-steroidal anti-inflammatory drugs), more commonly known as ibuprofen," Ray added. NSAIDS are a class of medications available by prescription and over-the-counter to treat pain, fever or inflammatory conditions. Some examples include naproxen (Aleve), ibuprofen (Motrin) and aspirin (Bayer), according to Cleveland Clinic. Drinking excessive amounts of alcohol, having stress, smoking cigarettes or being very ill in the hospital are also risk factors for ulcers. Ibuprofen and naproxen are available over-the-counter at lower strengths. They work by blocking an enzyme in the body known as cyclooxygenase that makes prostaglandins, which cause inflammation, fever and associated pain. People experience less pain as prostaglandins are reduced in the body. But prostaglandins also help protect the stomach lining, so certain NSAIDS that selectively block the enzyme can lead to ulcers. Drinking excessive amounts of alcohol, having stress, smoking cigarettes or being very ill in the hospital are also risk factors for ulcers, per Penn Medicine. Symptoms of the disease "Symptoms of peptic ulcer disease include burning abdominal pain, nausea and vomiting, and bleeding," Ray told Fox News Digital. The most common symptom is abdominal pain, according to the National Institutes of Health (NIH). Some may describe the abdominal pain as a full or burning sensation that comes and goes or pain that worsens with eating. The pain is often in the upper part of the abdomen, anywhere between the belly button and the breastbone that mimics stomach indigestion. Some may describe the pain as a full or burning sensation that comes and goes or pain that worsens with eating. The pain may also worsen at night or when the stomach is empty — and depending on the location of the ulcer, the pain may disappear for a little bit after eating. Watch for signs of bleeding Sometimes peptic ulcers can lead to complications, which are often associated with bleeding. It’s important to seek urgent medical attention if you start to have black stools or notice stools that are mixed with blood. Other red flags are vomiting blood or vomiting material that looks like coffee grounds. People should see a doctor right away if the abdominal pain worsens or refuses to go away. Other signs of bleeding are feeling lightheaded or like you're going to faint, according to the NIH. Diagnosis of peptic ulcer disease Sometimes X-rays and CT scans provide clues that an ulcer is present, added Ray of General Gastroenterology at Ochsner Health. "We typically diagnose peptic ulcer disease with an endoscopy (EGD) to look at the stomach and intestines with a camera and take samples if necessary," Ray told Fox News Digital. Under sedation, the EGD is a scope that is passed through the mouth, into the esophagus, then into the stomach. A gastroenterologist visualizes any abnormalities in real time on a screen because a light and camera are attached to the scope at the end, according to the NIH. "Treatment time can be up to 8 to 12 weeks." During the procedure, the doctor usually also takes samples of part of the stomach lining so that a pathologist can rule out the bacteria, H. pylori, that is known to cause ulcers. The EGD also allows doctors to cauterize a bleeding vessel when the ulcer erodes into a blood vessel. "To treat peptic ulcer disease, we generally start with identifying the cause and treating with an acid-reducing medication," the doctor noted. The therapy also involves antibiotics if H pylori is discovered on biopsy. "Treatment time can be up to 8 to 12 weeks," he added.	Disease Research
Nov 9 (Reuters) - Surgeons in New York have performed the first-ever whole-eye transplant in a human, they announced on Thursday, an accomplishment being hailed as a breakthrough even though the patient has not regained sight in the eye. In the six months since the surgery, performed during a partial face transplant, the grafted eye has shown important signs of health, including well-functioning blood vessels and a promising-looking retina, according to the surgical team at NYU Langone Health. “The mere fact that we transplanted an eye is a huge step forward, something that for centuries has been thought about, but it's never been performed,” said Dr. Eduardo Rodriguez, who led the team. Until now, doctors have only been able to transplant the cornea, the clear front layer of the eye. The recipient of the eye, Aaron James, is a 46-year-old military veteran from Arkansas who survived a work-related high-voltage electrical accident that destroyed the left side of his face, his nose, his mouth and his left eye. The transplant surgery took 21 hours. Initially, doctors were just planning to include the eyeball as part of the face transplant for cosmetic reasons, Rodriguez said during a Zoom interview. “If some form of vision restoration occurred, it would be wonderful, but... the goal was for us to perform the technical operation,” and have the eyeball survive, Rodriquez added. Whatever happens going forward will be monitored, he said. Presently, the transplanted eye is not communicating with the brain through the optic nerve. To encourage healing of the connection between the donor and recipient optic nerves, surgeons harvested adult stem cells from the donor’s bone marrow and injected them into the optic nerve during the transplant, hoping they would replace damaged cells and protect the nerve. Transplantation of a viable eye globe opens many new possibilities, Rodriguez said, even if sight is not restored in this case. Other research teams are developing ways to connect nerve networks in the brain to sightless eyes through insertion of electrodes, for example, to allow vision, he said. “If we can work with other scientists that are working on other methods of restoring vision or restoring images to the visual cortex, I think we're one step closer,” Rodriguez said. James, who had retained vision in his right eye, knew he might not regain vision in the transplanted eye. The doctors “never expected it to work at all, and they told me that from the get-go,” he said. “I told them, 'even if I can’t see... maybe at least you all can learn something to help the next person.’ That’s how you get started," he said. "Hopefully this opens up a new path.” James might still regain sight in the transplanted eye, Rodriguez said. “I don't think anyone can claim that he will see. But by the same token, they can’t claim that he will not see,” Rodriguez said. “At this point, I think we're pretty happy with the result that we were able to achieve with a very technically demanding operation.” Reporting by Nancy Lapid; Editing by Bill Berkrot Our Standards: The Thomson Reuters Trust Principles.	Medical Innovations
Becoming a full-fledged organism out of a handful of cells, complete with functioning tissues and organs, is a messy yet highly synchronized process that requires cells to organize themselves in a precise manner and begin working together. This process is especially dramatic in the heart, where static cells must start beating in perfect unison. Now, a cross-school collaboration led by researchers at Harvard Medical School and Harvard University has provided a glimpse into exactly how cells in the heart start beating. In a study conducted in zebrafish, the team discovered that heart cells start beating suddenly and all at once as calcium levels and electrical signals increase. Moreover, each heart cell has the ability to beat on its own, without a pacemaker, and the heartbeat can start in different places, the researchers discovered. The findings are published Sep. 27 in Nature. "People place such importance on the heart beating that it's been a focal point of investigations for a long time, but this is the first time we've been able to look at it in depth with so much resolution," said co-senior author Sean Megason, professor of systems biology in the Blavatnik Institute at HMS. Learning about the fundamental mechanisms underlying the heartbeat may be inherently interesting for the curious biologist, but it is also critical for understanding what is happening in situations where the cardiac system that regulates the heartbeat doesn't develop properly, or begins to malfunction. "The heart beats about 3 billion times in a typical human lifetime, and it must never take a break," said co-senior author Adam Cohen, professor of chemistry and chemical biology and of physics at Harvard. "We wanted to see how this incredible machine first turns on." Straight to the heart The researchers didn't set out to study how the heart starts beating. Rather, they were casting about for a scientific question that would combine the Cohen lab's expertise in imaging electrical activity with the Megason lab's interest in studying how cells in developing zebrafish learn to communicate and cooperate. Their search led them straight to the heart. They realized that despite millennia of research on the developing heart, stretching all the way back to Aristotle's observations in chicks, the details of how heart cells start beating were still a mystery -- one that they could potentially solve. "We wanted to answer a basic question: How do heart cells go from silent to beating?" Megason explained. "When your heart starts is a once-in-a-lifetime event, but it's not obvious how that happens." This was an exploratory study, the researchers noted, so they didn't know what they would find out. Maybe a few cells would start beating, and the beating area would slowly grow, they speculated, or different parts of the heart would start beating independently and eventually merge, or the heart would start with weak beats that would strengthen over time. As it turns out, the answer was none of the above. Using fluorescent proteins and high-speed microscope imaging, the researchers captured changes in calcium levels and electrical activity in heart cells of developing zebrafish embryos. To their surprise, they discovered that all the heart cells abruptly transitioned from not beating to beating -- characterized by simultaneous spikes in calcium and electrical signals -- and immediately began beating in sync. "It was like somebody had flipped on a switch," Cohen described. Further experiments revealed that for each heartbeat, one region of the heart fires first, initiating a wave of electricity that rapidly flows through the rest of the cells and prompts them to fire. Interestingly, the heartbeats started from different spots in different zebrafish, suggesting that there's nothing unique about the cells that fire first. This finding was counterintuitive because cells in adult hearts behave differently. "Unlike the adult heart, where a specialized population of pacemaker cells drives the heartbeat, most cells in the embryonic heart have the ability to beat on their own, making it difficult to predict the location of the first beats," said lead author Bill Jia, a joint graduate student in the Cohen and Megason labs. Because the heart cells start beating instantaneously, they must develop the ability to beat and sense their neighbors' beating before their very first heartbeat -- something Megason compares to an army that has to start marching in sync without practicing first. "The heart first learns how to keep pace without a clock, and individual cells first learn to cooperate without agreeing on what their roles are," Jia added. "It is very important for the heartbeat to be regular, but it is organized very quickly at the start of life from what seems to be a total mess." Developing zebrafish offer a convenient model for studying the heart because they are transparent, grow quickly -- developing a heartbeat in only 24 hours -- and can be imaged by the dozen. However, Megason thinks the same developmental process may be conserved across species, including humans. This finding, the team noted, opens the door to learning more about the development of heartbeat across species, and may one day illuminate how cardiac irregularities such as arrhythmias arise in humans. "By looking at how the heart develops, we can see how different control mechanisms are layered on, which may tell us something about what happens if they break down," Megason said. Story Source: Journal Reference: Cite This Page:	Disease Research
Here are some immune-boosting drinks you can enjoy to prepare your body for the winter season - and help fight off colds and flu. Of course, a healthy overall lifestyle that ensures plenty of high-quality sleep is essential for strong immunity, but drinking beneficial beverages can also help bolster your body's immune system. Here are six liquid recommendations... Water: Since our bodies are around two thirds water by weight, and every single bodily function requires water, drinking adequate amounts of H20 is a good place to start to keep your body (and brain) functioning optimally. When your body is dehydrated, it can lead to growth of bacteria and viruses. That's why it's so important to make sure you drink the optimal amount of water for your body's needs every single day. The U.S. National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is about 3.7 liters for men, and about 2.7 liters of fluids a day for women. These recommendations cover fluids from water, other beverages and food. About 20 percent of daily fluid intake usually comes from food and the rest from drinks. Green Tea: Another great beverage to enjoy to bolster your immune system. Green tea is rich in beneficial polyphenol flavonoids that provide myriad health benefits, from reducing the risk of heart disease and certain cancers to managing systemic inflammation. Here are five evidence-based health benefits of green tea. Lemon Ginger Tea: It's made by combining freshly grated ginger and lemon juice in hot water. If you don't want to make it yourself, there are several brands you can buy off the shelf. Some even have added probiotics for more immune-boosting benefits. Lemon is rich in vitamin C, a well known antioxidant. Vitamin C also provides anti-inflammatory properties and helps turn down negative immune responses, according to research published in the journal Antioxidants. (Also, why not consider having a glass of lemon water in the morning? For something that hardly takes any effort, it’s amazing just how many ways a glass of lemon water in the morning can make you healthier. For centuries, scientists have proclaimed ginger's healing properties. It has been found to do everything from promoting healthy ageing and weight loss to boosting immunity and fighting cancer. Discover more about the health benefits of ginger. Fruit Juice: Both orange and grapefruit juice are nutrient-rich and provide more than 100 percent of the total vitamin C you need a day in one serving. These fruit juices also provide vitamin A and folate. When buying orange juice, you can even find options that are fortified with vitamin D, a nutrient long known to be essential for healthy immunity. Tomato Juice: Like citrus fruit, tomatoes are rich in vitamin C as well as lycopene, a beneficial antioxidant carotenoid that possesses many health-promoting properties and is known to help tamp down systemic inflammation. Tomato soup is often recommended when you have a cold or flu for it's vitamin C, but refreshing tomato juice will provide similar amounts of vitamin C. Kefir: This is a fermented, yogurt-like drink made from different types of milk, such as cow, sheep, and goat. Like yogurt, kefir is rich in different beneficial probiotics. A review article published in the journal Nutrients reported that kefir provides antioxidant, antimicrobial, anti-inflammatory, wound healing, and many other health benefits.	Nutrition Research
Who Was SS Badrinath? Founder Of Chennai’s Sankara Nethralaya Dies At 83 Badrinath was awarded Padma Bhushan in 1999 from the Government of India. Here's all you need to know about him. Founder and chairman emeritus of Sankara Nethralaya Dr SS Badrinath died on Tuesday. He was 83. The news was confirmed by Tamil Nadu Congress vice president Rama Suganthan on X. Former Vice President of India M Venkaiah Naidu condoled the death of Dr Badrinath and said: "He was a one-man institution, a stalwart who built this iconic Hospital which caters to thousands of patients from all over. Om Shanti!" My Prayers and condolences to family and friends on demise of Dr Badrinath Founder Sankar nethralaya , a premier eye care hospital in chennai and that has served many poor patients ! ðð½#sankarNethralaya #eyecare pic.twitter.com/ZO6dwIImqI— ð¥ð®ðºð® ð¦ðð´ð®ð»ððµð®ð» (à®µà®¾à®´à®ªà¯à®ªà®¾à®à®¿ à®à®°à®¾à®® à®à¯à®à®¨à¯à®¤à®©à¯) (@vazhapadi) November 21, 2023 Deeply grieved to learn of the sad news of the demise of Dr. SS Badrinath, the founder of Sankara Nethralaya. He was a one-man institution, a stalwart who built this iconic Hospital which caters to thousands of patients from all over. Om Shanti! pic.twitter.com/PjaboYIBAU— M Venkaiah Naidu (@MVenkaiahNaidu) November 21, 2023 Who Was SS Badrinath? Early Life Dr Sengamedu Srinivasa Badrinath was born on February 24, 1940 in Triplicane, Chennai. His father, Sri S. V. Srinivasa Rao, was employed in the Madras Government Service as an Engineer in Public Works and Food production department. His mother, Lakshmi Devi, was the daughter of a leading advocate from Nerur, Tamilnadu. Badrinath was the youngest of seven siblings. He lost both his parents while still in his teens and completed his medical studies from the life insurance policy money obtained following the death of his father. SS Badrinath: Education Badrinath started his education late at the age of 7 due to a childhood illness. He studied at P S High School, Mylapore and Sri Ramakrishna Mission High School, T.Nagar, Chennai. Between 1955 and 1957, he completed the "intermediate" collegiate study at Loyola College. Badrinath was a student of the Madras Medical College between 1957 and 1962. He completed his medical studies in the first attempt and secured the highest marks in ophthalmology in the University Exams. Higher Education Badrinath pursued his graduate studies in ophthalmology in the United States of America at Grasslands Hospital, New York University postgraduate medical school and Brooklyn Eye and Ear Infirmary between 1963 and 1968. He worked as a fellow in the vitreoretinal services of Massachusetts Eye and Ear Infirmary, Boston under Dr Charles L. Schepens from 1968 to 1970. He passed the examination for the Fellow of the Royal College of Surgeons (Canada) and the American Board Examination in Ophthalmology in 1969 and 1970 respectively. SS Badrinath: Medical Career From 1970, Badrinath worked as a consultant at the Voluntary Health Services, Adyar. He set up his private practice in ophthalmology and vitreoretinal surgery at the H.M. Hospital between 1970 to 1972 and at Vijaya Hospital, Chennai between 1973 to 1978. In 1978, Badrinath founded the Medical Research Foundation, of which Sankara Nethralaya is the hospital unit. He was also the Chairman Emeritus of Sankara Nethralaya which aimed at providing quality care at affordable cost, teaching and training ophthalmologists and paramedical personnel and research in vision sciences. Badrinath was awarded Padma Bhushan in 1999 from the Government of India. SS Badrinath: Personal Life Badrinath met Dr Vasanthi Iyengar, a board-certified paediatrician and Hematologist in Brooklyn New York in 1966. The couple got married on June 3, 1967. They have two sons.	Medical Innovations
UMass Amherst researchers have pushed forward the boundaries of biomedical engineering one hundredfold with a new method for DNA detection with unprecedented sensitivity. "DNA detection is in the center of bioengineering," says Jinglei Ping, lead author of the paper that appeared in Proceedings of the National Academy of Sciences. Ping is an assistant professor of mechanical and industrial engineering, an adjunct assistant professor in biomedical engineering and affiliated with the Center for Personalized Health Monitoring of the Institute for Applied Life Sciences. "Everyone wants to detect the DNA at a low concentration with a high sensitivity. And we just developed this method to improve the sensitivity by about 100 times with no cost." With traditional detection methods, he says, "The challenge is basically finding the needle in a haystack." There are lots of molecules present in a sample that aren't the target DNA that can interfere with the result. That's where this method is different. The test sample is put within an alternating electric field. Then, "We let the DNA dance," he says. "When the strands of DNA dance, they have a specific oscillation frequency." Researchers can then read samples to see if there is a molecule moving in a way that matches the movement of the target DNA and easily distinguish it from different movement patterns. This even works when there is a very low concentration of the target DNA. This new method has huge implications for speeding up disease detection. First, because it is so sensitive, diagnoses can happen at earlier stages of a disease progression, which can greatly impact health outcomes. Also, this method takes minutes, not days, weeks or months, because it's all electric. "This makes it suitable for point of care," he says. "Usually, we provide samples to a lab and they can provide the results quickly or slowly, depending on how fast they go, and it can take 24 hours or longer." For instance, he cites how with a diagnosis, a biopsy sample is frozen and then sent to a lab for processing, which can take up to two months. The near-instant results with this new method mean treatment does not have to wait for lab processing times. Another benefit: it's portable. Ping describes the device to be similar in size to a blood sugar test tool, which opens the doors to improvements in health on a global scale. "It can be used at places where resources are limited. I went to a country and the doctor usually goes to a village once or twice a year, and now, maybe they can have a base that has this kind of tool and they'll have the chance to test for it quickly and easily." Ping is excited about the breadth of possible applications for this discovery, saying, "The nano-mechanoelectrical approach can be also integrated with other bioengineering technologies, like CRISPR, to elucidate nucleic acid signaling pathways, comprehend disease mechanisms, identify novel drug targets and create personalized treatment strategies, including microRNA-targeted therapies." Xiaoyu Zhang, a graduate research assistant from Ping Lab, will deliver an oral presentation relevant to this study at the Biomedical Engineering Society annual meeting on October 13, 2023 in Seattle, WA. This research was supported by the Trailblazer Award Ping received from the National Institute of Biomedical Imaging and Bioengineering. Story Source: Journal Reference: Cite This Page:	Medical Innovations
A single mum has issued a heartbreaking plea to raise funds for alternative treatment after being diagnosed with incurable cancer. Victoria Baillon, 37, from Hazlemere, Buckinghamshire, is fighting to prolong her life with Stage 4 cancer so that she has more time with her two children. Victoria is yet to tell her young kids, Austin, eight, and Eva, six, anything about her debilitating illness - but will be explaining to them "as soon as possible" as the progression of the disease has become very serious. Victoria told the Mirror: "My children are my whole world, I adore them so much. "Every time I see their happy faces they make me feel so loved and I realise why I need to fight as hard as I can and stay determined." The mum-of-two was first diagnosed with Stage 1 breast cancer in November 2020, where she underwent a mastectomy and presumed she had the all-clear. Then Victoria's health deteriorated as the cancer appeared in other areas of her body such as her neck, spine, liver and lungs. Despite being told that she wouldn't be able to stand for a year, Victoria amazed everyone with her extraordinary strength and courage to stand, walk, dance and even run. After further investigations and tests, doctors revealed in December that the treatment wasn't working and she had advanced Stage 4 metastasis to the bone. In an emotional plea to her Instagram followers on @life_with_victoria_charlotte, Victoria said: "They cannot be left without their mummy, I care for them and love them so very much and I'm pleading from the bottom of my heart for you to give anything you can to have them with me for as long as possible." Friends of Victoria have raised £22,000 for an oxygen chamber but she still needs £40,000 for immunotherapy that isn't offered in the UK. "I've had to have talks about end of life care, resuscitation, hospice care and what the outlook is realistically like for me, which has been absolutely heartbreaking and so difficult to deal with," Victoria said. "The problem is my cancer is showing to be extraordinarily active. I am desperately asking for help to support me for a life I can have as long as possible with my children. "There so many complimentary treatments and alternative treatments that England and the NHS just don't provide, and I know these treatments work as I've seen people who have lived 10-25 years after a terrible prognosis and end of life care. "Ultimately, I don't have months to wait for funds to come in. It's at a severe stage now that I need these treatments within weeks. "I absolutely hate asking and begging but I am desperate, for the sake of my beautiful children. I just want to get better and go back to my normal life, not living this nightmare every day." Her friend of 25 years, Christina Zealey, wrote on her fundraiser: "Despite the incurable diagnosis, Victoria being Victoria is ever the optimist and wants to fight this cancer head-on, especially for her children. "As resilient as Victoria is, there is only so much one person can do, she has two young children to try and be strong for, she really needs our help." Do you have a story to share? Email nia.dalton@reachplc.com.	Medical Innovations
DENVER -- Months after Colorado’s voters decided to join Oregon in decriminalizing psychedelic mushrooms, Denver will host a conference this week put on by a psychedelic advocacy group bringing together an unlikely cohort of speakers — including an NFL star, a former Republican governor and a rapper. The conference and the thousands expected to attend it is an indication of the creep, or perhaps leap, of cultural acceptance for psychedelic substances that proponents say may offer benefits for things like post-traumatic stress disorder and alcoholism. Still, medical experts caution that more research is needed on the drugs' efficacy and the extent of the risks of psychedelics, which can cause hallucinations. NFL quarterback Aaron Rodgers, who’ll soon debut with the New York Jets after years with the Green Bay Packers, has been open about his use of ayahuasca in the past and is slated to speak Wednesday. Rapper Jaden Smith, the son of Will Smith who has publicly shared the “ego dissolution” he felt when using psychedelics, will be speaking in Denver, too, as will former Texas Republican Gov. Rick Perry, who is an advocate for researching psychedelics’ potential benefits for veterans experiencing PTSD. The hosting organization, the Multidisciplinary Association for Psychedelic Studies, is the largest U.S. advocacy group. It has strategized to reach the full political spectrum, said Nicolas Langlitz, a historian of science who’s researched the boom and bust of psychedelic movements. “Overall, this strategy has been tremendously successful,” he said. “At the time when any topic gets politically polarized, ironically these super polarizing substances now get bipartisan support.” Still, Langlitz said, this conference is “purely designed to promote the hype," which can exaggerate the potential benefits but can also drive further funding. “Any kind of overselling is not good for science because science should be accurate rather than pushing things," he said. “It’s a tradeoff. (The conference) generates interest, it generates ultimately more research, even though the research might be skewed toward positive results.” Psychedelics are illegal at the federal level, though acceptance and interest in studying their potential benefits has grown. For example, some researchers believe psilocybin, the compound in psychedelic mushrooms, changes the way the brain organizes itself and can help users overcome things like depression and alcoholism. The drugs themselves — and the interest in them — are not new. Mid-last century, authors Aldous Huxley and Ken Kesey helped spur the use of psychedelics during the counterculture movement, and optimism brimmed among some psychologists over the drugs’ potential to augment the human psyche. But the Nixon administration criminalized psychedelics, pushing them underground. “In both cases you have this upwelling of exuberance that may or may not be irrational,” said author Michael Pollan, who wrote a book on psychedelics and will be speaking at the conference. “But I think a big difference (now) is that the enthusiasm for the potential of psychedelics cuts across a much more representative slice of the population — it’s not about a counterculture." Republican strongholds, including Utah and Missouri, have or are considering commissioning studies into the drugs, partly inspired by veterans’ poignant stories. That’s why, though he stops short of promoting recreational use, Perry has become an unlikely flagbearer and helped get a bill passed in the Texas legislature in 2021 to fund a study of psilocybin for treating PTSD. In Congress, successful proposals to fund psychedelic research for PTSD in veterans brought progressive Democratic Rep. Alexandria Ocasio-Cortez from New York and far-right Rep. Matt Gaetz from Florida into an unlikely alignment. Public interest also appears to be growing. Just six years ago in Oakland, California, the Multidisciplinary Association for Psychedelic Studies held a conference with roughly 3,000 attendees and a smattering of lesser-known speakers and die-hard proponents. This time, organizers estimate at least 10,000 attendees. Other famous speakers will include former NHL player Daniel Carcillo, who owns a company specializing in psychedelic therapies; Olympic silver-medal figure skater Sasha Cohen; comedians Reggie Watts and Eric Andre, top-10 podcaster Andrew Huberman; and Carl Hart, the chair of Columbia University's psychology department. The American Psychiatric Association has not endorsed the use of psychedelics in treatment, noting the Food and Drug Administration has yet to offer a final determination. The FDA did designate psilocybin as a “breakthrough therapy” in 2018, a label that’s designed to speed the development and review of drugs to treat a serious condition. MDMA, often called ecstasy, also has that designation for PTSD treatment. Both Pollan and Langlitz believe further research is key — especially as the nation faces an unprecedented mental health crisis and people struggle to find adequate treatment. But, Langlitz said, it's important to let research shape the narrative. “I would just try to keep my mind open to the possibility that in retrospect we will tell a very different story from the one that the protagonists of psychedelic therapies are currently predicting,” he said. ____ Bedayn is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.	Disease Research
Last week, smoke from more than 100 wildfires burning across Canada rolled into North American cities far from the flames. New York City and Detroit were listed among the five most polluted cities in the world because of the fires on 7 June. The smoke has triggered air quality alerts in several states in recent weeks. We asked Chris Migliaccio, a toxicologist at the University of Montana who studies the effect of wildfire smoke on human health, about the health risks people can face when smoke blows in from distant wildfires. What’s in wildfire smoke that’s a problem? When we talk about air quality, we often talk about PM2.5. That’s particulate matter 2.5 microns or smaller – small enough that it can travel deep into the lungs. Exposure to PM2.5 from smoke or other air pollution, such as vehicle emissions, can exacerbate health conditions like asthma and reduce lung function in ways that can worsen existing respiratory problems and even heart disease. But the term PM2.5 only tells you about size, not composition – what is burning can make a significant difference in the chemistry. In the northern Rockies, where I live, most fires are fueled by vegetation, but not all vegetation is the same. If the fire is in the wildland urban interface, manufactured fuels from homes and vehicles may also be burning, and that’s going to create its own toxic chemistry, as well. Chemists often talk about volatile organic compounds, (VOCs), carbon monoxide and PAHs, or polycyclic aromatic hydrocarbons produced when biomass and other matter burns having the potential to harm human health. How does inhaling wildfire smoke harm human health? If you have ever been around a campfire and got a blast of smoke in your face, you probably had some irritation. With exposure to wildfire smoke, you might get some irritation in the nose and throat and maybe some inflammation. If you’re healthy, your body for the most part will be able to handle it. As with a lot of things, the dose makes the poison – almost anything can be harmful at a certain dose. Generally, cells in the lungs called alveolar macrophages will pick up the particulates and clear them out – at reasonable doses. It’s when the system gets overwhelmed that you can have a problem. One concern is that smoke can suppress macrophage function, altering it enough that you become more susceptible to respiratory infection. A colleague who looked at lag time in the effect of wildfire smoke exposure found an increase in influenza cases after a bad fire season. Studies in developing countries have also found increases in respiratory infections with people who are cooking on open fires in homes. The stress of an inflammatory response can also exacerbate existing health problems. Being exposed to wood smoke won’t independently cause someone to have a heart attack, but if they have underlying risk factors, such as significant plaque buildup, the added stress can increase the risk. When smoke blows over long distances, does its toxicity change? Researchers have found that there seems to be a higher level of oxidation, so oxidants and free radicals are being generated the longer smoke is in the air. The specific health effects aren’t yet clear, but there’s some indication that more exposure leads to greater health effects. The supposition is that more free radicals are generated the longer smoke is exposed to UV light, so there’s a greater potential for health harm. A lot of that, again, comes down to dose. Chances are, if you’re a healthy individual, going for a bike ride or a hike in light haze won’t be a big deal, and your body will be able to recover. If you’re doing that every day for a month in wildfire smoke, however, that raises more concerns. I’ve worked on studies with residents at Seeley Lake in Montana who were exposed to hazardous levels of PM2.5 from wildfire smoke for 49 days in 2017. We found a decrease in lung function a year later. No one was on oxygen, but there was a significant drop. This is a relatively new area of research, and there’s still a lot we’re learning, especially with the increase in wildfire activity as the planet warms. What precautions can people take to reduce their risk from wildfire smoke? If there is smoke in the air, you want to decrease your exposure. Can you completely avoid the smoke? Not unless you’re in a hermetically sealed home. The PM levels aren’t much different indoors and out unless you have a really good HVAC system, such as those with MERV 15 or better filters. But going inside decreases your activity, so your breathing rate is slower and the amount of smoke you’re inhaling is likely lower. We also tend to advise people that if you’re in a susceptible group, such as those with asthma, create a safe space at home and in the office with a high-level stand-alone air filtration system to create a space with cleaner air. Some masks can help. It doesn’t hurt to have a high-quality N95 mask. Just wearing a cloth mask won’t do much, though. Most states have air quality monitors that can give you a sense of how bad the air quality is, so check those sites and act accordingly. Christopher T Migliaccio is a research associate professor of toxicology at the University of Montana This article is republished from the Conversation, a non-profit news organization dedicated to sharing ideas from academic experts	Epidemics & Outbreaks
Tens of thousands of junior doctors have started a 72-hour strike across England in a dispute with the government over pay. Many patients will have operations and appointments cancelled as the three days of action brings further widespread disruption to the NHS. But supporters of the strike say action is needed to stop junior doctors leaving the NHS, which is putting lives at risk. The British Medical Association (BMA) is calling on the government for pay restoration as it says the wage for junior doctors has fallen 26% since 2008/09, with newly qualified medics making less than a barista in a coffee shop. An advertising campaign launched by the trade union says: "Pret a Manger has announced it will pay up to £14.10 per hour. A junior doctor makes just £14.09. "Thanks to this government you can make more serving coffee than saving patients. This week junior doctors will take strike action so they are paid what they are worth." Junior doctors make up around 45% of the NHS's medical workforce and consultants and other medics have been brought in to provide cover in areas such as A&E. More than 100,000 patient appointments have already been postponed this winter after nurses took strike action in a dispute with the government over pay, according to NHS figures. Professor Stephen Powis, medical director of NHS England, told Times Radio that cancer care is likely to be affected by the strikes, saying the NHS is doing "everything we can to ensure that urgent cancer procedures go ahead but, unfortunately, even some of those may be affected this week". Picket lines formed outside hospitals throughout England on the first day of what will be the longest-ever period of industrial action by junior doctors. He has been a junior doctor working in London for more than five years and has seen colleagues leaving the NHS for better-paid jobs abroad. When asked why he has chosen to stay, he told Sky News: "Because fundamentally I believe in the NHS, and believe everyone should have access to good quality health care, regardless of how much money they have." Professor Philip Banfield, the BMA's council chair, joined a picket line outside the Queen Elizabeth Hospital in Birmingham and said: "It's the refusal of government to listen to junior doctors and the crisis unfolding in the NHS. "We have the worst crisis in the NHS that I have ever known and it's seeing junior doctors leave in their droves. "The junior doctors' strike is so sad to see but they feel they have been driven to this." He added: "What is going on day in, day out is that patients are dying. "The Royal College of Emergency Medicine estimates that between 300 and 500 people are dying unnecessarily, because of the state of emergency departments across the UK, per week. "That is an absolute national scandal." Sumi Manirajan, 29, who works at a hospital in London, said that she had been forced to borrow money from her parents in order to sit her medical exams. She said: "Not only are we being paid a ridiculously low wage for our work, but we also have to handle the expense of sitting our exams, and we don't get any financial support from the NHS to do this. "Most doctors are working at least 48 hours a week, but there are junior doctors who pick up second jobs or do locum shifts to make ends meet. "Nobody decides spontaneously to become a doctor, it is something that takes years of training and preparation to achieve. "I didn't expect my working conditions to be like this when I started training." The government has been criticised for its handling of the pay disputes, which have been escalating for months. Talks between the government and health unions will continue this week in the hope of a breakthrough. Prime Minister Rishi Sunak said: "It is very disappointing that the junior doctors' union are not engaging with the government. "We are actually having constructive dialogue with other unions who have accepted our offer to come in and talk through it." If you are an NHS worker and would like to share your experiences with us anonymously, please email NHSstories@sky.uk	Health Policy
As a breast oncologist with Yale Medicine, Eric Winer, MD, is on a mission to lessen racial disparities in breast cancer. And thereâs one âentirely unacceptableâ statistic he canât get off his mind.Â âIf youâre a Black American woman and youâre 20 years old, you have literally twice the chance of dying of breast cancer before the age of 50, compared to the 20-year-old white American woman who might live in the next town or over on the next street,â says Winer, director of the Yale Cancer Center, physician-in-chief of Smilow Cancer Network, and president of the American Society of Clinical Oncology.Â Experts think higher rates of triple-negative breast cancer (TNBC) may play a role in these mortality differences. This is an aggressive disease diagnosed nearly three times more often in Black women. Itâs also found later and is deadlier for women in this group.Â Thereâs no single reason for why TNBC takes such a toll on Black women. Itâs likely a complex mix of things going on. But if youâre a Black woman with metastatic TNBC, or youâre at risk for the disease, thereâs a key message that experts want you to keep in mind.Â âWhile disparities exist, people should not despair,â says Kimberley Lee, MD, a breast oncologist with Moffitt Cancer Center. âMetastatic triple-negative breast cancer is treatable, and Black women respond to the treatments that we have.â Why Do Black Women Get Triple-Negative Breast Cancer More Often? Around 15% to 30% of all breast cancers in Black women are triple-negative. According to Anne Marie McCarthy, PhD, a cancer epidemiologist and assistant professor at the University of Pennsylvania, TNBC rates are around 5% to 10% for non-Hispanic white women. While itâs clear there are large racial disparities in rates of TNBC, âweâre not sure why that is,â McCarthy says.Â âAlthough, we have some ideas.â Age and breastÂ tissue density. TNBC is found more often in Black women younger than 55 who have very dense breasts. This fibrous tissue can cause an added issue with mammograms, and these machines may have a hard time snapping shots of TNBC tumors early on in these women.Â Reproductive habits. Unlike other kinds of breast cancer, the odds of TNBC appear to go up with the number of babies you have. Breastfeeding seems to lower some of that risk, butÂ Black women are typically less likely to breastfeed or may not breastfeed for as long as other groups.Â Obesity. Thereâs some evidence it may fuel the kind of inflammation that leads to TNBC. And Black women tend to have higher levels of body fat than some other groups. But the research on the link between higher body mass index (BMI) and TNBC is mixed.Â Itâs important to note that people with obesity who are diagnosed with any kind of breast cancer generally have poorer health outcomes no matter their race or ethnicity.Â Genes. The disparity in TNBC canât be totally explained by non-biologic risk factors.Â There are likely some other genetic differences involved, but scientists havenât found them yet. âBlack and African ancestry populations are underrepresented in genetic studies,â McCarthy says.Â Why Is Metastatic Triple-Negative Breast Cancer Deadlier for Black Women? TNBC doesnât have any hormones to target. This limits everyoneâs treatment choices and chances for success. But researchers are trying to figure out if thereâs something about the tumors in Black women that makes cancer in their body more aggressive from the start. But Winer thinks genetic differences are likely only a small piece of the death rate puzzle.Â Â âI think itâs much more about racism, poverty, and lack of (health) education and access to care than it is about any biologic differences in the cancer.âÂ Rachel Greenup, MD, is chief of breast surgery with Yale Medicine. She studies how financial hardship affects cancer treatment and says researchers have found that Black women generally face more barriers to care across all domains. And this may create aÂ domino effect that leads to poor outcomes for this group. Â For example, Black women tend to have a lower household income, higher rates of Medicaid or no insurance, and more transportation troubles. Black women are also more likely to lose their jobs or healthÂ insurance after their breast cancer diagnosis.Â Financial strain can boost your risk of dying no matter what kind of cancer you have. But for people with breast cancer, your chances of dying are âabout 1.5 to 2 times higher if you go bankrupt than if you donât,â Greenup says. Hereâs a breakdown of other things that might affect racial disparities in TNBC:Â Socioeconomic status.Â Studies show that people with a lower socioeconomic status are more likely to be diagnosed with advanced breast cancer. This can lead to other hurdles that delay or interrupt treatment. âThere are women who canât afford child care or transportation,â Winer says. âThere may be people who canât afford the copays of certain cancer drugs.â Â Less use of anti-cancer drugs.Â Black women are less likely to get standard breast cancer care. That includes less surgery, chemotherapy, and other treatments known to help people live longer. âWe are very well aware of the disparities in the use of drugs used to treat triple-negative breast cancer in the early setting,â Lee says.Â Not enough Black doctors. Black women usually get cancer care from people who donât share their race. That can lead to some amount of medical mistrust that may impact treatment. âThat mistrust is probably well-founded,â Winer says, âand relates to the underlying racism that exists in our country that we need to address.â How to Reduce Racial Disparities in Metastatic Triple-Negative Breast Cancer More research is needed to find the driving force behind these inequities. But here are some steps you can take to improve your cancer care right now: Ask about genetic testing.Â Your odds of TNBC go way up if you test positive for the BRCA1 gene mutation, so tell your doctor if you have a strong family history of breast or ovarian cancer. Theyâll help you find out if genetic counseling or testing is right for you.Â Once you know you have a genetic mutation, you can act on that information. Ask your doctor about preventive strategies to manage your breast cancer risk.Â Bring up breast density.Â Not everyone with dense breast tissue gets breast cancer. But if youâre a Black woman at higher risk of TNBC, you might benefit from breast MRIs or more frequent breast cancer screenings.Â Talk to a patient navigator.Â These are people on your cancer team who can help you overcome personal barriers to treatment. Theyâll set up child care, rides to appointments, copay assistance, or financial aid.Â Ask your doctor who to talk to or reach out to the Patient Advocate Foundation. Thatâs a nonprofit group that gives professional case management services to people with chronic or life-threatening illnesses like cancer.Â Where Is Breast Cancer Disparity Research Headed? Scientists continue to study why Black women get TNBC at higher rates than other groups. But experts agree there needs to be an urgent focus on reducing racial disparities in breast cancer treatment.Â Going forward, researchers are focusing on finding answers to the following questions:Â - Are doctors offering the right treatment at the right time to Black women? - Are doctors explaining treatment options as well to Black women as they do with white women? - Do Black women have more trouble paying for out-of-pocket expenses? - Is there enough follow-up from doctors in terms of the importance of early treatment that works well? - Do Black women have tumors that donât respond as well to common cancer drugs?Â - Can community outreach boost breast cancer screenings and help people stick with treatment? - How can we increase the number of Black and brown doctors in our workforce faster? Experts think this awareness may bring us one step closer to finding a way to improve cancer outcomes for all women.Â Show Sources Photo Credit: Juanmonino / Getty Images SOURCES:Â Eric Winer, MD, professor of pharmacology; professor of medicine (medical oncology), Yale School of Medicine; director, Yale Cancer Center; physician-in-chief, Smilow Cancer Network.Â Anne Marie McCarthy, PhD, assistant professor of epidemiology, Perelman School of Medicine, University of Pennsylvania. Kimberley Lee, MD, assistant member, Department of Breast Oncology, Moffitt Cancer Center. Rachel Greenup, MD, associate professor of surgery (oncology, breast), Yale School of medicine; chief, breast surgery, The Breast Center at Smilow Cancer Hospital.Â Frontiers in Public Health: âRacial Disparities in Triple Negative Breast Cancer: A Review of the Role of Biologic and Non-biologic Factors.âÂ Cancer Medicine: âRelationship of established risk factors with breast cancer subtypes.âÂ Journal of the National Cancer Institute: âTriple-Negative Breast Cancer Risk Genes Identified by Multigene Hereditary Cancer Panel Testing.âÂ Annals of Oncology: âTriple-negative breast cancer: epidemiological considerations and recommendations.âÂ Breast Cancer Research: âLifetime risks of specific breast cancer subtypes among women in four racial/ethnic groups.âÂ Journal of Clinical Oncology: âFinancial Impact of Breast Cancer in Black Versus White Women,â âFinancial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer.â Â	Disease Research
Norovirus cases hit their highest level for a decade Hospital admissions for the 'winter vomiting bug' have almost doubled over the last year with over-65s particularly affected and the majority of outbreaks now taking place in care homes. Thursday 9 February 2023 17:29, UK Norovirus cases in England have risen "significantly" to hit their highest levels in a decade, according to the UK Health Security Agency (UKHSA). An average of 743 adult hospital beds were occupied last week by patients with diarrhoea and vomiting, or norovirus-like symptoms, up 88% from the week to 29 January. Last year the average for that time period was 302. The virus is often known as the 'winter vomiting bug' because it is notorious for spreading rapidly during the colder months. The rise is especially affecting over-65s, with the majority of outbreaks now taking place in care homes. There have also been increases in schools and hospitals. Read more: Number of patients in hospital with flu jumps 40% in a week Norovirus cases on the rise in care homes and nurseries Vomiting bug norovirus surging as COVID-19 restrictions lift Health experts urged people with symptoms of the illness to stay at home and not go to work, or to keep their children home from school, until two days after any signs of the virus have cleared. UKHSA said that cases are currently running 66% above the average compared to the past five seasons, but because this period included lockdown it means that fewer people would have gone to their doctor or hospital for help, meaning that prevalence within the wider community was likely to have been much higher. The overall level of infection is likely to be higher than that reported by medical authorities as it is accepted that there is a general reluctance among the community to seek medical help since the COVID-19 lockdowns. Norovirus spreads easily through contact with someone carrying the virus or with contaminated surfaces. Most people make a full recovery within two or three days, but it can lead to dehydration for some, especially the very young or old, or those with weakened immune systems. The biggest increase in laboratory-confirmed norovirus is among people aged 65 and over. While high numbers of cases in this age group can be expected at this time of year, current levels haven't been seen in more than a decade. Dr Lesley Larkin of the UKHSA Gastrointestinal Infections and Food Safety Division, said: "Norovirus levels are currently the highest we have seen at this time of year in over a decade. "Most reported cases are in the over-65s and we're also seeing a rise in reported outbreaks, particularly in care home settings." Professor Stephen Powis, NHS medical director for England, said hospital cases of norovirus have risen "significantly" in line with what is being seen in the community and in care homes.	Epidemics & Outbreaks
Now Britain's biggest ever avian flu outbreak infects mammals including otters and foxes as figures show disease has killed 208M birds globally - Animal and Plant Health Agency found avian flu in nine foxes and otters in the UK - Expert says UK still 'long way' from situation where bird flu could infect humans The Animal and Plant Health Agency (Apha) found avian flu in nine foxes and otters in the UK who are believed to have fed on dead birds infected with the virus. Global figures reported by the BBC show the disease has led to the death of about 208 million birds with at least 200 recorded cases in mammals. An expert from the Animal and Plant Health Agency (Apha) has said the UK is still 'a long way' from being in a situation where bird flu could infect humans and spread in a similar way to Covid-19. Health officials have said the risk to the public is low. Professor Ian Brown, scientific services director, spoke to BBC Radio 4's programme over evidence that avian flu had jumped to other species in the UK. The Animal and Plant Health Agency (Apha) found avian flu in nine foxes and otters in the UK who are believed to have fed on dead birds infected with the virus (stock image) Professor Ian Brown, scientific services director, said Defra and the devolved administrations are supporting a programme for actively looking for mammals that might scavenge and feed on wild birds He said: 'We've recently detected events both here in and around the world - evidence that this virus can on certain occasions jump into other species. 'To be clear, though, this is still a bird virus essentially, that wants to be in birds. 'These animals, these are wild mammals, animals that scavenge on sick and dead birds and there's a lot of dead wild birds at the moment due to the bird flu presence around the globe, and those animals are...consuming and being exposed to very high quantities of virus and that's leading to some spillover infection. 'What we don't have any evidence of is that it can then go from fox to fox or otter to otter, so these are what we call dead-end infections.' Asked about potential spread to humans, he said: 'We need to understand the consequence of this infection. Does it make the virus change by jumping its host? We're aware those events can sometimes lead to that.' Asked whether there was a possibility that bird flu could become a virus that infects humans like Covid-19, he said: 'At the moment, we're a long way from that. 'We've seen this jump, we've not seen maintenance in a mammalian species and, importantly, we haven't seen a succession of changes in the virus that tell us it's moving more towards a virus that can infect humans. 'This still is a spillover, but we need to be watchful, which is why we're doing the surveillance.' Prof Brown said it was 'difficult to control the disease in wild birds' but 'what we can do is effectively control the disease in poultry' (stock inage) Bird flu outbreak: Everything you need to know What is it? Avian flu is an infectious type of influenza that spreads among birds. In rare cases, it can be transmitted to humans through close contact with a dead or alive infected bird. This includes touching infected birds, their droppings or bedding. People can also catch bird flu if they kill or prepare infected poultry for eating. Wild birds are carriers, especially through migration. As they cluster together to breed, the virus spreads rapidly and is then carried to other parts of the globe. New strains tend to appear first in Asia, from where more than 60 species of shore birds, waders and waterfowl head off to Alaska to breed and mix with migratory birds from the US. Others go west and infect European species. What strain is currently spreading? H5N1. So far the new virus has been detected in some 80million birds and poultry globally since September 2021 — double the previous record the year before. Not only is the virus spreading at speed, it is also killing at an unprecedented level, leading some experts to say this is the deadliest variant so far. Millions of chickens and turkeys in the UK have been culled or put into lockdown, affecting the availability of Christmas turkey and free-range eggs. Can it infect people? Yes, but only 860 human cases have been reported to the World Health Organization since 2003. The risk to people has been deemed 'low'. But people are strongly urged not to touch sick or dead birds because the virus is lethal, killing 56 per cent of people it does manage to infect. He said Defra and the devolved administrations are supporting a programme for actively looking for mammals that might scavenge and feed on wild birds. 'We analyse those viruses if we detect them, and we share that data very rapidly with our public health counterparts, so we can make clear and rapid assessments.' He added: 'If you analyse the genetic code of the virus, you can work out whether it's come from a bird or whether it's going from one mammal to another. So it's about that dissection and looking in the genes of the virus.' Prof Brown said it was 'difficult to control the disease in wild birds' but 'what we can do is effectively control the disease in poultry'. He added that, in the UK, the virus had not spread from one poultry farm to another. 'So if you can cut that source of infection off, and we can do that around the world, you reduce the risk of it spilling over into wild birds and evolving further.' In its December analysis, the UKHSA said four samples from the affected otters and foxes 'show the presence of a mutation which is associated with potential advantages for mammalian infection'. The UKHSA warned that the 'rapid and consistent acquisition of the mutation in mammals may imply this virus has a propensity to cause zoonotic infections', meaning it could potentially spread to humans. It put the level of risk to human health at level 3, which means there is 'evidence of viral genomic changes that provide an advantage for mammalian infection'. The UKHSA said there was 'limited genomic surveillance sampling in wild birds' and 'very limited surveillance of mammals'. There have been no reported cases of avian flu in humans between October and December last year and only one case from October 2021 to September 2022. Dr Meera Chand, incident director for avian influenza at UKHSA, said: 'Latest evidence suggests that the avian influenza viruses currently circulating in birds do not spread easily to people. We remain vigilant for any evidence of changing risk. 'There have recently been some detections of avian influenza viruses in a small number of mammals in the UK, however, the risk assessment conducted by UKHSA and partners did not identify any signals of increased risk to the general public from avian influenza at present. 'We are working with partners across government and academia to keep this under constant review.'	Epidemics & Outbreaks
A man who almost took his own life due to the extreme pain he was in every day, watched his own leg being chopped off in a bid to be free of the "Suicide Disease" which tortured him for years. Andrew Lawton was rushing to buy Valentine’s Day gifts back in 2019 when his knee buckled underneath him. At first, he didn’t think much of it, but his life changed forever. The slightest touch of his leg would result in severe bruising and ulcers; even a dressing to cover up a wound would cause the skin surrounding it to die. The 44-year-old would rarely go outside, anxious others would be disgusted seeing the sight of his open wounds that he was unable to cover up with trousers or even a blanket as they would leave him in excruciating pain. The father-of-one was even sacked from his job when his boss said he was too slow to walk down the stairs during a fire drill at the office. He subsequently won a discrimination claim and more than £30,000 compensation. Andrew, from Leigh, Lancashire, was eventually diagnosed with CRPS - Chronic Regional Pain Syndrome - also know as the Suicide Disease. He told the Mirror it was only the thought of leaving his partner Amy and 16-year-old son Tyler that stopped him taking his own life on four occasions, as he battled with the pain that would be with him 24 hours a day. IT manager Andrew said: "I was in extreme pain 24 hours a day for three and a half years. It felt like someone was giving me a Chinese burn, like your skin was being pulled in two different directions, it's that burn you feel all the time. "I had deep bruising from my thigh to my foot and it just got progressively worse day by day, the bruising and the ulcers were like torture. "CRPS is unusual so they had to test me for everything else first, I was put on controlled narcotics for the pain, but they had to keep upping the dose and by the end I was on six different ones at the maximum dose, which would just start to take the edge off." Andrew stayed at home, worried people would stare at him or be put off their food in a restaurant if they saw the state of his leg, and if he was caught in the rain every drop would cause his skin to burn. Before CRPS entered his life, Andrew would volunteer at Formula 1 races, jumping over the barriers after crashes, and would also Scuba dive in his spare time. "I just shut myself off from the world and stopped all my hobbies. It was like my world had shrunk. "It's called the suicide disease and I had been down that route three or four times, especially towards the end. "I knew my pain would be gone, but I'd just be passing that pain onto the ones I love, my partner Amy and my 16-year-old Tyler, who is doing his GCSEs now. "I'm the main breadwinner, I couldn't leave them behind to deal with that." By June 6, 2022 Andrew was in so much pain he blacked out, and was found unconscious on his kitchen floor by his partner who called 999. While waiting for the ambulance, he came round, but immediately passed out again, as his body shut down. Over the next two days, he was in and out of consciousness in hospital. Doctors struggled to get to grips with his pain medication, and the decision to go ahead with an above-the-knee leg amputation was confirmed. Andrew had already been through psychological testing to make sure he knew what to expect, but doctors warned him that going under general anaesthetic and waking up with his leg gone, could mean he would get "phantom" leg pain and defeat the purpose of taking the leg away. He added that he was actually relieved when he was told by doctors he was going to get the amputation, but was warned it may not be a cure, and CRPS could come back at any point in his life in a different part of his body. Andrew opted to watch the surgery in the hope it would lessen the chance of phantom pain, and said after the epidural went in he knew it was the right decision. "After the epidural, while I was waiting for the surgery, I broke down in tears. "It was the first time I had been pain-free in three and a half years. From that day I haven't felt any more pain." Andrew now has a prosthetic leg and is getting his life back on track. He is planning to take part in a skydive to help raise money for others in the same position, and has a kickstarter business to help the NHS with cheaper and better prosthetics. The NHS website admits that "CRPS is poorly understood" and in June, the Mirror spoke to the mum of 11-year-old Dillon Wilford, from Bolton, who also has the condition. Like Andrew, the schoolboy has suffered debilitating pain and told his mum he wanted to die to escape the agony. Dillon's mum Melanie told the Mirror that her son was screaming “24 hours a day” and can’t stand the “wind or rain” on his skin. She said: “When people hear that Dillon is in pain they think his leg hurts a lot but it’s important people realise CRPS doesn’t just hurt, it’s excruciating constant pain 24 hours a day. “As a family we are pretty broken, myself and [his sister] Maddie have both listened to Dillon saying he wanted to die, imagine hearing your 10-year-old say he wants to hurt himself to numb the pain of his leg, how absolutely heartbreaking this is for us." Dillon’s family spent almost £18,500 to travel from the UK to the US for specialised treatment, and he has become pain-free for the first time in months. Melanie, Dillon’s mum added: “Honestly it’s just unbelievable, absolutely unbelievable, and all of that was in the space of a couple of days.” The family is now campaigning for the VECTTOR machine, which helps Dillon to stimulate the nerves to produce certain neuropeptides that are essential for the body function, reducing his pain levels, to be available on the NHS.	Disease Research
With temperatures expected to climb as high as 32C today, many of us are tempted to throw on swimwear and sunnies and soak up the sun. But hot weather can have adverse effects on the body - from dehydration to heatstroke. Sky News looks at the best ways to stay healthy during the late summer burst of hot weather. The only way humans can cool down is through sweating. But the more we sweat, the more dehydrated we become. Even in cooler weather, most people do not drink enough water. The moment you feel thirsty, you're likely to be significantly dehydrated already. Drinking plenty of water is the best way to stave off the nasty effects of dehydration which can include headaches, lightheadedness and confusion. The NHS recommends drinking between 1.5 and two litres of water per day. You may think drinking any beverage can help the above goal of staying hydrated but skipping that glass of wine may be a good idea in the late summer heat. Your favourite tipple, as well as your morning cup of coffee or tea, act as diuretics and can cause dehydration. Keeping your body temperature low is key to avoiding the more destructive effects of heat. The NHS advises that taking a cool dip or morning shower will keep your body heat regulated. Applying ice to the wrists and side of the neck can also help as the blood vessels in those areas are close to the skin's surface. Fashion choices can also play an important role in keeping you cool. Wearing loose clothing allows heat to evaporate off your body more easily. Choosing lighter colours is also beneficial as these tend to reflect heat rather than absorb it as darker colours do. Stay out of the sun It may seem like you're missing out on the fun, but the NHS recommends staying out of the sun during the hottest part of the day - between 11am and 3pm. If you are planning on being outdoors, try to stay in the shade and make sure you have plenty of food, water and any medication needed. Read more: What is a heat dome and how long will Britain's hot spell last? How hot is too hot for the human body to function? Heat exhaustion and heat stroke - what are the signs? Also make sure to regularly apply sunscreen - at least SPF30 - to lower your risk of getting skin cancer. Top up your sunscreen every two hours, as well as after swimming. While it might seem counterintuitive, keeping windows closed and drawing the blinds during the peak heat will keep rooms cooler. Open windows for ventilation when it is cooler outside. Fans can also help your body regulate its temperature - and sticking a pan of ice cubes in front of it can make the circulating air even cooler. The Met Office advises adjusting your plans in the sweltering heat including avoiding exercise or strenuous activity. Exercise often makes you hotter and increases sweat - all of which should be avoided during the unusual heat.	Stress and Wellness
Key Takeaways: - Volunteering later in life may protect the brain against cognitive decline and dementia. - New study of older adults found better memory and executive function among those who volunteered. (Sacramento) Volunteering in late life is associated with better cognitive function — specifically, better executive function and episodic memory. Those are the findings of a new study from UC Davis Health presented today (July 20) at the Alzheimer’s Association International Conference 2023 in Amsterdam. “We hope these new data encourage individuals of all ages and backgrounds to engage in local volunteering — not only to benefit their communities, but potentially their own cognitive and brain health,” said Donna McCullough, Alzheimer’s Association chief mission and field operations officer. Volunteer activities — such as supporting educational, religious, health-related or other charitable organizations — allow older adults to be more physically active, increase social interaction and provide cognitive stimulation that may protect the brain. However, there has been a lack of information on the relationship between volunteering and cognitive function, especially in large, diverse populations. Yi Lor, an epidemiology doctoral student at UC Davis, and Rachel Whitmer, the study's principal investigator, examined volunteering habits among an ethnic and racially diverse population of 2,476 older adults. The participants are in the Kaiser Healthy Aging and Diverse Life Experiences Study (KHANDLE) and the Study of Healthy Aging in African Americans (STAR). The study group had an average age of 74 and contained 48% Black, 20% white, 17% Asian and 14% Latino participants. A total of 1,167 (43%) of the participants reported volunteering in the past year. The researchers found that volunteering was associated with better baseline scores on tests of executive function and verbal episodic memory. This was true even after adjusting for age, sex, education, income, practice effects and interview mode (phone versus in-person). Those who volunteered several times per week had the highest levels of executive function. Volunteering may be important for better cognition in late life and could serve as a simple intervention in all older adults to protect against risk for Alzheimer’s disease and associated dementias.” “Volunteering may be important for better cognition in late life and could serve as a simple intervention in all older adults to protect against risk for Alzheimer’s disease and associated dementias,” Lor said. “Our next steps are to examine whether volunteering is protective against cognitive impairment, and how physical and mental health may impact this relationship.” Volunteering was also associated with a trend toward less cognitive decline over the follow-up time of 1.2 years, but this association did not reach statistical significance. “You’re not in control of your family history or age — you can’t turn back the clock. But you are in control of how you spend your day and life,” Whitmer said. “Volunteering is about keeping your brain active. It’s also about socializing, which keeps you engaged and happy, and potentially lowers stress.” Resources	Longevity
Millions of women in England will soon be able to access free contraceptive pills by going to their local chemist without having to see a GP. The new NHS plans start next month, and they will give women greater choice over where to get the pill and will free up appointments in under pressure GP surgeries. Where women choose the combined oestrogen and progestogen pill, they will need a check-up with a pharmacist to record their blood pressure and weight. But no checks are needed for the mini-pill (progestogen-only). This is also the case in other settings, NHS England said. NHS chief executive, Amanda Pritchard, said: "This is really good news for women - we all lead increasingly busy lives, and thanks to this action, rather than making a GP appointment, they can simply pop into their local pharmacy when they need or want to access contraception. "We will also be expanding services so that more health checks are available for patients on the high street, which is not only better and easier for patients but also frees up NHS time for more GP appointments for those who need them most." Women who are deemed at risk of blood clots on the combined pill because they are too overweight or whose blood pressure is high may be referred to their GP for further checks. And ongoing checks to monitor blood pressure and weight, required by women on the pill, will also be available in pharmacies. NHS England said it expects almost half a million women to be able to access the pill next year without needing to contact their GP first, with the figure rising after that. Prescription figures for 2022/23 suggest there were almost three million prescriptions for the combined pill and more than four million for the mini pill. Pharmacies need to sign up for the new service, meaning it will not be available immediately everywhere in England but as more pharmacies join the scheme, the nhs.uk web page will be updated so women can check which locations offer the service. Read more on health: More people dying from antibiotic-resistant infections post-Covid Six new medicines approved in Scotland The rollout is part of the NHS and government's primary care access recovery plan, announced by the head of the NHS and the prime minister in May, which committed it to making it quicker and easier for millions of people to access healthcare on their high street. Pharmacists will also be able to offer life-saving blood pressure checks to at-risk patients over the next year with a commitment to deliver 2.5 million a year by Spring 2025 - up from 900,000 carried out last year. It is estimated this could prevent more than 1,350 heart attacks and strokes in the first year. And beginning from early next year, patients will also be able to get treatment for seven common conditions directly from a pharmacy, without the need for a GP appointment or prescription. The new service will cover sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women. The ambitious plan aims to free up to 10 million GP appointments a year by next winter. Victoria Atkins, health and social care secretary, said: "It is a pleasure to start my time as secretary of state with such a positive example of the government, NHS and pharmacy sector working together to reach an agreement to improve services and save lives. "For the public, these changes will mean more options for women when making a choice about their preferred contraception, reduce the risks of people suffering heart attacks and strokes and make it easier to access medicines for common conditions. "And for healthcare professionals, this will free up GP appointments and make better use of the skills and expertise within community pharmacies." However, the Family Planning Association told Sky News: "We welcome this but it's not a giant breakthrough - women could previously get both types of pill from their GP. "It's positive because it gives women choice and convenient access at a time when it can be hard to get an appointment at GPs and sexual health clinics. "A better solution would be to give more funding to GPs and clinics in addition to the new access via pharmacies. "The pill isn't right for everyone. It's important that anyone who needs contraception is offered appropriate information and access to the full range of contraception. That includes the most effective long-acting reversible contraceptive methods so that they're able to make a genuine informed choice. "So while this is a welcome initiative, it only covers the pill. Investment in contraception services is still needed to make sure all women can make a choice that's right for them."	Women’s Health
Image source, HBO/Warner Media/Liane HentscherImage caption, A scene from HBO's post-apocalyptic TV drama The Last of Us showing a body consumed by Cordyceps fungiLet me introduce you to something truly horrifying - the fungus that turns its victims into zombies. Its spores enter the body. The fungus then grows and begins to hijack the mind of its host until it loses control and is compelled to climb to higher ground. The parasitic fungus devours its victim from the inside, extracting every last nutrient, as it prepares for its big finale.Then - in a scene more disturbing than the scariest horror film - a tendril of death erupts from the head. This fruiting body of the fungus showers spores on everything around it - dooming others to the same zombie fate. It sounds like a work of fiction. But the kingdom of fungi - distinct from plants and animals - ranges from edible mushrooms to nightmare-fuel parasites.Species of parasitic Cordyceps and Ophiocordyceps fungi are very real. Here, on the BBC's Planet Earth series, Sir David Attenborough watches as one takes control of an ant:Figure caption, Warning: Third party content may contain advertsThat clip of zombie ants inspired "The Last of Us" - possibly the best video game I've ever played, and now a hit TV series which follows the same plot. In both the game and on TV, Cordyceps makes the leap from preying on its usual insect victims, to infecting humans. The resulting pandemic leads to the collapse of society.But in the real world, is a Cordyceps pandemic - or one caused by another fungus - ever likely to happen? "I think we underestimate fungal infections at our peril," Dr Neil Stone, leading fungal expert at the Hospital for Tropical Diseases in London, tells me."We've already done that for too long and we are completely unprepared for dealing with a fungal pandemic."At the end of October last year, the World Health Organization (WHO) issued its first list of life-threatening fungi. There are some nasty bugs on there, but you'll be relieved to know that zombifying-Cordyceps do not feature.Image source, Getty ImagesImage caption, A caterpillar consumed by a parasitic fungus - with its spore-releasing tendrilsDr Charissa de Bekker, a microbiologist at Utrecht University, has studied how Cordyceps creates zombified ants and says she cannot see the same ever happening in people."Our body temperature is simply too high for most fungi to nicely settle and grow - and this is the same for this Cordyceps."Their nervous system is simpler than ours, so it would definitely be easier to hijack the brain of an insect versus our brain, also their immune systems are very different from ours."Most species of parasitic Cordyceps have evolved over millions of years to specialise in infecting just one insect species. Most do not jump from one insect to another. "For this fungus to be able to jump from an insect to us and cause an infection is a very big leap," says Dr de Bekker.Listen to James on the Inside Health podcast: Is a fungal pandemic possible?The threats posed by fungi have been dismissed for a long time. "People think of it as something trivial, superficial or unimportant," says Dr Stone.Only a handful of the millions of species of fungi cause disease, but some of them can be so much worse than an irritating bout of Athlete's foot or an infected toenail.Fungi kill around 1.7 million people a year - that's about three times as many as malaria. Deadly threats bigger than CordycepsThe WHO has identified 19 different fungi it thinks are a significant worry. These include the sudden emergence of a deadly superbug, Candida auris - and a fungi, Mucormycetes, that eats our flesh so quickly that it leads to severe facial injuries. Dr Neil Stone invites me to Health Services Laboratory (HSL) in London, where samples from UK patients are analysed to see if their infections are caused by a fungus and what treatments may work. We discuss some of the biggest fungal dangers. Image source, James GallagherImage caption, Dr Neil Stone says we ignore the fungus, Candida auris, "at our peril"Candida auris is the first we look at. It's a yeast-type fungus and you get that strong waft of a brewery, or bread dough, when you are near it. But if it gets inside the body, it can invade the blood, nervous system and internal organs. The WHO estimates up to half of people die if they have an invasive infection of Candida auris."It's like a monster which has appeared in the last 15 years or so, but it's now being found all over the world," says Dr Stone. The first documented case was in the ear of a patient at Tokyo Metropolitan Geriatric Hospital in 2009. Candida auris naturally shrugs off anti-fungal drugs and some strains are resistant to all of the medicines we have. That's why it's considered a superbug. Transmission is mainly through contaminated surfaces in hospitals. It sticks to intravenous lines and blood pressure cuffs. It's really hard to clean off. The solution is often to close entire wards. This has happened even in the UK.Dr Stone says it is the "most worrying" fungi and we "ignore it at our peril" as, if it takes off, "it could shut down entire healthcare systems".Another killer fungus - Cryptococcus neoformans - is able to get into people's nervous systems and cause devastating meningitis. Sid and Ellie were only in the first days of their honeymoon in Costa Rica when Ellie started to feel ill.Image source, Sid and EllieImage caption, Sid and Ellie celebrating their wedding before Ellie caught a fungal infectionHer initial symptoms - headaches and nausea - were put down to too much sun, but then she started jerking and developed full-blown seizures. She had to be bundled up in a hammock and taken in a boat to get medical help."I've never seen something more horrifying and especially feeling so helpless," Sid tells me. Scans showed swelling on her brain and tests identified Cryptococcus. Fortunately, Ellie responded to treatment. She came out of a coma after 12 days on a ventilator. "I just remember screaming," she says. She had delusions - including of having triplets, and that her husband had gambled their money away. "So the first thing I said to him was it's over," she says.Now, Ellie is recovering well. She says she "never" thought a fungus could do such a thing to a person. "You don't think you're going to go on your honeymoon and almost die."Mucormycetes also known as black fungus, causes the flesh-eating disease mucormycosis. It has a nickname that reveals its insidious nature - the lid lifter. Image source, James GallagherImage caption, Mucormycetes fungi can grow incredibly rapidlyIt takes off so quickly. This image shows that, after just 24 hours growing in a petri dish, it can lift the lid off."When you have a piece of fruit and the next day it's turned to mush, that's because it has had a mucor-fungus [Mucormycetes] inside of it," says Dr Rebecca Gorton, a clinical scientist at HSL. She says it's rare in humans, but can be a "really serious infection". Black fungus is an opportunist that takes hold in people with weak immune systems. It assaults the face, eyes, and brain and can be fatal or leave people severely disfigured. A bad infection "grows as quickly" in the body as it does in fruit or the lab, warns Dr Gorton.During the Covid pandemic, there was an explosion of black fungus cases in India. More than 4,000 people died. Steroids being taken for Covid, which weakened immune systems, and high levels of diabetes, are thought to have aided the fungus's proliferation. Should we take fungi more seriously?Fungi are very different types of infection to bacteria or viruses. When a fungus makes us ill, it is nearly always picked up from the environment rather than spread through coughs and sneezes. We are all regularly exposed to fungi, but they often need a weakened immune system in order to take off. As medicine keeps more of us alive - such as surviving some cancer treatments - there are more of us with weaker immune systems. Dr Stone says a fungal pandemic would probably take "a different form" to Covid - in both how it spreads and the type of people it infects.He thinks the threat is there because of "the pure volume of fungi in the environment... climate change, international travel, increasing number of cases and their deep neglect in terms of treatments we have".Fungi might not turn us all into zombies, but they can cause far more problems than a bit of Athlete's foot. Follow James on Twitter. Inside Health was produced by Erika Wright. More from Inside Health	Epidemics & Outbreaks

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